This is a big week for dental care in Minnesota, and maybe nationwide.
The country's first class of dental therapists (DTs) and advanced dental therapists (ADTs) -- oral health providers akin to nurse practitioners -- take their boards April 2-3 at the University of Minnesota. We all should be rooting for them.
Their success means that thousands of uninsured Minnesotans will have access to quality dental care in supervised settings. The key word in that sentence is "supervised." The American Dental Association (ADA) remains "firmly opposed" to the concept, arguing that midlevel providers are a Band-Aid approach to a national epidemic of dental disease.
"I wish them luck," said ADA President Raymond Gist, "but I think we're going to find the same problems we're already having in trying to get treatment done." The ADA questions the Minnesota model's economic feasibility and the wisdom of giving midlevel providers "more responsibility than they should bear."
No one is suggesting that dental therapists will replace dentists. They'll fill holes, literally and figuratively, in community settings where dentists aren't going. Regular dental care is out of reach for about 350,000 low-income Minnesotans. And Minnesota's ranking among the top five states for dental health masks an ugly truth -- 80 percent of tooth decay is found in just 25 percent of our children, most of them low-income.
This doesn't surprise Jamee Rosell, a dental hygienist for 14 years and an ADT candidate. Rosell, 37, manages the Neighborhood Involvement Program's (N.I.P.) Uptown Community Clinic in Minneapolis, which last year served nearly 600 uninsured patients in its two-seat dental clinic. While about one-third of the patients were immigrants, most were retired baby boomers without dental insurance, military veterans and a few children whose parents don't qualify for public assistance but can't afford private insurance.
Former Gov. Tim Pawlenty signed the two-tiered Dental Therapist Legislation into law in 2009. It requires dental therapists to have a bachelor's degree and licenses them to fill cavities and extract teeth under an on-site dentist's supervision. An advanced dental therapist must have a master's degree and complete 2,000 clinical hours before being licensed to practice in settings such as nursing homes and Head Start programs, with an off-site dentist supervisor.
The U's Dental School and a Metropolitan State University-Normandale Community College partnership developed the programs. Other countries have similar programs, as does an Alaskan tribe, but Minnesota's is unique in the United States. That is likely why some trade groups are pushing back.
Sharon Oswald, a consultant for LPaC Alliance, a Minneapolis law and consulting firm specializing in health care, helped develop the program. "Implications for national replication and growth of the model is pretty strong," she said, "so there's some urgency of the opponents in minimizing Minnesota's impact."
Rosell sees urgency, too. One of her patients drives two hours each way to get to her clinic every three months. Another wrote: "I know my teeth would be in a state of utter disaster had N.I.P. and Jamee not been around to take care of me."
For Rosell, it's simple.
"I can't sit back and not treat this population," she said. When she attains the ADT level, she'll have eight years of education and training under her belt. "We'll be well-educated," Rosell said. "I don't want [dentists] to look at us as a threat. I'll always ask advice of a dentist. I want them to see us as an asset, working alongside them."
Some dentists are shifting from their opposition. Many already participate in programs that provide oral health care services to low-income patients. But most such care takes place in community clinics.
Jodi Hager, a dental hygienist and ADT candidate, practices in rural Madelia where about half the children she sees are way past the prevention stage; about 10 percent, she said, need urgent care.
Christy Fogarty, also an ADT candidate, sees problems common to rural areas spreading into the suburbs.
"From Owatonna to Maple Grove," she said, "there's a silent minority of people with no dental insurance, so they go without care."
The pioneering students will be grilled on everything from the anatomy of the mouth to filling cavities in volunteer patients. Mostly, though, they're eager to get going.
"It's a big weekend," Rosell said. "It basically determines your fate."
Gail Rosenblum • 612-673-7350 firstname.lastname@example.org