At The James Madison Institute, I’ve spent years engaged in the battle of ideas, advancing conservative economic principles and free market ideals, I have been surprised and a bit disappointed with the idea that the government and special interests can stand in the way of solutions that are right there in front of states. And, health policy and the often overlooked costs both financial and personal of oral health is certainly a challenge.
As a policy guy I get right to the pressing question — what can be done? In short, dental therapy. But let’s take a step back a minute.
Pardon the pun but surgical innovation is where the solutions ultimately lie — not in more layers of bloated government bureaucracy and special interest protectionism. Looking to the states often provides such innovations.
So, to explain what a dental therapist is we need to first examine the existing landscape to understand how an innovative approach can remedy a growing challenge like oral health and dental care. Most individuals pay for dental care out-of-pocket, or via discount card programs offered by various providers. As a result of this (and other reasons), many do not get regular preventative oral care and maintenance. In many cases a lack of simple care, like tooth cleanings, can snowball into life threatening illness. In fact, a young man named Deamonte Driver from Maryland sadly is no longer with us due to a preventable infection that spread from his mouth to his brain in 2007.
In addition, Medicaid presents additional problems because of the lack of dentists accepting it. And the few that do only see a tiny number and often do not accept new patients. On the whole, we currently have, and will continue to face, a critical shortage of oral health professionals. This challenge will be exacerbated in the very near term as thousands of dentists retire without an adequate supply pipeline to replace them.
Just about every state has designated dental health professional shortage areas. Data from Kaiser Family Foundation indicates that these shortage areas cover about 63 million people. In my home state of Florida — the third most populous state in the U.S. — 63 of the 67 counties have these designated shortage areas. The Department of Health and Human Services projects that while the population of dentists will increase by six percent nationally by 2025, the demand over that same time period will grow by 10 percent.
Some states have begun to address this challenge with a patient-centered, market-oriented innovation. Starting in the geographically dispersed state of Alaska and spreading to bigger population centers like Michigan and Minnesota, policymakers have worked with the healthcare community to get qualified mid-level dental care professionals — referred to as dental therapists — working with patients and those most in need.
Under the supervision of dentists, dental therapists provide routine preventive care like cleaning and education and restorative care services such as drilling and filling cavities. They are hired and supervised by dentists and able to practice outside of dental offices in community-based locations like schools and nursing homes. In states that have adopted this innovative workforce model, individuals going through the program are trained right alongside future dentists. They take the same exam as future dentists. Much like a physician’s assistant, their role is to expand the ability of people to get treatment and allow a dentist to focus on more complex procedures like implants and crowns. In Minnesota, which has had dental therapists going on 10 years now, their research shows three things — dental therapists have 100 percent job placement upon graduation, they allow dentists to see more patients, and dentists are clamoring for more of them.
To be certain, entrenched interests have, and will continue to, oppose innovation. They’ll make bogus claims about the quality of care, the efficacy, and the efficiency of the proposal. Make no mistake — much in the same way that 15 years ago trade associations opposed the expansion of physicians’ assistants, this opposition is short sighted and just plain wrong. It’s also important to remember that many years ago, trade associations opposed the idea of creating the job of a dental hygienist. Meanwhile, today they are a critical component of overall dental care.
Ensuring that individuals (especially our most vulnerable) have access to quality oral care is objectively sound policy. Presented with the facts about our need, policymakers around the country would be on solid ground working to expand into mid-level practitioners like dental therapists and innovate.
Dr. Robert McClure provides expert perspective on current issues facing our nation and his home state of Florida, the third-largest state in the nation and a policy bellwether for the country. Recently named one of the Most Influential People in Florida Politics, Dr. McClure serves as the President and CEO of The James Madison Institute, Florida’s premier free-market think tank. He is a frequent commentator on television and talk radio programs and has lectured nationally on diverse policy issues. Dr. McClure has been published numerous times at both the state and national level on topics including property rights, tax policy, health care, and education reform. To read more of his reports — Click Here Now.
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