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How Dental Therapists Could Be the Key To Fixing Dental Care Gap

Anyone who has even casually been following along with politics over the last few months knows how much of a hot-button issue health care has become. But in all of the media coverage and pundit bickering, one important area remains largely undiscussed: dental care.

AAPD recommends that kids and teens see a pediatric dentist every six months to for regular checkups including an exam, cleaning, fluoride treatment, and occasional x-rays to prevent cavities and other problems. While a lack of access to dental care is prominent across the spectrum, the gap is especially acute among seniors and low-income rural and inner city communities.

Millennials of color are far less likely to have received dental care, according to Market Place. With  74% dentist-676421_640
adults believing an unattractive smile is a liability professionally, lack of access to dental care is yet another disadvantage faced by people of color in their professional lives. Additionally, 82.5% of people saw a noticeable difference after having their teeth whitened by a dentist.

Seniors are also particularly underprotected when it comes to dental care. Most seniors rely on a combination of Medicare and Medicaid to cover their medical expenses, neither of which cover dental care — although there are optional dental benefits in some states. Even for most Medigap plans, dental insurance is one of the six commonly omitted healthcare concerns (the others being hearing aids, eyeglasses, long-term care, vision, and private nursing.)

The average American retires at age 63. In 2016, the average life expectancy is 78.8 years. That means most seniors spend more than 15 years without dental care insurance.

One solution currently being explored is to create a new, intermediate dental care profession, the dental therapist.

A dental therapist is roughly the equivalent of a nurse practitioner. In order to become a dental therapist, dental hygienists are being trained on the basics of dental care, including pulling teeth and filling cavities. Because a dental hygienist requires only an associate’s degree and accreditation, they can provide these services at a lower cost.

Since the first dental therapist program began in Minnesota, it has been lauded as a success, bringing low-cost dental care to people with low income and the uninsured. Two other states, Maine and Vermont, have adopted the program and others have begun considering it.

Harriette Chandler, a state senator in Massachusetts who has sponsored a bill to create a license for therapists, said to the Christian Science Monitor, “We have hygienists who are active, well-trained, and well equipped to help these people. They can serve as caregivers for people who have no caregivers for oral health.”

But dental therapists won’t be able to help every community equally. While lower cost services mean that people from lower income backgrounds, particularly the inner city and rural areas, will have a better chance of receiving health care, seniors will still face difficulty. That is because more complicated procedures, like denture replacements, are beyond the dental therapists’ skill level.

“It’s clearly not an immediate fix in providing comprehensive care to seniors,” Massachusetts Senior Action Council’s executive director, Carolyn Villers, said. But she also notes that many will still benefit from the general care therapists provide.

So far, New York state has not taken any steps to adopt a similar practice. In fact, as recently as 2013 the state legislators have dismissed the idea that dental hygienists be considered on par with nurse practitioners.

But while it is not clear how the New York legislature plans to address the disparity in dental care, the need is painfully apparent.

As Kristen Mizzi Angelone, a dental policy expert with Pew Charitable Trusts, says, “No matter what Congress does [on health-care] it’s clear that every state around the country is in a budget constraint, and there are millions of people who aren’t getting dental care.”