Dental therapists are the key to improving oral health in underserved rural areas, advocates say

Dental therapists could be the solution for improving oral health in rural areas, Pew Charitable Trust's oral health advocates Julie Stitzel and Rebecca Singer Cohen report for Stateline. Of the 4,438 areas designated as having dental health professional shortages, 60 percent are in rural areas. The oral health deficiency is compounded by rural residents being more likely than urban ones to be poor, lack dental insurance, have poor water supplies and often have long distances to travel to the dentist.

Another problem is that only about one-third of dentists accept Medicaid or other public insurance, Stitzel and Cohen write. As a result, many patients skip dentists and go to the emergency room with oral care concerns. "In 2012, there were more than two million dental-related visits to hospital emergency rooms—most of them for preventable conditions that could have been addressed earlier in a dental office. The cost for this care was about $1.6 billion."

Midlevel dental providers—or dental therapists—are the solution, Stitzel and Cohen write. These professionals "have a proven ability to deliver cost-effective and high-quality preventive and routine restorative care—such as filling cavities, placing temporary crowns and extracting loose teeth—to a variety of underserved populations. The growth of dental therapy in recent years mirrors the rise of physician assistants and nurse practitioners in the mid-1960s during a time of physician shortages in rural areas and in primary care."

Minnesota was the first state to authorize dental therapists in 2008, with a therapist opening a private practice in rural Montevideo, Stitzel and Cohen write. "In the therapist's first year, new patients increased by 38 percent," and the therapist served 500 more Medicaid patients and made an additional $24,000 in profit. The American Dental Association has publicly criticized dental therapists, saying a in February statement: "The supply of dentists is adequate to serve America’s needs," and ADA "remains firmly opposed to allowing non-dentists to perform surgical procedures."