Editorial: There's a need for dental practitioners

Mid-level providers could help meet dental care needs.

Last update: April 8, 2008 - 7:26 PM

Recent wheeling and dealing over bonding and budgets unfortunately sidelined a pioneering health care proposal -- creating the dental equivalent of a nurse-practitioner -- to help address Minnesota's widespread gaps in dental care access.

The legislation is on track to get an airing at the Capitol this week. With much of outstate Minnesota and wide swaths of Minneapolis and St. Paul federally designated as "Dental Health Professional Shortage Areas,'' legislators should give the concept of mid-level dental providers their full consideration and find ways to end turf battles plaguing the issue.

So what exactly is a mid-level dental practitioner? Training requirements vary around the world, but a dental hygienist who has completed a master's level of specialized training would qualify. In more than 40 countries, these providers fill cavities, pull teeth in limited situations and administer medication. They do so with relative independence, consulting with dentists usually not on site.

The initiative calls for allowing 30 of these new professionals to practice in underserved areas or at low-income clinics. Both have difficulty recruiting dentists and have waiting lists that can stretch for months. The Minnesota Dental Association strongly opposes this initiative, saying it jeopardizes patient safety. It's concerned that new practitioners would have half of dentists' postgraduate education and that irreversible procedures would be done without adequate supervision.

The Minnesota proposal would make the state the first to allow mid-level practitioners to independently fill cavities and pull teeth, though similar providers have practiced this way on Alaskan Indian reservations. The 30 would begin practicing in 2011 and 2012. A licensed dentist -- though not necessarily on site -- would supervise, with program oversight by the Minnesota Department of Health.

Mid-level dental providers, who earn about a third of dentists' salaries, have a long track record internationally of providing high-quality care. Their work in Alaska drew high marks in a 2005 University of Washington report. In Minnesota, the 2008 Legislative Commission on Health Care Access endorsed these providers. Another supporter is Hennepin County Medical Center, which provides dental care to about 20,000 low-income or uninsured people.

The proposal before legislators needs adjustment; namely, more detail on how the providers would be supervised, how the program would be evaluated and what happens if it's not successful. The University of Minnesota School of Dentistry should also be a full training partner.

The nation already relies on nurse practitioners, physician's assistants and midwives to provide cost-efficient care. Minnesota legislators should find a way to extend this model to patients sitting in a dental chair.

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