The News Herald (Willoughby, OH)
Backers of rural dental care find something to smile about
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.
“You might think extracting a tooth is very simple,” said Peter Larrabee, a retired dentist who teaches at the University of New England. “It can kill you if you’re not in the right hands. 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.
But the states looking to allow therapists must also find ways to train them. Only two states, Alaska and Minnesota, have educational programs, and they aren’t accredited. Minnesota’s program is the only one offering master’s degrees, a level of education that satisfies many opponents — dentists generally need a doctorate — but is also expensive.
“I would have to relocate to another state to go to school, and if you need to work and you still have a job, why would you do that?” said Cathy Kasprak, a dental hygienist who once hoped to become a therapist under Maine’s 2014 law.
Some dental therapists start out as hygienists, who generally hold a two-year degree, do cleanings and screenings, and offer patients general guidance on
oral health. Some advocates of dental therapists argue they should need only the same level of education as a hygienist — a notion that horrifies many opponents.
Some lawmakers in Maine, which will require therapists to get a master’s from an accredited program, are optimistic about Vermont’s efforts to set up a dental therapy program with distance-learning options. It’s proposed for launch in fall 2021 at Vermont Technical College with the help of a $400,000 federal grant.
Nearly 58 million Americans struggle to afford and make the trip to dental appointments in thousands of communities short on dentists, according to the Kaiser Family Foundation.
One of the biggest benefits
of dental therapists, proponents say, is that they can make preventive care easier to get by lightening the load of dentists, whose appointment slots are often stolen by complex procedures.
Even in states where therapists must practice in dental offices, like Minnesota, they can shorten travel times by opening slots for simple procedures closer to home, a small but growing body of evidence shows.
Dental therapists make $38 to $45 an hour in Minnesota, according to the Minnesota Dental Association. Dentists, meanwhile, average over $83 an hour, according to the Bureau of Labor Statistics.
Ebyn Moss, 49, of Troy, Maine, went without dental appointments for seven years before breaking a tooth below the gum line in 2017.
Moss has since had four teeth pulled, a bridge installed, a root canal, two dental implants and seven cavities filled at a cost of $6,300, and expects to shell out another $5,000 in the next year — a bill Moss is paying off with a 19% interest credit card and $16,000 in annual income.
“That’s the cost of choosing to have teeth,” she said.