Allowing ‘dental therapists’ in Michigan will expand access to oral care

Amy Zaagman is executive director of the Michigan Council for Maternal and Child Health.

In 2000, former Surgeon General David Satcher released “Oral Health in America: A Report of the Surgeon General.” The report — the office’s first-ever on the oral health of Americans — revealed oral disease as an expansive problem that caused “needless pain and suffering, complications that devastate overall health and well-being, and financial and social costs that diminish the quality of life and burden American society. What amounts to a ‘silent epidemic’ of oral diseases is affecting our most vulnerable citizens — poor children, the elderly, and many members of racial and ethnic minority groups.”

Sixteen years later, health officials are still citing the “silent epidemic” of poor oral health in our country, and the story is no different in Michigan.

Oral health is more than pearly white teeth — research has shown that oral health is linked to the health of the entire body. For those who can’t find a dentist to treat them, tooth loss, gum disease and pain negatively impact daily life and can erode their overall health. Consider:

• More than one-third of all Michigan seniors have lost six or more natural teeth due to tooth decay or gum disease. Low-income seniors are more than three times as likely to have lost six or more teeth from tooth decay and/or gum disease.
• Almost 3 out of 4 new mothers in 2008 did not receive dental care during their most recent pregnancy. Research shows gum disease is associated with preterm birth.
• 66 percent of third-graders in the Upper Peninsula had a history of dental decay in their primary and/or permanent teeth, compared with 56 percent statewide.

This situation exists despite efforts in Michigan to create and expand meaningful supports, particularly expansion of the Healthy Kids Dental program, which will cover all children on Medicaid in all counties beginning next year. According to the 2016 University of Michigan’s Child Health Evaluation and Research Unit, approximately 40 percent of children covered under Healthy Kids Dental did not receive dental services in 2014.

Years of studies, reports and task forces show us there is no one solution to this problem. But one strategy that hasn’t been tried in Michigan yet is adding mid-level dental providers to our state’s workforce to expand access to care.

Senate Bill 1013, introduced earlier this month by Sen. Mike Shirkey, would authorize a type of midlevel dental professional called a dental therapist. These providers would be able, with appropriate training and licensing, to deliver routine but critically necessary care such as filling cavities.

Similar to a physician assistant on a medical team, dental therapists would not work independently, but under the supervision of a dentist. Only dentists who want to hire dental therapists to expand their practices would do so.

Right now many people in Michigan have difficulty finding a dentist who will see them. They may face those challenges because there are not enough dentists where they live, or because no dentist nearby accepts Medicaid, or because they have barriers to traditional dental settings like a physical disability.

One of the key provisions of SB 1013 is to ensure dental therapists help create access for underserved populations. The bill requires them to practice in safety net settings like a public clinic or that at least 50 percent of their patients are on Medicaid, uninsured or face other significant barriers to getting dental care.

Some dentists who do see Medicaid and uninsured patients want and need dental therapists. They are overwhelmed by demand and want to utilize the skills a dental therapist could contribute.

In a released statement on SB 1013, the Michigan Dental Association said dental therapists are not needed in Michigan, and the “most impactful solution is to more effectively utilize” the state’s existing dentists, hygienists and dental assistants.

Licensing dental therapists to work in Michigan won’t be the magic bullet that solves the problem of poor oral health for so many individuals, but it is a cost-effective strategy that could make an impact. For providers who don’t see underserved populations, and don’t want to hire a dental therapist, you have to wonder why would they care if someone else is willing?

Faced with access-to-care issues in their states, Minnesota, Maine, Vermont and tribal governments in Alaska, Washington, and Oregon allow dentists to hire these midlevel providers. At least 15 other states are considering bills similar to Michigan’s. Rather than viewing a new provider as a threat and settling for the status quo, Michigan should join these states by embracing the opportunity to expand care to those who need it.