Sen. Mike Shirkey (R- Clarklake) introduced Senate Bill 541 to address significant gaps in access to oral health services across the state by licensing dental therapists to practice in Michigan. Passed by the Senate in October 2017, 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. The legislation is currently before the House Health Policy Committee.

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.

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.

Arizona became the latest state to license dental therapists in May when Gov. Doug Ducey signed legislation that was passed by the Arizona House of Representatives 47-13 and passed unanimously in the Senate. Including Arizona, seven states now authorize dental therapists in some capacity. 
Tribal leaders, in particular, supported the measure, which they argued would help address disparities in care, according to news reports. Native American adults have more than double the average rate of untreated tooth decay. The rural location of many tribes in Arizona makes it difficult to attract and retain dentists.
Dental therapists can practice in urban Indian clinics or tribal health centers, community health centers, non-profit dental practices, federally qualified health centers and other locations under the new law. 

In 2011, Apple Tree Dental began deploying an advanced dental therapist, as part of its care team at the Madelia Center for Dental Health, a dental clinic located within the Madelia Community Hospital and Clinic in rural southwestern Minnesota. In 2016, the population of Madelia was 2,239, and both the hospital and Apple Tree served patients from surrounding south-central rural counties.

This case study, covering the dental therapist's work from 2014 through 2016, provides an analysis of the productivity and cost effectiveness of an Advanced Dental Therapist (ADT) and the findings strongly suggest that other rural dental practices could benefit from adding dental therapists to their dental care teams. You can read the full case study here.

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.