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Why Are Dentists Opposing Expanded Dental Care?

Citing safety as the reason, dentists are fighting states’ efforts to create mid-level dental providers who can provide care to underserved areas. Some speculate they just fear losing business.

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The eyes may be the windows to the soul, but the mouth is an indicator of overall health. Poor oral health has been linked to serious problems like cardiovascular disease, worsening diabetes, osteoporosis and premature birth. Regular dental care is, therefore, a key component in reducing costs associated with the care of those chronic diseases.

But dental care is hard to come by in underserved areas of the country. Try finding a dentist in the remotest rural or deepest urban pockets of the land, and for blatantly economic reasons, they just aren’t there. That’s why states are looking to fix the problem by creating a so-called mid-level dental provider. Much like a nurse practitioner (NP) or physician assistant (PA) is to a doctor, this provider would be educated and licensed to perform basic dental services -- routine checkups, cleanings, filling cavities and extracting teeth -- under the supervision of a fully trained dentist. These providers would be charged with providing care in underserved areas.

Yet in much the same way that the American Medical Association fought against the creation of NPs and PAs, the American Dental Association (ADA) and its state chapters are lobbying hard to thwart state legislatures as they work to create this new level of dental care providers, who are common and well liked in other parts of the world. Legislatures in 10 states, including Connecticut, Kansas, New Mexico, Oregon, Vermont and Washington, are all debating such bills, but so far only Minnesota has succeeded in enacting legislation. In 2009, a controversial bill establishing the creation of dental therapists and advanced dental therapist providers was signed into law.

The bill was pushed by the Minnesota Health Care Safety Net Coalition, which was formed under the aegis of a lobbying group called the Law, Policy and Consulting Alliance. Sharon Oswald, a consultant with the alliance, says that the bill had bipartisan legislative support, but the Minnesota Dental Association (MDA) objected all the way to the end. “Publicly their main objection is safety issues,” Oswald says. “They tried to discredit the model, saying the therapists were not trained to the same level as dentists. In reality, all the research around the world shows that [mid-level providers] provide as good, if not better, care. Every time they stated safety as a factor, we asked for research, which they didn’t have.” The unstated objection, she says, is the fear of losing business.

The MDA says it ultimately agreed to the bill when it was assured the new providers would be part of “an integrated dental team, with dentists as the leader of that team,” says Dr. Michael Flynn, president-elect of the association. But the ADA remains opposed to mid-level providers, and the Minnesota group remains skeptical. “We are still concerned whether this will really address the issue of access,” Flynn says. “Everyone agrees we have a lot of barriers to care, and creating a new workforce worker doesn’t necessarily reduce the barriers. I hope it does work, but it requires more than just dental therapists.”

Still, it’s a start, says Judy Lee, a North Dakota state senator who is just beginning to look into the issue (with the help of Oswald’s firm). She knows that dentists in her state will oppose the issue, and she understands why. “They fear loss of control and lower-quality care, which I get,” says Lee, chair of the state’s human services committee. But she says that this is one way to get dental care into underserved communities where dentists refuse to go, “and I’d rather have someone looking in that mouth than no one looking in that mouth.”

Caroline Cournoyer is GOVERNING's senior web editor.
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