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6 years in, dental therapist experiment is working, experts say

 

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In 2008, the Minnesota Legislature authorized the licensing of mid-level dental care providers, known as dental therapists. The new career was supposed to expand access to dental care to more state residents, especially those with low incomes or who live in rural areas where dentists may be rare.Wochit

The mid-level providers perform routine, dentist-level work, adding access to dental care for low-income families

 

Eight years ago, the Minnesota Legislature authorized the licensing of mid-level dental care providers, known as dental therapists, to practice in Minnesota. The new career was supposed to expand access to dental care to more state residents, especially those with low incomes or who live in rural areas where dentists may be rare.

Comparable to a nurse practitioners, the first dental therapist graduates began seeing patients in 2011. Six years later, those benefits are materializing, according to Sharon Oswald, foundation and community affairs program manager with Delta Dental of Minnesota. A 2016 study by the University of Minnesota found dental therapists saw up to 90 percent of uninsured patients or patients on public assistance. 

But they're also showing benefits for all dental patients —  such as shorter waiting times for appointments — and proving to be an economic asset to dentists.

A 2014 study by the Minnesota Department of Health showed that almost one-third of all patients saw a reduction in wait times to get an appointment, especially in rural areas. Time with a provider increased by 10 minutes.

The practice is also saving money. While a dentist might make an average of $75 an hour for a filling, a dental therapist would make half that for the same work, said Sarah Wovcha, executive director of Children's Dental Service, a nonprofit clinic that treats low-income, uninsured and diverse kids and pregnant women

 

"We as a clinic are saving around $1,200 a week," Wovcha said. That's about $62,400 a year, or the cost of another full-time dental therapist.

Other states are looking to Minnesota to see how it's working and more research is underway, said Mark Schoenbaum, director of the Office of Rural Health and Primary Care at the Minnesota Department of Health.

Experts are starting to see the idea take hold in private clinics now, which is a good sign. Besides being a public good and expanding access, dentists have found dental therapists can be sustainable in their practice, and may even result in more profits. Officials hope it will lessen the impact of baby boomer retirements in the dental profession.

Still, the impact of dental therapists so far is small.

There are roughly 70 licensed dental therapists in Minnesota, according to the health department. As of 2008, the state had about 3,000 dentists, about 4,800 dental assistants and about 3,200 dental hygienists practicing in Minnesota. That means dental therapists are 1 percent of the dental workforce, McLain said.

Currently, only two programs in the state produce dental therapist graduates, about 20 a year. So it could take a while to see significant impact across the state.

Why does it work?

There's a parallel to nurse practitioners, which were created in the 1970s, with some controversy, Wovcha said.

"Now nurse practitioners are lauded as a huge health reform success, reducing the cost of care, and are able to spend more time with patients. They're an integral part of the health system, and highly respected, especially with the public," Wovcha said. She hopes the same will soon be said of dental therapists.

Dental therapists perform routine dental work, including fillings, while the dentist concentrates on more complicated cases. So far, they've shown to be just as efficient and competent as dentists

"They're able to complete procedures at least as efficiently, sometimes more," Wovcha said. Her clinic got involved with dental therapists out of necessity. It was the only way they could afford certain kinds of care.

Dental Therapist Kassie Scott works at the HealthPartners

Dental Therapist Kassie Scott works at the HealthPartners St. Cloud Dental Clinic Thursday, Feb. 16, in Sartell.  (Photo: Dave Schwarz,

)

 

At her clinic, staff has been able to increase care by about 10 percent per year. That means they served an additional 20,000 patients. In addition, they now have two dentists who only do hospital-based anesthesia care and two dentists who focus on root canals.

"Both of those things came to be after we had dental therapists. We finally had the capacity to get those dentists trained and focus on those higher-level procedures. We couldn't do it before," Wovcha said.

Wovcha's clinic has employed about 20 dental therapists over time, with no complaints. During the same time, they had four complaints against dentists and one against a hygienist.

"The research showed that when there's a limited scope for procedures, care is equivalent if not even a little better," Wovcha said, compared to a dentist.

A dentist needs  to know how to do about 550 procedures whereas a dental therapist needs to know 50.

"They happen to be the most common, especially in practices that treat children. They're doing those services repeatedly," Wovcha said. "They develop expertise in this limited scope of practice."

What problem are they trying to fix? 

