By Jane Grover, DDS, MPH, Director, Council on Access, Prevention and Interprofessional Relations, American Dental Association
Many challenges keep people from visiting a dentist including, lack of oral health education, cost, fear of the dentist and a belief that they don’t need care. Dental therapists have failed to show meaningful results in addressing these barriers.
A handful of states created this provider to treat underserved patients, especially in rural areas. But these patients are more likely to have complex dental disease and health issues that require the skill and training of a dentist to diagnose and treat.
Despite the best intentions of connecting dental therapists to needier rural populations, they primarily practice in metropolitan areas.
Nationally, children have seen improvements in dental access with the gap in utilization between low-income children and high-income children narrowing in 49 states.
Poor children shouldn’t be stopped from seeing a dentist by a restructured system that redirects them to providers with less training than dentists. In Michigan, 80 percent of dentists participate in Healthy Kids Dental for Medicaid enrolled children. The proposed therapist model tries to fix a system that isn’t broken, relegating disadvantaged kids to a lesser standard of care.
Dental therapists are frequently cited as making dental care more affordable. But insurers and the states pay set fees for dental procedures no matter who performs them. In spite of having introduced dental therapists seven years ago, only 43 percent of Minnesota children with Medicaid visited a dentist in the past year compared to 48 percent nationally.
These programs are too expensive to survive without subsidies and mirror the Canadian program, which failed once government subsidies ended. Instead of having another provider to drill and fill teeth we should better connect patients with a fully-trained doctor of dentistry and utilizing the existing dental workforce.
The Community Dental Health Coordinator (CDHC), a community health worker, is a better option. They provide oral health education, disease prevention, help coordinate appointments and can reduce patient no-show rates from nearly 50 percent to below 10 percent.
Increasing access to care isn’t about increasing the number of providers, it’s about providing the right care, by the right provider at the right time.
This letter was originally published in the Wall Street Journal (WSJ) on Aug. 31, 2016, in response to the the Aug. 19 article, “You Don’t Have to be a Dentist to Fill A Cavity,” which proposed dental therapists as the solution to access to care issues. Note: In most cases, the WSJ requires a subscription to access its articles online.