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Statehouse push made for mid-level dental practitioners

More than 100 advocates donned yellow scarves and press legislators to approve new licensing category

By Phil Cauthon | February 12, 2014

Dr. Daniel Minnis, a Pittsburg dentist, talks with Deborah Weatherbie (white shirt) who is an instructor for a two-year dental hygiene program at Flint Hills Technical College in Emporia. Thirteen of her students traveled with her today to join about 100 others in lobbying legislators to sanction mid-level dental practitioners in Kansas. The state's dental association opposes the move, but Dr. Minnis is among a handful of dentists who support it.

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More than 100 advocates from around the state — all in yellow scarfs — were in Topeka today to ask their legislators to approve the licensing of mid-level dental practitioners.

The advocates included dental hygienists, hygiene students and a handful of dentists, including Dr. Daniel Minnis of Pittsburg. He told a group of advocates from Emporia that this year most legislators seem to be concerned that mid-level practitioners would cut into dentists' business.

In the past, he said they were more focused on the Kansas Dental Association's claim that licensing mid-level dental providers would endanger patients.

"How often do you see medical emergencies result from simple restorative procedures? In 28 years I've never had one in my office," Minnis.

Minnis suggested that when visiting with legislators the hygienists should focus on the growing dental care shortage in Kansas. According to a 2011 report, at least 57,000 Kansans live in "dental deserts," areas where the closest dental office is at least a half-hour drive from the resident's home.

"Just due to the (Affordable Care Act), 75,000 children are now going to have dental coverage in the state of Kansas," Minnis said. "You need a dentist for every 2,000 patients, so that means we need at least 30 new dentists in the state. That comes from the American Dental Association's own economic advisor who came in November and talked to the Kansas Dental Association."

"Who's going to serve them?" Minnis said.

Deborah Weatherbie, an instructor for a two-year dental hygiene program at Flint Hills Technical College in Emporia, urged the 13 students who traveled with her to remind legislators that mid-level practitioners, as proposed, would still have to work under the supervision of a dentist.


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"The fear that some day we would open up shop across the street and be competing with them is not true. We couldn't be independent practitioners, we'd still be working for them," Weatherbie said.

"But we could serve the children who aren't getting served. Why not give us those duties — simple fillings, simple extractions, prophylactic things — while the dentists do what they're trained to do, crown preps and the things that are more detailed," she said.

Advocates pointed to a report released in January by the National Governors Association that concluded mid-level dental practitioners can play a critical role in improving access to high-quality services, especially for underserved or vulnerable populations. "Thus far, studies of pilot programs have shown safe and effective outcomes," according to the report.

Another report — released today by Pew Charitable Trusts — concluded that dental practices employing mid-level practitioners in Minnesota and Canada opened oral health care access to significant numbers of underserved patients, and that the practices continued generating profits.

Mid-level proposal

A mid-level dental practitioner's training places them between a regular dentist and a dental hygienist — able to fill cavities and perform simple extractions of teeth. Under House Bill 2157 and Senate Bill 197, the practitioners would be able to provide a list of routine dental services under the supervision of a dentist, but the dentist would not necessarily have to be present during the procedures.

As proposed, hygienists would need 18-months additional training to become a mid-level.

Dentists remain firmly opposed to the bills as currently written, said Kevin Robertson, executive director of the Kansas Dental Association.

"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.

Robertson said the proposal in Kansas goes too far by allowing mid-level providers to perform procedures that are, by definition, considered surgery — that is, anything that includes the cutting of the hard surfaces of teeth.

"As far as irreversible surgical procedures, the threshold has always been a (dental) degree," Robertson said. "There are other things in that bill that we certainly could come to some agreement to. But I think the line for both of us — as far as what they want and what we want — is irreversible procedures."

The dental association says there are better ways to increase access to oral health care — such as increasing Medicaid reimbursement rates. Absent that, the association last year began a scholarship and loan repayment program for students and dentists who agree to serve for at least two years in a dental desert.

Alaska was the first state to sanction licensing of mid-level dental practitioners in 2006, and only Minnesota has done so since.


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Fourth year trying

This will be the fourth legislative session that supporters of the bills have pushed the idea of licensing mid-level practitioners, which they say is the best solution to the problem faced by many Kansans of inadequate access to oral health care.

The supporters — under the banner Kansas Dental Project coalition — say they are gaining steam with dozens of new coalition members since last session, including most recently Americans for Prosperity.

The coalition was formed by the Kansas Health Consumer Coalition, Kansas Action for Children, the Kansas Health Foundation — a major funder of the Kansas Health Institute — and some 50 other groups.

Among them is Kansas City-based REACH Healthcare Foundation. Its chief executive Brenda Sharpe said she thinks support for the mid-level practitioner proposal is approaching critical mass.

"The difference we see this year in terms of support is the continued expansion of coalition members, particularly those who understand the job creation and economic benefits of this model. It's a new angle on the initial benefits that brought our foundation to the table — increased access and a more sustainable approach," said Sharpe.

Related coverage: Kansas' Oral Health Care Provider Shortage

Bill considered that would allow dentists to have more practice locations (2/18/14)
Statehouse push made for mid-level dental practitioners (2/12/14)
Americans for Prosperity joins effort to license mid-level dental providers (1/8/14)
Kansas Medicaid program still lags nation in oral health care for kids (11/12/13)
Kansas dental program for children on hold because of KanCare MCO (11/11/13)
Dental mediation effort ends without compromise (11/4/13)
Disputing parties enter formal mediation over mid-level dental providers (10/3/13)
Pew report cites need for mid-level dental providers (6/25/13)
Dentist groups announce scholarships for dentists going to rural areas (2/7/13)
Advocates for mid-level dental providers meet with legislators (2/6/13)
Bill to license mid-level dental providers introduced (1/29/13)
Regents will hear proposal to train mid-level dental practitioners (10/17/12)
Dentist shortage proposal not funded in Regents' recommended budget (9/20/12)
Report questions economic viability of mid-level dental providers (7/26/12)
Task force recommends building state's first dental school (6/21/12)
Dentists shouldn't fear mid-level dental care, expert says (4/20/12)
No consensus on how to end ‘dental deserts’ (4/9/12)
Worldwide review says mid-level dental providers give good care (4/10/12)
Bill to increase dental care access given initial approval in Senate (3/15/12)
New caucus told of oral health success in southeast Kansas (3/8/12)
More Kansans head to ER for dental care (2/29/12)
Dental association says new program will increase access in rural areas (2/2/12)
‘Turf battle’ continues over dental practitioner bill (1/30/12)
Summit to focus on training plan for mid-level dental practitioners (11/29/11)
Between a hygienist and a dentist, a hard sell (10/26/11)
Political fight continues over mid-level dental practitioners (10/11/11)
Better prevention would help solve dentist shortage, advocate says (7/22/11)
Dentists: Practitioner bill flawed (3/9/11)
Videos detail shortage of Kansas dental providers (12/8/10)
Slow going in efforts to solve state’s dentist shortage (8/30/10)
Safety-net clinics filling gap in dental services to low-income Kansans (8/30/10)
Replacing town’s only dentist ‘hardest’ project ever (8/30/10)
Progress made on oral health, but problems remain (1/14/09)
Funding bill contains seed money for 'dental hubs' (5/4/07)
Increasing access aim of oral health coalition (12/21/06)

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