Sen. Mike Shirkey (R- Clarklake) has introduced Senate Bill 541 to address significant gaps in access to oral health services across the state. At a news conference September 7, Michigan health advocates and providers urged the Legislature to support efforts to expand access to oral health care. SB 541 would allow dentists to treat more patients by hiring dental therapists, similar to a physician assistant on a medical team, to provide preventive and routine restorative care such as filling cavities.
Michigan has an uneven distribution of dentists, resulting in a shortage of dental providers in many rural and urban communities. 77 out of Michigan’s 83 counties have at least one dental shortage area, leaving millions of residents without access to necessary oral care. SB 541 will expand oral health care especially to vulnerable people, including seniors, pregnant women, children and people living in rural areas.
“Expanding the dental team to include a dental therapist could improve overall access to oral health care for underserved patients while allowing dentists to increase their revenues and modernize and expand their practices,” said Sen. Shirkey. “When people cannot get dental care, they often resort to emergency rooms for relief which costs Michigan taxpayers money. Relying on emergency rooms doesn’t alleviate patients’ underlying problems and places an unfair burden on taxpayers.”
Access to dental care is limited or nonexistent for millions of Michigan residents:
• More than one-third of all Michigan seniors have lost six or more natural teeth due to tooth decay or gum disease.
• Half of new mothers in 2014 did not receive a preventative dental visit during their pregnancy. Research shows gum disease can increase the risk of preterm birth.
• Approximately half of the kids covered by Medicaid or Healthy Kids Dental did not receive dental services in 2016.
Currently under state law, only dentists are allowed to perform routine procedures like filling cavities. By creating a new dental provider, the law would increase the number of highly trained professionals able to perform these basic procedures under the supervision of a dentist and allow dentists to focus their time and skills on more complicated procedures. Health professionals and providers support SB 541, saying it’s an important way to increase access to dental services.
“Many Michigan residents wouldn’t receive any dental care if they didn’t get it from their local health center,” said Loretta V. Bush, CEO of Michigan Primary Care Association, which represents 45 community-based health center organizations throughout Michigan. “With dental therapists on the front lines in underserved areas, Michigan’s health centers could provide vital oral health services to those who would otherwise go without.”
Minnesota, Maine, Vermont and tribal governments in Alaska, Washington, and Oregon allow dentists to hire these midlevel providers. More than a dozen other states are considering similar bills.
“Pregnant women who do not have access to regular dental care are more likely to deliver their babies pre-term,” said Amy Zaagman, executive director of Michigan Council of Maternal and Child Health. “Oral health is indicative of an individual’s overall well-being. Neglecting oral health care can have a lifelong impact, leading to tooth loss, pain or consequences to one’s overall health. Dental therapists would help dentists provide accessible, routine dental care for Michigan’s most vulnerable residents.”
Children and adults had lower rates of tooth extractions and more preventive care in Alaska Native communities served frequently by dental health aide therapists than residents in communities not receiving these services, according to a new study released by the University of Washington.
Led by Donald Chi, DDS, PhD, and funded by The Pew Charitable Trusts, the Rasmuson Foundation and the WK Kellogg Foundation, the study presents an analysis of patients in the Yukon-Kuskokwim Health Corporation (YKHC) from 2006 to 2015. The YKHC, which is a part of the Alaska Tribal Health System, serves 25,000 Alaska Natives representing 58 federally recognized tribes. Read more here.
Two recent case studies show that the addition of dental therapists at two private, for-profit clinics in Minnesota helped increase access to oral health services for low-income and underserved residents while providing quality care and significantly increased cost-efficiency. In 2009, Minnesota approved legislation authorizing the statewide use of dental therapy. State dental therapists must work in practice settings that serve low-income and underserved people or in areas designated by the federal government as a "dental health professional shortage area" (DHPSA).
