Kansas dentists propose plan to address state’s dental shortage

Plan would expand hygienists’ role, not license mid-level practioners

0 | Oral Health

The Kansas Dental Association today unveiled its plan to address the state’s critical dentist shortage ahead of another, expected proposal by advocates for the uninsured.

Notably, the KDA proposal seeks to expand the role of dental hygienists in prevention while advocates have said the best way to solve the shortage is to license mid-level practitioners to do basic dental work like fillings and restorative services.

David Hamel, President of the Kansas Dental Association, said his organization believes hygienists are more suited to the state’s health care needs.

“We believe that all Kansans deserve a dentist to care for their overall needs. Dental hygienists are valuable,” Hamel said. “They provide all kinds of preventive care.”

When asked how the proposals would be paid for, Hamel said the KDA had had “no specific discussions yet of cost.”

“Estimates would be very, very general at this point and I wouldn’t feel comfortable saying any particular number,” Hamel said.

A Kansas Department of Health and Environment survey found that in 2009, 91 of the state’s 105 counties don’t have enough dentists to meet their populations’ needs.

Many of the dentists practicing in the state’s rural areas have said they are planning to retire in six to 10 years.

Only one in four dentists in Kansas sees Medicaid patients.

Included in the dental association proposal:

• Creation of loan program to help local, rural, and underserved communities attract dentists.

• Restore funding — $70,000 — for a program that helped cover lab fees associated with donated dental care for the elderly and disabled.

• Expand dental education opportunities for Kansas students at the University of Missouri-Kansas City School of Dentistry; require these students to work in underserved areas in Kansas for four years.

• Expand the state’s Medicaid program to include basic preventive dental care for low-income adults.

• Appoint a commission to recommend improvements in Medicaid-funded dental care for children.

• Make it clear that nonprofit foundations may help offset the costs of training dental providers and of charitable dental treatments.

Expand the list of procedures that dental hygienists are allowed to perform in schools, nursing homes, county health departments, and safety-net clinics.

Currently, hygienists are allowed to provide preventive care such as cleanings and fluoride treatments in a dentist’s office.

If they want to see patients in nursing homes, senior centers, safety-net clinics, jails, schools and other locations where dental care otherwise might be hard to get, they’re expected to apply for an extended care permit.

To work with children outside a dentist’s office, hygienists are required to have at least 1,200 hours of experience; to work with patients over age 65: 1,800 hours.

These restrictions, the dental association has argued, ensure high-quality care.

Advocates for the uninsured are expected to counter the association’s plan with a bill for licensing mid-level practitioners.

A mid-level would be allowed to perform basic drilling, filling and restorative services — more than what hygienists are allowed to do.

A mid-level practitioner’s work would be supervised by a dentist, much as the work of a physician’s assistant is overseen by a physician.

The initiative is a product of the Kansas Dental Project, a foundation-funded effort led by the Kansas Health Consumer Coalition, Kansas Association for the Medically Underserved, and Kansas Action for Children.

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Proposal aims to expand dental services to Kansans

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