Even scarier than how much candy our kids will consume this week is the thought that another Minnesota child will land in the emergency room, under costly and risky general anesthesia, for a procedure that should have been addressed years earlier in the dentist's chair. But it will happen.
Fortunately, this sad scenario probably will happen far less in coming years. Minnesota, which just a decade ago had the worst dentist-to-patient ratio in the nation, is now a national leader in innovative thinking, with the creation of a new oral health practitioner called a "dental therapist." This therapist, akin to a nurse practitioner, is licensed to perform duties such as filling cavities and extracting teeth, under a dentist's supervision.
It's a promising solution for the 350,000 low-income Minnesotans for whom regular dental care is a luxury they don't enjoy. Still, getting the bill passed was like pulling teeth. One proponent of the bill only half-jokingly refers to recurring post-traumatic-stress disorder. Results from a new study should ease his stress.
A two-year study of more than 400 indigenous Alaskans, commissioned by the W.K. Kellogg Foundation, found that dental therapists are safely and successfully performing cleanings, fillings and uncomplicated extractions. Patients, many of whom previously had to wait months or travel for hours to seek pain relief, were "highly satisfied" with the care.
The authors emphasize that Alaska has "some of the most severe oral disease in the country," and the program "has not had enough time yet to make a measurable impact on oral health." Still, it shows "incredible promise."
Lead dentist Mary Williard is "thrilled" by the results. She saw dental care, or the lack thereof, as she traveled to remote corners of Alaska to treat native patients. "We were failing to improve their health," she said. In some areas, she performed full-mouth restorations using general anesthesia on children as young as 2. Alaskan "dental health aid therapists," living and working in these communities, "made so much sense to me," Williard said.
The American Dental Association (ADA) differed vehemently, arguing that quality care could only be delivered by a trained dentist. The ADA sued the Alaska Native Tribal Health Consortium, and lost. "I can understand some of what they're saying," Williard said of the ADA. "Everybody should get safe, quality care. We were fighting for the same thing, but had different understandings about it."
The Dental Therapist Legislation, signed into law in 2009 by Gov. Tim Pawlenty, provides two tiers of providers. A dental therapist requires a bachelor's degree and will work with a dentist on-site.
An advanced dental therapist requires a master's degree and will work in community settings, such as nursing homes and Head Start programs, in collaboration with an off-site dentist supervisor.
The University of Minnesota Dental School and a Metropolitan State University-Normandale Community college partnership have developed programs; each dental therapist could provide at least 2,000 dental visits annually.
"We are seeing far more advanced dental decay in younger children, and serious gum problems," said Colleen Brickle, dean of Health Sciences at Normandale.
Not just children. Last summer, unemployed Minnesotans, veterans of Afghanistan and Iraq, and many elderly Minnesotans flocked to her teaching clinics for the first time. "People are losing their dental insurance," Brickle said. "There is such a need."
Joan Sheppard, president of the Minnesota Board of Dentistry, also sees dental therapists as a way to shatter barriers of language and culture, as well as lack of insurance or participating dentists. Yet, even as the first dental therapists prepare to graduate next spring, pushback remains.
"There is no need to compromise the quality, nor the principles of care, that only dentists can provide," said Dick Diercks, executive director of the Minnesota Dental Association. He'd rather see more efforts like Give Kids A Smile and other dental association programs that provide oral health care services to low-income patients, as well as sending dental hygienists into schools in collaboration with dentists to provide preventive care.
Jamie Sledd, past dental association president, concurs. "We have enough dentists in the state and a huge surplus of dental hygienists," she said. Her biggest concern is that "the individuals who would receive care from a mid-level provider are often the most vulnerable, and we're not teaching therapists how to deal with unexpected events that might occur. Is it really fair to the patient to receive care from a provider who does not have comprehensive dental knowledge?"
Nope. That's why dental therapists will receive extensive training but still be limited to routine primary care services, all under a dentist's supervision.
Here's my question:
Is it fair that poor kids in Minnesota are twice as likely as their more affluent peers to have untreated tooth decay?
With the Alaska results in, let's hope skeptics finally jump onto this moving train. "I do feel that when we have dental therapists in practice for a time," Sheppard said, "people will have a better perspective on how this is going to work."
Gail Rosenblum • 612-673-7350 • firstname.lastname@example.org