Sen. Ralph Ostmeyer (R-Grinnell) meets with dental hygienist Tammi Engel (left) and Heidi Lowry, director of the Rawlins County Dental Clinic in Atwood. The two were among about 30 hygienists from around the state to meet with their legislators this week. by KHI News Service

About 30 dental hygienists from around the state were in Topeka this week to ask their legislators to approve the licensing of mid-level dental providers.

A bill to license so-called registered dental practitioners was introduced last week. If it becomes law, it would allow hygienists with 18-months additional training to, among other things:

• permanently fill teeth,

• extract teeth,

• repair dentures, and

• temporarily crown teeth.

The Kansas Health Consumer Coalition, Kansas Action for Children, the Kansas Health Foundation — a major funder of the Kansas Health Institute — and other groups have supported the licensing of mid-level dental practitioners in Kansas, and organized today's visits by the hygienists.

Heidi Lowry and Tammi Engel were among those who traveled the farthest. They are from Atwood — a town in the northwest corner of the state, which is designated a "dental desert."

According to a 2011 report, at least 57,000 Kansans live in "dental deserts," areas where the closest dental office is at least a half-hour drive from the resident's home.

Lowry and Engel met with Sen. Ralph Ostmeyer, a Grinnell Republican, to tell him how licensing the dental practitioners would improve oral health in Rawlins County and others like it.

"It's not just access" to care, said Lowry, a trained hygienist who now spends most of her time as director of the Rawlins County Dental Clinic.

"With the current economic climate on the state and federal level, we're going to have to look at ways to be self-sustaining. Being able to use (practitioners) is going to go a long ways toward being able to provide those services and do it in an economic manner. That's just more fiscally responsible with our Medicaid dollars, and all the way around," Lowry said. "When you're just talking economics, a (practitioner) is not going to make the same wage as a dentist. And when we're a safety net clinic and write off a significant portion of services every year, it's going to make the safety net clinics more sustainable without state, federal or grant dollars. That's huge. We can continue to see those who don't have insurance and not tax emergency rooms."

Ostmeyer asked the women if dentists were any less opposed to the idea than they were several years ago when licensing dental practitioners was first proposed.

"Are you able to sit down with the Kansas Dental Association?" Ostmeyer asked.

The dental association opposes the measure, saying there are better ways to increase access to oral health care — including its Kansas Initiative for New Dentists, which would offer loan repayment and scholarships to dentists and students who agree to serve for at least two years in a dental desert. The dental association has scheduled an event at the Statehouse tomorrow to announce the first four recipients of awards under the program.

"I've talked with several dentists in our area and we don't have near as much fight back. I don't think they'd publicly say 'I support this' in front of the dental association, but they see the need," Lowry said.

The need

It's not easy to recruit and keep a dentist in rural areas, Lowry said.

Before she and her supervising dentist arrived in Rawlins County in 2008, citizens there had been trying to lure a dentist for 10 years, she said.

"When you live in that rural of an area, there's things you just don't think about," Lowry told KHI News Service after her talk with Ostmeyer. "If you have to see a medical specialist, you're driving to Denver. There's concern with (obstetrics) care, if (a potential recruit is) young wanting to start a family," she said.

"We're 30 miles from the closest Walmart, shopping is not really available, there's no fast food per se...our movie theater is open Saturdays and Sundays. During the summer they show on Fridays but as soon as sports start up, they close," Lowry said. "You have to really want a rural, community-minded area."

One of the two dentists the community recruited using a school loan repayment program is leaving soon, she said.

"She's coming back to the city, to Kansas City. So we're going to be down to one, which is going to be difficult," Lowry said.

A different mindset

She said if practitioners were licensed, the needs of Rawlins County could be met with two of them in addition to the current three hygienists and dentist.

Among the needs that would be most immediately met: fillings in the baby teeth of children the clinic serves in schools using portable equipment. Currently the closest dentist who accepts Medicaid referrals is 60 miles away in Norton and only handles "extreme" cases.

Ostmeyer asked why it was difficult to get dentists to see Medicaid patients.

Lowry said Medicaid doesn't pay as well and "that's compounded by the fact that there's just a shortage of dentists in general, so their schedules are full seeing (patients who have) private insurance."

She said practitioners also would fill a need for caring for the developmentally disabled children and adults her staff treats.

"What we've found is that if we can see them on site, they don't have to have as much valium or other things to make them chemically relax, they don't have to be restrained. So if we could bring services to them, it would be much better," Lowry said.

"I've just found that the mindset of a hygienist, generally it's just a little bit different personality than dentists — one's a little bit more willing to go do the on-site, portable dentistry," she said.

Alaska was the first state to sanction licensing of mid-level dental providers in 2006, and only Minnesota has done so since.

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