KHI News Service

Political fight continues over mid-level dental practitioners

Oral health advocates push for new type of provider, but dentists remain opposed

By Mike Shields | October 11, 2011

Fort Hays State University is ready to launch a new degree program to train registered dental practitioners, if the Legislature will agree the technicians can be licensed to work in Kansas.

FHSU President Ed Hammond told a legislative committee today that the new training program would help solve the shortage of dental providers in rural Kansas and that he was certain he could raise private funds to launch it.

His testimony to the Legislature's Joint Committee on Home and Community Based Services made FHSU a new ally to a coalition that since last year has been trying to persuade lawmakers that they need to allow licensing of a new type of dental technician, essentially a better-trained hygienist who could perform a number of additional routine procedures that currently only dentists are allowed to perform.

A number of states already allow for registered dental practitioners.

The coalition of various health consumer and advocacy groups is the work of the Kansas Dental Project, a foundation-supported effort to increase access to dental care across the state. Earlier this year, the group introduced bills in the House and Senate that would allow the technicians to work in Kansas. Those bills weren't acted upon but technically are still alive for consideration by the 2012 Legislature.

According to the Kansas Department of Health and Environment, the dental workforce in Kansas is below the national average and shrinking. Fifteen of 105 Kansas counties have no dentist.

Lack of dental providers is particularly acute in rural areas where looming retirements could make it even harder to find care.

"The average age of dentists in rural areas of Kansas is higher than the state average," Hammond said. "The current workforce issues combined with the demographics of the providers in our part of the state make one thing clear: We have to act now to shore up our dental workforce, and training that new workforce in the western part of the state makes the most sense."

It was the second consecutive day this week that legislative interim committees dealt with issues of dental care.

On Monday, the Joint Legislative Budget Committee was urged to authorize routine dental care for adults on Medicaid.

Most of the organizations that support that expansion of benefits, including the state's safety net clinics, also support the licensing of registered dental practitioners.

An exception is the Kansas Dental Association, a group whose membership includes about 77 percent of Kansas dentists, according to Kevin Robertson, the association's executive director. There are about 1,500 practicing dentists in Kansas, he said.

A broad variety of groups testified in support of creating the new class of mid-level practitioner. But Robertson and two association dentists told legislators it would be a bad idea because "non-dentist clinicians" could jeopardize patient health and safety.

Paul Kittle, a pediatric dentist from Leavenworth, told committee members that allowing the technicians to work in Kansas could create "two tiers" of dental care in the state. He said the top tier, provided by dentists, would be for those who could afford it, while the second tier, of inferior quality, would be for the poor.

"This bill proposes to lower the standards of dental care for Kansas children," he said. "That is not acceptable. We are not a third world country. We cannot allow any non-dentist — whether they be a dental hygienist, an expanded therapist or someone straight out of high school — to drill into the nerve on a primary tooth, to extract a solidly embedded or an abscessed primary molar."

The proposed legislation would require that the technicians work under a dentist's supervision. The practitioners would be allowed to extract loose baby teeth but would not be allowed to perform major dental procedures such as root canals, according to others who testified.

Daniel Minnis, dental director of the Community Health Center of Southeast Kansas and a supporter of the proposal, told the committee that patient safety would not be an issue.

"All the research clearly indicates the safety and effectiveness of the dental mid-level provider," he said. "There are no reports or research indicating standards of care less than that of a dentist. I would hire a registered dental practitioner in my practice and allow them to perform their scope of practice on myself, my family members and my patients."

The committee took no action on the matter. But it is scheduled to meet again Wednesday to discuss its recommendations for the 2012 Legislature.

Related coverage: Kansas' Oral Health Care Provider Shortage

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Bill to license mid-level dental providers introduced (1/29/13)
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