Opinion: Dental therapists could help provide vital health care for rural Oregonians

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Miranda Davis

Davis, D.D.S., M.P.H., has been a tribal clinic dentist for 14 years and supervises dental therapists in Oregon. She is also director of the Native Dental Therapy Initiative for the Northwest Portland Area Indian Health Board.

As a dentist who works for tribes in Oregon and Washington, I understand first-hand the importance of access to high-quality dental care in communities that are most in need. Unfortunately, for far too many Oregon kids and families, that care is out of reach.

More than one million Oregonians live in areas with a shortage of dentists, based on state data. All but four counties in Oregon are considered to have a shortage of dentists. And 26 primary care service areas in rural Oregon — areas sometimes covering hundreds of square miles — have no full-time dentist at all, according to a 2019 report from the Oregon Office of Rural Health. Low-income families are hurt the most. Only 44 percent of Oregon kids and 27 percent of adults covered by Medicaid saw a dentist in all of 2016.

It doesn’t have to be this way. Right now, a diverse group of health and dental care organizations, educators, consumers and tribes are supporting a bill in the 2020 Oregon Legislature that would help bring high-quality care to where it is needed most.

Senate Bill 1549 would allow the state to license dental therapists — mid-level dental providers akin to physician assistants in medicine. Many states allow dental therapists, and Oregon already has dental therapists successfully working in some tribal communities as a part of a state-authorized pilot project.

Dental therapists do the basics of dental care: exams, fillings, and simple extractions – always under the supervision of a dentist. After creating a detailed practice agreement with their supervising dentist, a dental therapist can also provide care outside the dentist’s clinic while being supervised by a dentist from a distance. That means dental therapists could serve communities and areas that don’t have a dentist’s office. And that means more Oregonians could get the dental care they need and deserve.

Under similar guidelines, dental therapists have practiced safely and effectively in Alaska for 15 years, Minnesota for 10 years, and Washington state for four years. Twelve states have now authorized dental therapists in some or all settings. New Zealand has been using this model of dental care delivery for over a century, and more than 50 other countries have since followed suit.

Some opponents of the legislation have recently mischaracterized many aspects of the bill, devaluing the level of training dental therapists are required to receive, and insinuating that therapists would provide a lesser quality of care. In fact, SB 1549 is a carefully written bill that includes education, licensure and oversight requirements for dental therapists, just as the state mandates such requirements of all other health care providers.

It is important to understand that dental therapists are held to the same high standards that dentists are for every service they provide. All dental therapy training programs grant a college degree and all require hundreds of hours of clinical training. Dental therapists provide first-rate, high-quality care that would benefit any community, but especially helps those communities that need this care the most. They expertly provide the most commonly needed basic services, addressing the biggest root cause of dental problems in many communities: lack of access to care.

Researchers who have studied dental therapy have found that it works. A 2014 evaluation by the Minnesota Department of Health and the Minnesota Board of Dentistry determined that dental therapists improved access for underserved patients, resulting in reduced wait times and travel distances for dental care. A 2017 University of Washington study found that dental therapists in Alaska not only increased access; they also improved oral health outcomes. More people of all ages received preventive care, more adults were able to keep their teeth, and fewer kids needed their front teeth pulled.

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And there’s an economic boost to communities as well. Many dental therapists get their education and training and then return to work in their communities, often in rural areas. They work in well-paying jobs while serving the communities they call home.

Our state has been evaluating the effectiveness of dental therapy in tribal settings through a pilot project sponsored by the Northwest Portland Area Indian Health Board for the past four years. Another pilot, sponsored by Willamette Dental Group and Pacific University, has just been approved to do another five-year evaluation. But these pilots are incredibly resource-intensive — for the sponsors and the state. More of these resources should be going into actually delivering basic oral health care throughout Oregon.

It’s time to move our resources from evaluating what is already an evidence-based solution to bringing dental care to the alarming number of Oregonians who are suffering without. Dental therapy is a common sense solution that will keep children and adults healthier across the entire state.

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