January 25, 2013 Print

It's Legislative Day for the Washington State Dental Association!

Today is the Washington State Dental Association’s Legislative Day here in Olympia. In the past couple of months, I’ve written that it would be a good idea to allow mid-level dental care providers to work in this state because the current licensing scheme for dentists makes dental services both more scarce and more expensive than they really need to be.  Paradoxically, the existing law, presumably intended to improve the public’s dental health, has resulted in vast swaths of the state having inadequate access to affordable dental care.  And yet, when someone suggests that Washington might benefit from adopting a tested, proven system for improving the availability and affordability of dental care by increasing the number of trained dental professionals, those who benefit from the current lack of competition go into a full-court press to prevent any change that would allow consumers more flexibility.

Let me be absolutely clear… I am in no way an anti-dentite!  But because I know that there will be dozens (and perhaps hundreds) of dentists roaming the halls of the state capitol today, trying to discourage legislators from making any changes that would introduce more competition into their field of work, I wanted to take the opportunity to highlight – and shoot down – some of the common objections that are commonly raised against the idea of allowing mid-level dental therapists to serve the people of Washington.

Dental Therapists Are Untested and Unproven.

Not so! Dental therapists currently practice in more than 50 countries and mid-level providers have been helping meet people’s dental needs for almost one hundred years. Alaska started allowing dental therapists to practice in 2005 and Minnesota followed suit in 2009.

Dental Therapists are Untrained and Unprofessional.

Absolutely not.  In the places where dental therapists have been authorized to provide services, the government still requires a certain level of training before they may enter the market – and this training usually takes place at accredited dental schools.  Their training is not as extensive as a fully licensed dentist, so they may not be prepared to take on complex dental problems, but their education does allow dental therapists to provide safe, relatively low-cost services to people with minor dental issues.  They are easily distinguishable from just any Average Joe on the street corner holding a cardboard sign that says “Will pull teeth 4 food,” and many dental therapists actually work under the direct oversight of a dentist.

There’s No Such Thing as a “Minor” Dental Problem.

There are varying degrees of dental problems.  Some of these, of course, are both serious and unavoidable, due to genetics or trauma.  But a great many dental issues result purely from poor dental hygiene and neglect; lots of severe dental problems could be avoided altogether if someone had just identified and/or addressed them sooner.  So when it comes to addressing dental problems, there is a spectrum of difficulty involved.  As far as preventative care and hygiene are concerned, laypersons can do a lot for themselves – don’t forget to brush and floss, kids!  Other issues may require the help of someone with a little more training and/or experience.  Still others need real expert attention, the sort that only fully-trained dentists can provide.  Introducing dental therapists as an option should increase the ordinary citizen’s access to someone who can help them with relatively minor issues while also sending along to licensed dentists those patients whose problems exceed the dental therapists’ abilities.

Washingtonians Should Not Settle For Anything Less Than the Most Skilled Dental Care Providers.

For some people the inability to get dental assistance is geographical, for some it is financial, and for some it may an irrational, pathological fear of dentists.  Allowing dental therapists to serve the public can help with at least two of these factors, and it might even help with the third. No one would be required to see a dental therapist if they would prefer to see a regular dentist, but it would give those who can’t get to, can’t afford, or can’t stand regular dentists the chance to choose a more accessible, less expensive, and possibly less scary alternative.

Allowing Dental Therapists will Harm Washingtonians’ Dental Health.

The impact of dental therapists on public dental health has been thoroughly studied and the research is revealing that where they are practicing the public has a positive impression of their work, and there is no evidence of any reduction in the quality of dental services being provided in those communities. Introducing dental therapists in Washington is extremely unlikely to reduce public dental health, and in all likelihood will significantly improve dental health, especially for poor people and people living in areas with limited access to regular dentists.  This is a policy worthy of careful consideration.


David Roland

Director of the Theodore L. Stiles Center for Liberty

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