‘Dental therapist’ legislation snatched from jaws of defeat
Laws OK’d despite dentists’ opposition
AUGUSTA, Maine — It can be hard to keep smiles healthy in rural areas, where dentists are few and far between and residents often are poor and lack dental coverage. Efforts to remedy the problem have produced varying degrees of success.
The biggest obstacle? Dentists.
Dozens of countries, such as New Zealand, use “dental therapists” — a step below a dentist, similar to a physician’s assistant or a nurse practitioner — to bring basic dental care to remote areas, often tribal reservations. But in the U.S., dentists and their powerful lobby have battled legislatures for years on the drive to allow therapists to practice.
Therapists can fill teeth, attach temporary crowns and extract loose or diseased teeth, leaving more complicated procedures like root canals and reconstruction to dentists. But many dentists argue therapists lack the education and experience needed even to pull teeth.
“It can kill you if you’re not in the right hands,” said Peter Larrabee, a retired dentist who teaches at the University of New England. “It doesn’t happen very often, but it happens enough.”
Dental therapists currently practice in only 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.
The tide is starting to turn, though.
Since December, Nevada, Connecticut, Michigan and New Mexico have passed laws authorizing dental therapists. Arizona passed a similar law last year, and governors in Idaho and Montana this spring signed laws allowing dental therapists on reservations.
Maine and Vermont have also passed such laws. And the Connecticut and Massachusetts chapters of the American Dental Association, the nation’s largest dental lobby, supported legislation in those states once it 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.
Christy Jo Fogarty, a Minnesota dental therapist, said the organization she works for saves $40,000 to $50,000 a year by having her on staff instead of an additional dentist — and that’s not including the five other therapists.
The ADA and its state chapters report spending over $3 million a year on lobbying overall, according to data from the National Institute on Money in Politics.
In a statement, ADA President Jeffrey Cole said, “Available data have yet to demonstrate that creating new midlevel workforce models significantly reduce rates of tooth decay or lower patient costs.”