Frontline has done extensive reporting on the problems of dental care in America. In particular, they cite the lack of quality that both children and adults receive at various corporate dental firms (e.g., KoolSmiles, Aspen Dental).
The problem should not be placed solely on these corporate firms, however. Reimbursement rates for dentists are low to turn a profit these corporations have had to increase the number of patients they serve per dentist per day as well as the amount of lucrative services (e.g., fillings, crowns) provided to each patient. Corporate Dentistry does provide some benefits to low-income individuals.
Right now, most patients have a choice between low quality of care at corporate dental offices or high quality (but expensive) care at independent dental offices. For low-income Medicaid beneficiaries, the latter is not a viable option so low quality care is their only option.
Or is it?
Dental Therapists to the Rescue?
One viable alternative is dental therapists. The relationship between dental therapists and dentists is similar to the relationship between physicians assistants (or nurse practitioners) and primary care physicians. Dental therapists do not have the skills or training of fully-trained dentists. However, because dental therapists earn lower wages, patients can afford more time with a dental therapist than they would be able to afford with a dentist. Further, division of labor would permit dentists to focus on the most challenging cases.
But some states are weighing a way to broaden care without adding dentists, by training a new class of dental-care providers called “dental therapists.” They don’t have as many skills as dentists, but can perform basic procedures.
A recent study by the W.K.Kellogg Foundation found that dental therapists’ treatment is “technically competent, safe and effective,” particularly for children. Alaska and Minnesota both allow dental therapists to practice in underserved areas.
At least eight states have either had legislative discussions or considered bills to introduce dental therapists, including California and New Mexico. Ohio, Maine and North Carolina have grassroots lobbying campaigns. But as we report in our film, lobbying by dental associations so far has blocked any other state from establishing a dental therapist program.
This looks like a win-win solution. Lower cost, increased access to care, but still permitting individuals to access dentists if they have the funds. One group, however, does lose: dentists. And dentists are not going to let their market share erode without a fight.
Critics, including the American Dental Association, say dental therapists don’t have the skills that dentists do. “That model is not an answer,” Calnon told FRONTLINE. He added, “They go through training, but to compare that training to the training of a dentist, in my eyes, you just cannot do that.”
The Wall Street Journal also notes that “dentists boasted the largest single health-care political-action committee.” Without fail, the dental PAC will be lobbying heavily to protect dentists’ turf.
Hopefully, the free market and improving access to care for poor patients wins out over the vested interests of established dentists.
Nonphysician Clinicians
To see my other posts discussing licensing in medicine and nonphysician clinicians, visit this link.