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Dec. 5, 2012
LAWRENCE About 60 community organizers from eight states are meeting here this week to collaborate on their efforts to license mid-level dental providers in their respective states.
In each state, proposals for licensing the new position are intended to address long-standing shortages of dentists, especially in rural areas where other approaches — such as loan repayment incentives — have been unsuccessful, said Dr. Albert Yee of Community Catalyst, the Massachusetts-based organization spearheading the effort nationally.
Representatives of Kansas, Ohio, New Mexico, Vermont, Washington, Colorado, Michigan, and Minnesota are attending the three-day, semi-annual meeting coordinated by Community Catalyst.
A mid-level dental provider's training places them between a regular dentist and a dental hygienist — able to fill cavities and perform simple extractions of teeth. Alaska was the first state to sanction mid-levels in 2006, and only Minnesota has done so since.
Opposition from dentists has so far blocked proposed legislation to license mid-levels in Kansas and in other states.
Yee said the dentists' criticisms of mid-level dental providers — that they're undertrained or provide second-rate care — is unwarranted. He pointed to a recent report on 26 nations and territories’ experiences with mid-level dental therapists, which found that they provide good quality, cost-effective care.
"The evidence that's out there, the studies have shown that it's not a lower level of care. It's exactly the same quality of care that the dentists provide for the same procedures," said Yee, who also works with the Kellogg Foundation, which commissioned the report he cited. "There's really no study to the contrary, no evidence whatsoever that they provide second-rate care."
Yee said the opposition to mid-level practitioners — sometimes called dental therapists, registered dental practitioner, or RDPs — remind him of his experience as an internist in the 1980s and early 1990s, when similar opposition was aimed at nurse practitioners by doctors.
"Obviously nurse practitioners and physicians' assistants 25 years later are basically a normal part of the landscape. So with that, I saw the potential for dental therapy having that benefit in the dental profession in improving access to care for underserved populations," Yee said.
In Kansas, at least 57,000 people live in so-called dental deserts, where there are no dental services and where the closest dental office is at least a half-hour drive from the resident's home, according to a 2011 report.
Many more Kansans lack dental insurance and cannot afford routine preventive care, much less restorative care, said Suzanne Wikle of Kansas Action for Children, which is part of the effort to license mid-level practitioners in the state. The Kansas Health Foundation — a major funder of the Kansas Health Institute — is also part of that effort.
Wikle said lack of access to dental care leads to 17,500 hospital emergency room visits for dental care each year.
"The number one reason is cavities," she said.
The average cost for dental care in the ER is $400 to 600 per visit, Yee said.
"And they're not equipped (in emergency rooms) to provide dental care. They're only getting a prescription, they still need to get the care. Whereas the average dental visit could cost between $70 and $80," Yee said.
But Kevin Robertson, director of the Kansas Dental Association, has said the solution to that problem is not licensing mid-level practitioners.
Robertson said the bills introduced in the last two legislative sessions by supporters of the new licensing went too far by proposing that the practitioners be allowed to perform procedures which are, by definition, considered surgery — that is, anything that includes the cutting of the hard surfaces of teeth.
"A maximum 18-month training is simply not adequate for a dental hygienist to learn restorative dental surgical procedures, science, anatomy and emergency treatments should complications arise during treatment while these (mid-level providers) are treating patients without dentist backup anywhere in the state – perhaps in clinics with limited or no medical support," Robertson said.
He said that extending Medicaid dental coverage to adults, for example, would yield greater access to dental care in Kansas than licensing a new category of provider.
"Patients who cannot afford dental care from a dentist will not be able to afford treatment from a (mid-level provider) either without adult Medicaid," Robertson said.
Though bills introduced by advocates of the mid-level licensing have yet to be put to a vote in either chamber of the Legislature, Wikle said she thought momentum has been building in support of the idea.
And she said the more than 50 new lawmakers elected this year presented an opportunity to move the legislation forward in the 2013 session, which begins Jan. 14.
"Change is always a challenge on one hand, but also a great opportunity in this respect to move the legislation forward," Wikle said. "We've been working hard during the interim to educate those new policymakers about this project and the importance to their communities."
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