Dental care is best left to dentists, not dental therapists

Dental therapists would increase risks for our most vulnerable

The Washington State Dental Association agrees with a recent Seattle Times editorial [“Expand coverage with dental therapists and Medicaid reimbursements,” Opinion, Jan. 8] that calls for increased funding for dental Medicaid and that stated many eligible for Medicaid have difficulty accessing dental care.

However, the editorial’s proposed use of dental therapists in this state does not recognise fundamental problems associated with the delivery of dental care to low-income individuals and overlooks the most promising solution in increasing dental access: expansion of dental residencies.

A proposal before Washington’s Legislature would have Medicaid pay the same amount for dental procedures regardless of whether a dental therapist or a dentist provides the care. With costs being the same and no shortage of dentists in this state, the creation of a lesser-trained provider – dental therapists – wouldn’t save money, but does pose increased risks to vulnerable patients.

The proposed legislation would have dental therapists performing surgical, irreversible procedures, such as extracting teeth and performing root canals on children. The dental therapists’ training would consist of only two years beyond high school or obtaining a GED.

Dentists in Washington have long supported increasing the scope of practice of dental hygienists and assistants to perform preventive care, patient navigation and assist with restorative dentistry. We cannot, however, support delegating surgical, irreversible procedures – especially for those who need medically complex care.

Extracting teeth and procedures that use high-speed drills in an individual’s mouth regularly become more complicated than initially assessed. These procedures vary widely in complexity and can pose serious risks like permanent nerve damage and can be life threatening if not done properly. We feel strongly that low-income patients should not be treated to a lower standard of care by providers with less training.

Washington’s success in providing dental care for children shows that increased funding translates directly to increased utilisation. Medicaid pays twice as much for dental services for Washington’s children as it pays for adults. As a result, our children access dental care at one of the highest rates in the country.

The Seattle Times editorial calls for increased Medicaid reimbursement for adults who are pregnant or have diabetes, citing them as high-risk populations. We believe Medicaid reimbursement should be raised for all adults, including those who have cancer, developmental disabilities, live in nursing homes or have end-stage organ disease. All highly vulnerable, low-income adults should have access to dental care.

Dental residencies are our best option for strengthening the dental safety net. Dental residents are doctors who have completed eight years of training after high school. These positions are funded by federal dollars and are housed in hospitals and community health centres. Residents are dentists and are proven to help keep patients out of the ER. Each dental resident provides, on average, $500,000 in care to underserved patient populations.

Aggressive expansion of residency programmes has more than tripled the positions in our state over the last ten years. We are working to double the number of residency positions again to serve parts of the state where they do not currently practice.

Dentists take our oath to do no harm and provide quality dental care very seriously. We must use scarce resources to address the worst problems and support long-time efforts that are showing promise.

We believe residencies and increased Medicaid funding are the best solutions for Washington. Dental therapists increase risks for our most vulnerable. – Dr. Bryan Edgar, The Times

<Photo caption: Dr. Craig Smith drills fillings at Comfort Dental in Tacoma in August. (Ken Lambert/The Seattle Times)>