Millions of Arizonans struggle to access the dental care they need to lead healthy, productive lives. People go without care because they cannot afford it, cannot find a dentist who will take their insurance, cannot get to the dentist during weekday working hours, or live in an area where there is a shortage of dentists.
To address this problem, Arizona urgently needs to increase access to quality dental care that does not create additional government programs and cost. A proposal submitted to the Legislature would initiate legislation to authorize use of midlevel dental providers, known as dental therapists, to expand opportunities to efficiently and effectively serve patients and increase dentists’ revenue.
Dental therapists are similar to physician assistants or nurse practitioners on medical teams. They receive rigorous training in routine preventive and restorative procedures, such as filling cavities and performing extractions. When dental therapists provide routine dental care, dentists can focus on more complicated procedures.
Current gaps in care are costly for the state. When people cannot get dental care, they sometimes visit emergency rooms for relief of their
symptoms—an expensive and inefficient use of limited health care dollars. A lack of access to dental care especially affects low-income families, children covered by Medicaid, the elderly, people with disabilities, American Indians, and those living in rural communities.
Dental therapy training, education and clinical experience under Commission on Dental Accreditation (CODA) standards is consistent with the standards for education, training and clinical experience of dentists in dental schools for the procedures they both perform.
CODA requires dental therapists to have at least 3 academic years of study. Three academic years to learn roughly 80 procedures. Dental school is 4 years of training. Four years to learn over 430 procedures. Dental therapists are well trained to perform the procedures allowed within their limited scope.
Today there are 2.3 million people in Arizona living in a dental shortage area. You may hear that we do not need more dentists. This is true if you live in Scottsdale, where there are about 9 dentists per 5 square miles. Compare this to 1 dentist for all of Greenlee County, a population of over 9,000 people. (See map)
Dental therapists often work away from the traditional dental office in locations such as rural clinics, nursing homes, and schools while keeping in touch with their supervising dentists through telehealth technology. By working in communities outside normal business hours, dental therapists can extend access to people who face barriers getting to a traditional dental office. For instance, half of the dental therapists in Minnesota work in rural and remote areas of that state where dentists are scarce.
While we can’t compel dentists to move from Scottsdale to Ajo, Seligman or Peach Springs, we do know that continued efforts to stall innovative, cost-effective solutions will only protect a system where people in rural and underserved areas face long wait times and long travel distances to get to a dentist.
Since 2004 dental therapists have increased access to care for 40,000 Alaska Natives living in 81 rural communities. In Minnesota, dental therapists have been serving patients since 2011. In fact, dental therapists have been used in more than 50 countries for nearly 100 years.
Because dental therapy has been used in 54 countries since the 1920s, in Alaska since 2004 and in Minnesota since 2011, there is a great deal of evidence on it’s safety and effectiveness. A recent literature review of 1,100 published studies on dental therapists indicates that they offer safe, effective dental care.
“As the dean of a dental school accredited by CODA, this is the most significant signal to me that the dental midlevel providers are safe, are meeting the needs of the public, and are sought after by dentists in the existing marketplace.” Bruce Donoff, MD, DMD, Dean of Harvard School of Dental Medicine
“The results of a variety of studies indicate that appropriately trained midlevel providers are capable of providing high-quality services, including irreversible procedures such as restorative care and dental extractions.” J. Timothy Wright, past president of the American Dental Association Council on Scientific Affairs Journal of the American Dental Association (January 2013)
Dental therapists attend accredited colleges and universities, just like dentists do. If those are public institutions, say ASU or NAU, those state institutions get state funding in addition to tuition dollars—not for training therapists, but as state schools with a legislative appropriation.
If dental therapists treat a Medicaid patient, they get reimbursed for that service, just as a dentist would if she treated a Medicaid patient, only dental therapists would be reimbursed at a lower rate than the dentist—just as reimbursements for nurse practitioners and physician assistants are set at a lower rate than the physician for certain procedures—those reimbursement rates will be determined by Arizona’s Medicaid agency AHCCCS. So, in addition to not requiring a subsidy, these professionals, like other allied health professionals, save the state money.
In a time of limited resources and increased demand for dental care, Arizona must find ways to bring high quality dental care to more people, while stretching Medicaid dollars further, without creating another government-run health care program.
“A greater supply of qualified providers would enhance competition, which can yield lower prices, additional service hours, shorter wait times and innovations in care delivery, as we have seen from the increased use of advanced practice nurses and physician assistants.” Marina Lao & Tara Isa Koslov, Director and deputy director, respectively, of the Office of Policy Planning at the Federal Trade Commission June 1, 2016
It’s time to modernize the delivery of dental care in Arizona. The health care market can benefit from additional providers, and Arizonans need access to safe, affordable dental care.
Studies show that dentists and dental practices who use dental therapists serve more patients while maintaining or improving their overall income.
Even more, public health dental practices benefit by stretching non-profit and Medicaid funds further, allowing them to provide treatment for more patients with limited resources.