In what it says is an effort to increase access to dental care across Arizona, a coalition of nine groups today plans to submit a petition to authorize a new type of dental care provider in the state.
The mid-level position, called a dental therapist, would work under a dentist in a capacity similar to a physician’s assistant, said John Grant, director of The Pew Charitable Trust's dental campaign, which is a member of the coalition. Training for the therapists would cover a narrower range of topics than dental school and they would perform a more limited scope of procedures such as oral examinations, fillings, extractions and crowns, Grant said.
Advocates of the concept point to the statistic that 2.4 million of Arizona’s 7 million residents live in federally designated dental health professional shortage areas where there are one or fewer dentists per 5,000 people. They say a dental therapist model will increase the number of providers in the state, bring dental care to more rural or underserved parts of the state and improve care overall.
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The Arizona Rural Health Coalition and the Navajo Nation are other members of the coalition, called Dental Care for Arizona. Rep. Bob Thorpe, R-Flagstaff, has also signed on as a supporter. In an op-ed, Thorpe called dental therapists a “smart, proven solution” that has already been implemented in other states.
“This model has allowed dentists in these states to successfully practice in remote, rural parts of the state, thus expanding access where needed,” the representative wrote.
But the concept has met strong opposition from both the Arizona Dental Association and the American Dental Association.
Creating a dental therapist occupation won’t solve the biggest barriers to dental care access, including cost of care, Medicaid coverage and rural availability, said Kevin Earle, executive director with the Arizona Dental Association.
“We believe that it’s the wrong diagnosis and the wrong prescription,” Earle said.
He also raised concerns that dental therapists would be allowed to do oral procedures that come with a risk of complications, but wouldn’t necessarily need to be under the direct supervision of a licensed dentist. If something were to go wrong in that situation, it could be dangerous for the patient, he said.
“On the face, things can seem simple, but they can get complicated once you’re in there,” Earle said.
For its part, the American Dental Association published a statement saying: "There is no available data that demonstrate new models that replicate what dentists already do well have increased access to care at a lower cost."
This isn’t the first time such a debate has occurred in Arizona. Dental Care for Arizona proposed the legalization of licensed dental therapists last year as well but the application was voted down by a legislative review committee. That essentially prevented the proposal from moving on to a formal hearing during the legislative session.
Democratic Sen. David Bradley from Tucson told the Arizona Daily Star in April that proponents didn’t adequately address safety concerns and failed to show that access to care was a serious issue in Arizona and was tied to the number of providers.
This time around supporters are hoping for a different outcome, saying they have a stronger coalition, better data showing the need for dental care in the state and more information about testing and licensing structures. According to Arizona law, the review committee is supposed to deliver its recommendation for or against the proposal before Dec. 1.
THREE OTHER STATES, A DOZEN IN PLAY
Three states, Minnesota, Maine and Vermont, allow for licensed dental therapists, while Washington, Oregon and Alaska allow them on tribal land. About a dozen others are considering the concept, Grant said.
In 2015, the Commission on Dental Accreditation created national training standards for dental therapy education, which provide a blueprint for state legislation, he said.
Grant said dental therapists are paid at a lower rate but did not directly answer whether that would bring down the cost of care for patients.
“The short answer is it’s complicated,” he said.
He did say that in the case of Federally Qualified Healthcare Centers like North Country HealthCare that provide services on a sliding scale, the addition of therapists could allow them to accept more patients.
Dental therapy supporter Alicia Thompson, coordinator for the Southern Arizona Oral Health Coalition, focused on the potential for the new providers to target rural and underserved areas. She referenced a case study in Alaska native communities where therapists are recruited from communities that need dental service, then trained and sent back to practice in those locations. Thompson said she could see something similar happening in Arizona.
While the therapists would have to be under indirect supervision of a dentist, they would be allowed to travel to remote settings as long as they followed a pre-established treatment plan and stayed in touch with their supervisor via phone or teletechnology, Grant said.
Earle agreed that residents’ dental care needs aren’t being fulfilled in all parts of the state, but said the problem isn’t a lack of dentists. Over the past decade, there has been a net increase in the number of dentists that roughly matches population growth, he said.
For most people, the biggest barrier is the cost of dental care, which is tied to the fact that Medicaid doesn't cover dental services for non-disabled adults, Earle said. That will start to change in October when Medicaid will again cover emergent dental needs, but to truly improve dental health in Arizona the state needs to expand Medicaid coverage to include comprehensive dental care, Earle said.
The goal of dental therapist advocates to increase dental care in rural areas ignores realities that some places don't have enough people to support a clinic, Earle said. The state’s loan forgiveness program is meant to incentivize healthcare professionals to work in rural areas is also “really, really weak,” he said.
He suggested teledentistry and mobile dental care programs that are already happening in the state are the best way to address those challenges.
As for Flagstaff dentists, of 10 dentists the Daily Sun contacted this week for comment on the proposal, only one responded before Thursday evening.
Jef Abramowitz said he had heard from the dental association that the dental therapist proposal was unnecessary because there are already enough dentists in the state.
“I’m really kind of on the fence myself,” Abramowitz said. “I don't really know one way or another whether they're needed.”
Emery Cowan can be reached at (928) 556-2250 or email@example.com
“This model has allowed dentists in these states to successfully practice in remote, rural parts of the state, thus expanding access where needed."
--State Rep. Bob Thorpe, R-Flagstaff