Should Dental Therapist Legislation in Minnesota spread to other states?

Supervising a non-profit, dental clinic in Minneapolis, Minn., Jamee Rosell has witnessed the overwhelming need for dental care among poor, uninsured, unemployed, elderly, immigrant and other underserved populations.

Though it is a relatively new concept and has been controversial, Rosell believes allowing for a mid-level dental practitioner is one way to begin to address the problem of people going without oral healthcare.

“We see families in our clinic who make $1,200 to $1,500 a month,” she said. “If you’re talking about a crown that is $1,000, how is a family going to afford that?”

Reaching these people with affordable, preventative care before they get to the point of needing a crown or of losing a tooth is how Rosell sees the function of a mid-level dental provider, a role that she is currently pursuing as one of the first seven students in a groundbreaking Oral Health Practitioner program offered in partnership with Normandale Community College at Metropolitan State University in St. Paul, Minn.

Rosell and the other students are slated to become the first graduates this summer of the program that will furnish them with a  a Master of Science degree and make them eligible to be licensed as dental therapists and certified as advanced dental therapists.
 
The mid-level of dental providers would be able to remove decay and restore teeth for children and adults, as well as extract primary teeth, while under the supervision of a licensed dentist. They would only be able to practice in areas where half of the population is privately insured and the other half is uninsured, underinsured or on public assistance.

In 2009, Minnesota Governor Tim Pawlenty signed into law the Dental Therapist Legislation, which provides two levels of providers. A dental therapist requires a bachelor's degree, and an advanced dental therapist requires a master's degree. Many advanced dental therapists may work in community settings under general supervision of a licensed dentist.

“There are so many people who are underserved,” said Suzanne Beatty, a dentist and curriculum coordinator at Metropolitan State for the Master’s program. “This would free up the dentist to do more complex procedures. It’s not an independent practice. It’s part of a collaboration.”

The need is expected to become even greater in Minnesota where dentists are aging out of the profession. The Minnesota Department of Health reports that about one-third of its 3,000 practicing dentists are 55 years or older, and there are seven Minnesota dentists retiring for every five entering the profession.

According to a 2007 study from the Centers for Disease Control and Prevention, more than 50 million Americans, particularly children, the elderly and the working poor, are not getting the oral health care they need.

“We need to put more qualified dental therapists and advanced dental therapists into the market,” said Beatty. “These mid-level dental practitioners will make it easier and more affordable for underserved populations, including children, the elderly and working poor to obtain high-quality oral health care.”

Student in the oral health practitioner program are receiving hands-on experience serving patients while collaborating with dentists and other health care professionals. They also begin to meet their licensure requirement of 2,000 hours of supervised clinical practice.

Like Rosell, student Christy Fogarty said she also has seen the need for a mid-level practitioner. She has worked as a dental hygienist in a variety of settings, from poor to affluent areas.

“I’ve worked in rural clinics, in the Twin Cities, suburbs and I’ve seen underserved at every level,” she said. “There are a lot of working poor whose dental needs are going unmet.”

The toll of underserved patients is costly. A study presented to the American Public Health Association in 2007 found that more than 10,000 emergency room visits in the Twin Cities were related to oral health problems (mainly pain and infection) and the cost was more than $4.7 million in one year.

Though she is energized by her goal of being able to work with underserved populations, Fogarty said completing the 26-month oral health practitioner program has been challenging. She is looking forward to completing it and to being able to continue doing what she likes while expanding her skills.

“It has all the things I like about being a dental hygienist like the patient contact, plus I’d be able to do a whole lot more,” Fogarty said.

The role of a dental therapist may seem an easier fit for a public health clinic, but Fogarty said she thinks it also will work well in a private practice. She is open to pursuing a job in either setting.

“I am open to anything,” she said. “I think the model can work in private practice. We need someone (a private practitioner) to be the groundbreaker.”

Rosell said she believes a minimum starting salary between $45 and $50 an hour seems fair for a dental therapist, and is the range she will seek.

As dentists become more familiar with the role of the dental therapist, Fogarty and Rosell both believe they will see how it can allow them to expand their practices.

“I think private practices will be able to think about taking more clients,” Rosell said.

The idea that dentists can benefit from hiring mid-level practitioners is supported by a 2010 study published by the Pew Center on the States.  The study, “It Takes a Team: How New Dental Providers Can Benefit Patients and Practices” found that most private-practice dentists who hire allied dental providers can serve more patients, while maintaining or improving their financial bottom line.

Reaching more people in the need is the goal for both Rosell and Fogarty. Since lack of transportation is an obstacle that prevents many people from receiving dental care, Rosell said she envisions someday going into communities to provide dental health care via equipped mobile vans, and under the oversight of a dentist.

“We could use teledentistry (to communicate with the collaborating dentist),” Rosell said. “We could get out into the community and provide services. That would be huge.” 

Registered dental hygienists with 1,000 clinical hours of experience beyond their bachelor's degree may apply to the master's level program at Metropolitan State University. The master's program consists of 44 credits and takes approximately two and a half years to complete.