America's Dental

Crisis Is Happening.
Here Is the Solution.

By Jennifer Minjarez
August 24, 2017

AfterWorldWarII,Americafacedasevereshortageofprimarycare.Doctorsstruggledtomeetthe
risingdemandbroughtonbythebabyboom,whilethecostofcarebecameincreasingly
unaffordable.In1965,thefirstnursepractitionertrainingprogramlaunchedattheUniversityof
Colorado.Theresult:amidlevelpractitionerandincreasedaccesstocarefortheaverage
Americanfamily.

Today,historyrepeatsitselfintheformofanationaldentalcrisis.Thereare5,493dentalhealth
professionalshortageareas(HPSAs)nationwide,inwhichtherearemorethan5000patientsper
dentist.Whilelawmakersanddentalprofessionalsexplorewaystoexpandaccesstocare,some
statesarelookingtothepastforsolutions.

Minnesota,Maine,andVermontarelicensingmidleveldentalpractitioners,calleddentaltherapists,
toaddresstheircareshortages.Dentaltherapistsarethenursepractitionersofdentistry.Their
trainingqualifiesthemtoperformupto80procedures,includingroutine,preventative,and
restorativedentalcare.Tocompare,dentalhygienistsandassistantstypicallyperform3040
procedures,whiledentistscanperformupto600.Dentaltherapiststreatsomeofthemostcommon
dentalissues,suchascavityfillingsandsimpleextractions.

ArecentstudyfromtheUniversityofWashingtonshowsthatdentaltherapistssignificantlyimproved
oralhealthoutcomesinAlaskaNativecommunities.Forsomepopulations,theproportionof
childrenwhoreceivedpreventivecareincreasedfivefold.

Unfortunately,incumbentdentistscaremoreaboutprotectingthemselvesfromcompetitionthan
promotingoralhealth.Dentaltherapistsfacethesameoppositionfromorganizedmedicinethat
promotingoralhealth.Dentaltherapistsfacethesameoppositionfromorganizedmedicinethat
nursepractitionersfacedinthe60s.

Thefirstgenerationofnursepractitionerswasstronglyopposedbymedicalandnursing
organizations.TheAmericanMedicalAssociationandtheNationalLeagueofNursessoughtto
discreditnursepractitioners,claimingtheyweresimplyplayingdoctor,andthatpatientswerenot
safeintheirhands.

Today,thereareapproximately234,000nursepractitionerslicensedintheU.S.Alargebodyof
literaturedemonstratesthehighqualityofcaretheyprovide.Theyhavebecomeessentialtothe
medicalteamworkingwithdoctors,notagainstthem.

Likenursepractitionersinthe1960s,dentaltherapistsfacestrongoppositionfromnationaland
statedentalassociations.In2011,theAmericanAssociationofPublicHealthDentistrydevelopeda
curriculumfortrainingdentaltherapists.Shortlyafter,theAmericanDentalAssociation(ADA)the
nationslargestassociationforpracticingdentistsexpressedanunequivocaloppositiontonon
dentistsperformingsurgical/irreversibleprocedures.TheADAsmainconcernwithdentaltherapists
wasnotthequalityofcaretheyprovide,butthefactthattheywerenondentists.

The84thTexasLegislatureconsideredabillestablishinglicensurerequirementsfordentalhygiene
therapists,anothernamefordentaltherapists.TheTexasDentalAssociationtestifiedagainstthe
bill,backedbythefullforceoftheADA.Thebillfailed,despitehavingbipartisansupportfrom
organizationssuchastheTexasHospitalAssociation,AARP,andtheCenterforPublicPolicy
Priorities.Aboutadozenstateshaveconsidereddentaltherapylegislation,andthesamesadstory
hasplayedoutinmost.

AsurveyconductedbytheTexasDentalHygienistsAssociationshowsthat87percentof
hygienistssupportanewworkforcemodel(withmoreservices,collaborativeagreementswith
dentists,nontraditionalsettingsandadditionaleducationandlicensure).Allofthesebenefitsare
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integralpartsofthedentaltherapymodel.

Muchlikenursesinthe1960s,dentalhygienistswantopportunitiestobroadentheirscopeof
practiceandtreatunderservedpatients.Theywanttobedentaltherapists.

Todrawanotherparallel,thedevelopmentofnursepractitionerswasanimportanteconomicvictory
forwomen.Inthemid20thCentury,nearlyalldoctorsweremen,andnearlyallnurseswere
women.Nursepractitionerprogramsofferedwomenmoreeducation,moreresponsibility,and
higherpay.Today,98percentofdentalhygienistsarewomenandabout70percentofdentistsare
men.Dentaltherapyisahigherpayingjobopportunityformanyfemalehygienists.Itisalsolikelyto
attractnew,diversegroupsofpeopletothefieldofdentistry.

TheDepartmentofHealthandHumanServicesprojectsanationalsurplusofdentalhygienistsby
2025.However,hygienistscannotmeetpatientsunmetdemandfordentalcarealone.Solongas
dentistshaveamonopolyonmostdentalprocedures,hygienistscandonothingtohelpthosewho
needrestorativeorpreventativecare.Tomakemattersworse,the2025projectionsincludea
needrestorativeorpreventativecare.Tomakemattersworse,the2025projectionsincludea
nationalshortageof15,600dentists.

Addingdentaltherapiststotheteamwouldfreeupdentiststimeandallowthemtooperateatthe
heightoftheirtraining,toperformthoseproceduresonlyafullytraineddentistcando.Itwouldalso
granthygienistsmorecareeropportunities,allowingthemtoescapeanoversaturatedjobmarket.
Mostimportantly,allowingdentaltherapiststopracticewillimproveaccesstooralcare.

Innovationisaneffectivewaytocombatshortage.Deliverysystemscanbeinnovatedjustlike
goodsandservices.Thecreationofnursepractitionerswasaclever,effectivemarketsolutiontoa
shortageofprimarymedicalcare.Statelawmakerswouldbewisetoapplythesamesolutiontothe
lackofdentalcare.

JenniferMinjarezisapolicyanalystintheCenterforHealthCarePolicyattheTexasPublicPolicy
Foundation.Shecanbereachedatjminjarez@texaspolicy.com.

Theviewsabovebelongsolelytotheauthor.

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