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February 23, 2015 - Kim Moore [see other posts]

Dental Operatory

Better Dental Care:
Dental Assistants-Hygienists-Dental Practitioners-Dentists

In remote tribal regions of Alaska, a "demonstration project" is showing how to improve oral health delivery. Started because of the impossibility of securing permanent, consistent dental care for residents of scattered, small villages, a new member of the dental team was developed: the Dental Health Aide Therapist (DHAT). Overcoming strenuous objections and legal fights instituted by the American Dental Association and its on-the-ground affiliate, the Alaska Dental Association, a wedge of care and service now reaches residents traditionally afflicted by bad oral health and infrequent, long-distant service. You can learn more about this specific development by viewing www.youtube.com/watch?v=HJSpUQd000k. Fifty-two other counties also have a form of the dental therapist.

In Kansas, for five years the Kansas Dental Project has been working to secure the needed state legislation to authorize a similar new dental team member. States including Kansas use a labyrinth of professional practice laws to decide through licensing who can and who can't perform certain tasks: barbering, lawyering, medicine, dentistry, etc. These laws in Kansas recognize three people who can perform dental activities in the mouths of its citizens: dental assistants, hygienists, and dentists [medical providers can do things in the mouth which are not the practice of "dentistry"]. The result of the Kansas practice law is that you don't have any "dental treatment" legally occurring in the mouth of a Kansan unless one of approximately 1,500 licensed practicing dentists is doing it.

In our eleven years of oral health work at the United Methodist Health Ministry Fund, I learned how that last sentence can be a very limiting factor in the process of improving oral health. An analysis we funded in 1999 determined that 35 of the then 1,150 dentists in Kansas served 50% of all Kansas Medicaid beneficiaries. This astounded me, but I quickly learned that the pattern held across the country. A very small segment of licensed dentists do the vast majority of all Medicaid dental work in virtually every state. This naturally creates geographical gaps and waiting times for many Medicaid beneficiaries. Later, I learned that dental services for persons with disabilities were also difficult to access. The Kansas Dental Association runs a valuable disability services project (Donated Dental Services); while the Health Ministry Fund was providing some of the core operating support for the project, I watched the project's map of Kansas showing counties where no services were available, counties where the services were full and a waiting period established, and counties where the waiting period was so long that they quit taking patients for the waiting list. There are 13 counties, generally low population, where there is no dentist at all. Several times, the Health Ministry Fund and other private and public funders paid for expensive dental operatories inside safety-net clinics and - for months at a time - no services could be performed because the clinics could not hire a dentist.

The idea of a new dental team member in Kansas is based on simple logic:

  • There are a number of dentists who now serve Medicaid patients and persons with handicapping conditions in significant numbers,
  • There are a number of safety-net clinics willing and able to serve low-income patients, and
  • There are some rural dentists who would like to extend their practices into neighboring unserved areas if they could staff the extensions.

We can give them a qualified team member - called the dental practitioner in Kansas legislation - who will permit the extension of the services of those dentists already reaching these populations, thereby improving access.

The dental practitioner is very similar to the physician's assistant in the medical field. Working under direct or indirect supervision of dentists (never independently), the dental practitioner will have a specified range of practice which includes those activities permitted for dental assistants, hygienists and a few of the more frequent and less complicated dental procedures performed by dentists. In Kansas, this practitioner will first be a hygienist, then have at least 18 more months of dental education and finally will perform at least 500 hours of service under a supervising dentist in order to be permitted to perform any of the services now performed by a dentist. The practitioner's supervising dentists will determine which of the permitted dental treatment services the individual practitioner can actually perform. The supervising dentist will be a referral source for work which the dental practitioner identifies but which is beyond the practitioner's scope of practice.

This legislative session, the concept of a new dental team member is contained in House Bill 2079 and Senate Bill 49. I testified in favor of Senate Bill 49 this week. My testimony may be accessed at www.healthfund.org/kansasdental. You can also read much more about the details of this work at the website of the Kansas Dental Project: www.kansasdental.com. More importantly, you can contact your legislators and ask them to support expanded dental care access in Kansas by creating a new dental team member to better serve Kansans.