Dental care access for low-income people is a nationwide problem, but the problem is amplified in Minnesota. The state has some of the lowest reimbursement rates for pediatric dental care services in the nation. As a result, dentists say they can't afford to treat any or many Medical Assistance patients.

"There's a a huge shortage of dentists able or willing to serve kids on MA or who are uninsured," Wovcha said. "In Minnesota, only 40 percent of kids on MA see dentists each year. That's how bad it has become."

Emergency rooms and mobile dental clinics were sometimes their only options. But both are expensive, said Joe Lally, executive director of Delta Dental of Minnesota Foundation.

If dental practices were to be reimbursed at the rate procedures actually cost, it would cost an additional $100 million , Wovcha said.

"There just isn't an appetite for that," Wovcha said.

The state is also just seeing more need.

"When I started 16 years ago, we served 4,000 kids and pregnant women. Now we serve around 35,000. The needs have been growing, " Wovcha said.

It may only get worse. The average age of dentists is somewhere in the 50s, meaning the state can expect a wave of retirements in the next 10-20 years.

"More dentists are retiring now than new dentists entering the workforce," Wovcha said.

It comes at a time when there's already a shortage of dentists, especially in rural areas. Nearly two-thirds of Minnesota counties have a shortage of dentists, for some or all of the county. That includes the western half of Stearns County.

One solution made it easier for foreign-trained dentists to practice in Minnesota, but it was ended as new providers tended to leave Minnesota. The functions of dental hygienists has been expanded, which does help.

"But because so many kids and families ... are not getting care, there's huge pent-up demand for restorative services in general," Wovcha, including fillings."We just dug ourselves into a hole so much in Minnesota that it's hard to get out."

All of this compounds the impact poor dental health can have on an individual's overall health.

Dental Therapist Kassie Scott works at the HealthPartners

Dental Therapist Kassie Scott works at the HealthPartners St. Cloud Dental Clinic Thursday, Feb. 16, in Sartell.  (Photo: Dave Schwarz,

)

 

"Dental disease is the most chronic childhood illness, more than asthma, diabetes and obesity," Wovcha said. Kids lose 51 million hours of school time due to dental disease.

"Left untreated, it leads to life-long problems," Wovcha said. That includes cardio-vascular disease, preterm labor and diabetes. The loss of teeth impacts nutrition or the ability to get a job. The problem is worse for kids of color.

"Even if you don't care about overall health or think poor people should take care of themselves, the reality is, we as taxpayers pay the cost of their care," Wovcha said, when they use emergency rooms.

Will there be more dental therapy programs? 

There are currently only two dental therapist training programs in the state: the School of Dentistry at the University of Minnesota and a partnership between Normandale Community College and Metropolitan State University, which is part of the Minnesota state college system.

That isn't keeping up with demand.

"I've had a posting for dental therapists open for six months," Wovcha said. "I'm thrilled on the one hand. ... I think we need hundreds more dental therapists."

​If schools follow demand, there will be.

"We do know MnSCU is looking at expanding to include some rural sites or greater Minnesota in the next year or two," Oswald said.

Legislators added dental therapists to the state's loan forgiveness programs to practice in rural areas. The state is getting more applications than it can fund.

The Delta Dental Foundation is investing in nonprofit clinics in the metro area and outstate Minnesota.

"When the clinics open, by January of 2019, we'll have added 100,000 annual patient visits in the state, mostly visits for public-program patients," Lally said.

Experts think many of these will be staffed by dental therapists. Many will be employed by dentists supported by similar loan forgiveness programs.

"It's a win for the community to have a dentist. It's a win for the retiring dentists who don't have anyone to sell their practice to so they retire and the dental clinic closes," Lally said. "It's a win for the individual. That's a good chunk of your student loans are paid, then you're relieved of that burden after five years. So you can buy a practice, expand, invest in your clinic."

Follow Stephanie Dickrell on Twitter @SctimesSteph, like her on Facebook at www.facebook.com/sctimessteph, call her at 255-8749 or find more stories at www.sctimes.com/sdickrell.

More on dental therapists

What can they do? 

 

  • Evaluate teeth and gums, including X-rays.
  • Education and prevention, including polishing, sealants and fluoride treatments.
  • Restorations, including temporary fillings, preparation for dentures and tooth reimplantation.
  • Extraction of teeth or pulp in some cases. 

Who are they?

 

  • About two-thirds are ages 34 and younger. 
  • Predominantly female and white, similar to dental hygienists and assistants professions.

Read more: https://t.co/7yobLDwHU8

Categories: Dental News