The case studies assessed the contribution of dental therapists at Midwest Dental and Grand Marais Family Dentistry. These two private, for-profit clinics are located in rural areas of Minneosta that are designated as DHPSAs. The results show that the clinics were able to serve more patients with public insurance after hiring dental therapists. Read more here.
The Washington Post’s recent article “The Painful Truth About Teeth” paints a sobering picture of everyday Americans with limited access to care: “Millions of [people] rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left.”
“Our Teeth Are Making Us Sick,” a New York Times column, also highlights difficulty with care and explores the long-term health problems that result from neglect: “Gum disease can increase the risk of heart disease and diabetes, and among pregnant women it is correlated with lower birth weights for their babies.” Additionally, tooth decay causes pain, an inability to eat solid foods, and even more serious problems if left untreated.
These articles are especially timely as more and more states wrestle with how to increase access to dental care.
A new webinar--Dental Therapists: What Mid-level Providers Could Mean for Your Practice--was designed for dentists throughout the state to learn more about dental therapists, their training and how can they be integrated into dental practices.
Dr. Frank Catalanotto, DMD, from the Department of Community Dentistry and Behavioral Science at the University of Florida, and Dr. John Powers, DDS, owner of Main Street Dental Care in Montevideo, Minnesota were our featured speakers, who shared their own experiences with dental therapy and took questions from participants.
Americans overwhelmingly support the concept of dental therapists, according to the results of a recent phone survey. Interviewers asked thousands of registered U.S. voters if they would like a new type of midlevel provider similar to a nurse practitioner, and 80% of respondents said yes.
The survey, which was conducted by Lake Research Partners and funded by the W.K. Kellogg Foundation, reached 2,400 adults who voted in the 2016 U.S. elections. The results are almost identical to a 2011 poll that also found about 80% of adults supported the concept of dental therapists.
"Overall, it's a concept that people get," said Tera Bianchi, the Dental Access Project director at Community Catalyst, in an interview with DrBicuspid.com. Community Catalyst is nonprofit advocacy organization focused on healthcare that has partnered with the W.K. Kellogg Foundation on the Dental Access Project, which advocates for the use of dental therapists for low-income and rural populations.
Read more of this article from Dr.Biscuspid.com using the download link below.
The need to improve access to oral health care in Michigan is not a new issue. Despite efforts, the lack of access persists for many populations in our state. We must follow up on past recommendations and look for new solutions as numerous populations in our state—children, the elderly, the disabled and pregnant women to name a few—remain underserved.
The Michigan Council for Maternal and Child Health (MCMCH) and its partners are working to further evidence-based, cost effective policy solutions to improve access to oral health services. One solution is to expand the dental team by licensing a midlevel provider called a dental therapist. This will allow dentists to hire dental therapists, leading to better oral health in areas where state data shows routine dental care is limited or nonexistent.
Sen. Mike Shirkey (R-Clarklake) has introduced Senate Bill 541. This common-sense, cost-effective legislation would enable dentists to delegate routine procedures to dental therapists working under their supervision, and allow dentists to focus their time and skills on more complicated procedures. Dental therapists are similar to physician assistants on medical teams, and are well trained to perform routine dental procedures currently only performed by dentists, such as filling cavities.
Michigan now has the opportunity to be a national leader in addressing its oral health needs through this innovative, cost-effective solution. We opened the conversation about how a new workforce model incorporating dental therapists in the dental team could be part of a long-term solution.
For decades, disparities in oral health have existed due to barriers to access, including a misdistribution of dental providers, a shortage of dentists in Michigan who accept Medicaid and a lack
of dentists who specialize in populations such as children, special needs adults and senior citizens. Other barriers to oral health care include lack of transportation, delays in getting appointments
during a dental emergency, and lack of awareness of parents and caregivers about the importance of oral health care.
MCMCH and its partners are working to develop evidence-based, cost-effective policy solutions to improve oral health access in Michigan. To learn more about our work, visit the About page.