Should 'dental therapists' be allowed to drill and extract?

Minnesota is poised to become only the second state in the country to allow someone other than a dentist to fill cavities and pull teeth.

The proposal, which cleared a state Senate committee on Wednesday, would create the dental equivalent of nurse practitioners to provide care in parts of the state where dentists are in short supply.

But one big question has yet to be settled: Just how independent should they be?

The Minnesota Dental Association insists that dentists must be on the premises to supervise the new clinicians, known as "oral health practitioners" or dental therapists. But a group called the Minnesota Safety Net Coalition says the new clinicians should be free to work in other settings in order to reach thousands of low-income children and adults who now get no dental care at all.

Last year, the Legislature gave its initial blessing to the idea of a new type of dental practitioner, and asked members of both sides to join in a "work group" to hammer out their differences. But on Wednesday, there was little sign that the debate has eased.

Dr. Scott Lingle, past president of the Dental Association, warned that even a simple tooth extraction can lead to serious complications, and that dental therapists won't be able to handle them without a dentist present. "Essentially, you're playing doctor without going to doctor school," he said.

Another dentist, Dr. Chris Carroll, said in written testimony that the idea "resembles, too much, what is now being done in the lesser developed parts of the world," adding that "it would be reproducing a level of patient care that America evolved away from years ago."

But Dr. Ron Nagel, a dentist from Alaska, said there's plenty of evidence that dental therapists operate safely on their own, with supervising dentists off-site. Nagel, who was invited to testify by the Safety Net Coalition, said he's worked with dental therapists in remote parts of Alaska for four years and has done "quite a bit of research" in other countries, such as Canada, where they've been used for decades.

"There is no evidence to support claims that the services provided by dental therapists are unsafe or of poor quality," Nagel said. "Virtually all of the existing literature suggests just the opposite."

The coalition's proposal is supported by the Minnesota Hospital Association, the Minnesota Council of Health Plans, and the Pew Center on the States, among other groups.

On Wednesday, both sides could claim victory. The Senate Committee on Health, Housing and Family Security agreed to create two versions of dental therapists, with different training requirements: one would require more oversight, the other could operate more independently. In both cases, they would be limited to working with low-income and "underserved" populations.

Related legislation is pending in the House.

Maura Lerner • 612-673-7384