Monday, August 19, 2019

States increasingly allowing dental therapists to practice, which can help bring more dental care to rural areas

It can be difficult to find adequate dental care in rural areas, since there usually aren't enough dentists and many rural residents lack money and/or dental insurance. One solution, adopted by dozens of countries, is to let dental therapists to practice in rural areas. Roughly speaking, the therapists are to dentists what nurse practitioners are to doctors. But in the U.S, dentists and their powerful lobbies have argued for years that dental therapists should not be allowed to set up shop in rural areas.

"Therapists can fill teeth, attach temporary crowns, and extract loose or diseased teeth, leaving more complicated procedures like root canals and reconstruction to dentists," Marina Villeneuve reports for The Associated Press. "But many dentists argue therapists lack the education and experience needed even to pull teeth."

In the U.S. right now, dental therapists practice in four states, "on certain reservations and schools in Oregon through a pilot program; on reservations in Washington and Alaska; and for over 10 years in Minnesota, where they must work under the supervision of a dentist," Villeneuve reports.

But more states have passed, or are in the process of passing, laws to authorize dental therapists. Arizona, Maine and Vermont have passed such laws; Connecticut, Michigan, Nevada and New Mexico did so since December, and Idaho and Montana's governors signed laws this spring that allow dental therapists to operate on reservations. "Legislation failed in North Dakota and Florida this spring. Bills are pending in Kansas, Massachusetts and Wisconsin, as well as Washington, where therapists could be authorized to practice outside reservations," Villeneuve reports.

The American Dental Association and its state chapters spend more than $3 million a year on lobbying, some of it in opposition to dental-therapy laws. ADA chapters in Connecticut and Massachusetts supported legislation in those states that satisfied their concerns about safety. "The Massachusetts proposal, not yet law, would require therapists to attain a master's degree and temporarily work under a dentist's supervision," Villeneuve reports.

Education could be an obstacle to increasing the ranks of dental therapists. Some start out as hygienists, who usually have a two-year associate's degree. And though some advocates say dental therapists should only need the same education level as a hygienists, many opponents say therapists need more training. However, only Alaska and Minnesota have dental therapy educational programs, and Minnesota's program is the only one that offers a master's degree—an expensive proposition for prospective therapists, Villeneuve reports. Vermont is creating a dental therapy program at Vermont Technical College set to launch in the fall of 2021. The program, funded with the help of a $400,000 federal grant, will have distance-learning options.

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