National advocates for mid-level dental providers meet in Lawrence
- on December 6, 2012
LAWRENCE — About 60 community organizers from eight states are meeting here this week to collaborate on their efforts to license mid-level dental providers in their respective states.
In each state, proposals for licensing the new position are intended to address long-standing shortages of dentists, especially in rural areas where other approaches — such as loan repayment incentives — have been unsuccessful, said Dr. Albert Yee of Community Catalyst, the Massachusetts-based organization spearheading the effort nationally.
Representatives of Kansas, Ohio, New Mexico, Vermont, Washington, Colorado, Michigan, and Minnesota are attending the three-day, semi-annual meeting coordinated by Community Catalyst.
A mid-level dental provider's training places them between a regular dentist and a dental hygienist — able to fill cavities and perform simple extractions of teeth. Alaska was the first state to sanction mid-levels in 2006, and only Minnesota has done so since.
Opposition from dentists has so far blocked proposed legislation to license mid-levels in Kansas and in other states.
Similar to nurse practitioners
Yee said the dentists' criticisms of mid-level dental providers — that they're undertrained or provide second-rate care — is unwarranted. He pointed to a recent report on 26 nations and territories’ experiences with mid-level dental therapists, which found that they provide good quality, cost-effective care.
"The evidence that's out there, the studies have shown that it's not a lower level of care. It's exactly the same quality of care that the dentists provide for the same procedures," said Yee, who also works with the Kellogg Foundation, which commissioned the report he cited. "There's really no study to the contrary, no evidence whatsoever that they provide second-rate care."
Yee said the opposition to mid-level practitioners — sometimes called dental therapists, registered dental practitioner, or RDPs — remind him of his experience as an internist in the 1980s and early 1990s, when similar opposition was aimed at nurse practitioners by doctors.
"Obviously nurse practitioners and physicians' assistants 25 years later are basically a normal part of the landscape. So with that, I saw the potential for dental therapy having that benefit in the dental profession in improving access to care for underserved populations," Yee said.
In Kansas, at least 57,000 people live in so-called dental deserts, where there are no dental services and where the closest dental office is at least a half-hour drive from the resident's home, according to a 2011 report.
Many more Kansans lack dental insurance and cannot afford routine preventive care, much less restorative care, said Suzanne Wikle of Kansas Action for Children, which is part of the effort to license mid-level practitioners in the state. The Kansas Health Foundation — a major funder of the Kansas Health Institute — is also part of that effort.
Wikle said lack of access to dental care leads to 17,500 hospital emergency room visits for dental care each year.
"The number one reason is cavities," she said.
The average cost for dental care in the ER is $400 to 600 per visit, Yee said.
"And they're not equipped (in emergency rooms) to provide dental care. They're only getting a prescription, they still need to get the care. Whereas the average dental visit could cost between $70 and $80," Yee said.
'Not the solution'
But Kevin Robertson, director of the Kansas Dental Association, has said the solution to that problem is not licensing mid-level practitioners.
Robertson said the bills introduced in the last two legislative sessions by supporters of the new licensing went too far by proposing that the practitioners be allowed to perform procedures which are, by definition, considered surgery — that is, anything that includes the cutting of the hard surfaces of teeth.