Oral Health Advocates Push for Dental Therapists

Oral health advocates, bolstered by favorable national reports on dental therapists, are pushing for legislation that would train and deploy mid-level providers. But the Oregon Dental Association (ODA) promises to fight any bill introduced next session.

Judith Woodruff, health work force program director with the Northwest Health Foundation, advocated for developing training programs for dental therapists, a new type of provider whose scope of practice falls between that of a dental assistant and a dentist. Dental therapists would be relatively inexpensive to train and hire, Woodruff said in testimony before the Senate Interim Committee on Health Care last week.

Woodruff presented some sobering statistics. According to the Department of Human Services, oral disease is five times more common in Oregon children than asthma, and is also to blame for over half of all school absences in a given year.
 
Additionally, 22 of Oregon’s 36 counties have a shortage of dental professionals, which will pose greater problems in 2014, when federal healthcare reform extends coverage to more than 500,000 Oregonians.
 
“Oral health needs in this state are not being met,” Woodruff said. “We’re asking you to think about different models of oral health services.”
 
Dr. Tom Bornstein, who works with the Dental Health Aid Therapist program in Alaska, the nation’s first dental therapist initiative, joined Woodruff. The Kellogg Foundation, which funded that program, documented widespread patient and dentist satisfaction with dental therapists in rural Alaskan communities in a recent study.
 
Patients, dentists and dental therapists in five tribal villages were surveyed over two years, and asked about quality of care, job satisfaction and relationships with providers or colleagues. The study found that “the level of patient satisfaction was generally high.” All the dentists who participated had positive professional relationships, and “felt that all of the therapists’ work was technically competent.”
 
Dental therapists’ ability to meet pressing oral healthcare needs in rural communities also saved residents a multi-hour trek to the nearest dentist.
 
 “A gold standard of [dental] care can be accomplished closer to home by mid-level providers under professional supervision,” Bornstein told legislators.
 
However, the American Dental Association isn’t convinced by those findings. Dr. Raymond Gist, its president, said the study “did not provide the robust examination or projectable metrics on which to base important policy and public health decisions.”
 
Introducing a new dental team member is just a partial answer to addressing access issues, said Dr. Rick Asai, immediate past president of the ODA.

“We need to incorporate prevention or we’re never going to solve these problems,” he said.
 
Senator Alan Bates (D-Ashland) remains skeptical of introducing new providers.
 
“We have a budget hole the size of the Grand Canyon, and we’re going to spend all our energy on scope of practice issues? I see this as a distraction from working to maintain the system we do have.”
 
But a recent report by the Pew Children’s Dental Campaign suggests that mid-level providers could be a financial boon. The report evaluated several scenarios using a “productivity and profit” calculator developed in part by dental professionals and designed to assess new healthcare models.
 
The report found that by adding an “allied provider,” such as a dental therapist, not only increased a dental practice’s earnings by as much as 54 percent, but also the number of patients who were seen.
 
To find common ground, the ODA and the Oregon Oral Health Coalition, which includes stakeholders from Regence, BlueCross BlueShield Kaiser Permanente and the Oregon Dental Hygienists Association, have been working with a mediation group, Oregon Consensus.
 
Initially, the ODA refused to participate in mediation, said Senator Laurie Monnes Anderson (D-Gresham), who chairs the Health Care Committee. However, Sam Imperati, the mediator, said the two sides had a “constructive, problem-solving” initial meeting on Dec. 15. Another session is scheduled for January.
 
Meanwhile, numerous stakeholders who favor dental therapists are keeping mum about what’s taking place behind the scenes.
 
Lynn Ironside, who chairs the hygienists’ association government relations council, said details of the mediation were “not for conversation at this time.”
 
Whatever transpires next session, Dr. Mary Willard, Alaska’s training director, hopes Oregon and other states eventually embrace dental therapists.
 
“The U.S. is only industrialized nation that doesn’t utilize a therapist-type provider,” he said. “It’s a very adaptable model that works.”