Facing rural dentist shortages and an abundance of low-income residents unable to pay for dental care, more states are establishing laws that allow hygienists to provide services traditionally restricted to dentists, giving strength to the concept of a new mid-level dental care professional.
Following the medical industry’s shift towards using physician assistants and nurse practitioners to attend to minor ailments, these dental hygienists, being dubbed as dental therapists, undergo additional training to learn how to perform routine dental procedures.
The practice aims to address insufficient resources in areas designated as health professional shortage areas by the US Department of Health and Human Services — many of which are rural communities — and to meet the needs of low-income and uninsured patients who can’t afford to visit the dentist.
Medicaid patients often struggle to find a dentist who will accept them due to low reimbursement rates, and dental ER visits are a growing concern. Dentists graduating with high debt loads tend to establish practices in well-populated areas where patients can pay for services.
In California, recent legislation allows dental hygienists to treat cavities with low-cost temporary fillings that require no drilling and stop the decay progression until the patient can see a dentist. Hygienists are supervised by a dentist via remote technologies (known as virtual dentistry or teledentistry). The program is aimed at serving preschools, elementary schools, senior centers, and other locations lacking affordable access to dental care.
The practice is carried out in a handful of other states and will likely spread under the Commission on Dental Accreditation’s recently established education standards for dental therapists. Alaska has used dental therapists since 2003, and Minnesota has allowed degreed dental therapists to fill cavities, extract teeth, and place crowns and spacers since 2009. Maine began licensing dental therapists last year, and a dozen more states are exploring options.
However, some dentists are firmly against the idea of adding a new tier of dental professionals. A proposal in Massachusetts to expand hygienist duties is under fire from area dentists who support other means of improving access to care. The American Dental Association maintains that dentist-supervised employees shouldn’t perform surgical or irreversible procedures.
Meanwhile, demand for dental professionals is taking off. Dental hygienists are expected to be among the fastest-growing career fields over the next decade, with growth of more than 30%.
Dentists are also expected to increase at a faster-than-average pace (16% over the next decade) as the patient demographic ages. However, a large number of dentists are reaching their retirement age and the number of dental graduates may not be sufficient to fill the gap. The shrinking number of private-practice dentists is adding to existing shortages in rural areas.
The adoption of mid-level dental professionals is increasingly recognized as a means of filling the gap in dental care, but the practice is likely to remain controversial in states where dentists voice strong objections.
Anne Law has been a member of the D&B editorial department for more than a decade, providing content for the Hoover’s and First Research products. She currently covers the health care and insurance industries for First Research. For industry news, follow Anne on Twitter.