A new midlevel dental provider position could be established in Michigan.
The Michigan House of Representatives is slated to vote Oct. 3 on whether to allow the practice of dental therapy in the state, a bill introduced last year by Sen. Mike Shirkey, R-Clarklake.
Dental therapists would be able to provide assessments, simple cavity preparation, restoration and simple extraction. This is greater than the abilities of hygienists, who cannot perform irreversible procedures.
Proponents say the new position would benefit those who have trouble accessing dental care due to poverty, transportation issues or lack of dentists.
Amy Zaagman, executive director of Michigan Council for Maternal and Child Health, has led the in-state push for dental therapy, seeking Shirkey to sponsor the bill.
She said the organization has formed a coalition that sees lack of dental health as an impediment to overall health; the coalition includes The Arc Michigan, Michigan Coalition Against Homelessness, Michigan Community Action and Michigan Disability Rights Coalition.
According to Zaagman, the bill also has support of the Michigan Dental Hygienists’ Association and Michigan Primary Care Association, which represents federally qualified health centers, such as Grand Rapids-based Cherry Health.
Tasha Blackmon, CEO of Cherry Health, said dental therapists would be easier to recruit and would allow the organization to see more patients.
Zaagman said a lot of the effort is to cost effectively expand the reach of dentist offices that accept public insurance. Dental therapists would allow expanded services for less pay than adding additional dentists.
The bill allows dental therapists to work in private practices and safety net settings, such as FQHCs, school-based health centers, and tribal and rural health centers.
If the private practice is in an area with no dental care shortage — such as Kent County — it would be required that 50 percent of the therapist's patients receive public insurance or have no insurance.
Zaagman said her organization approached the issue from the interest of children and pregnant mothers.
The MCMCH said half of pregnant women do not receive preventive dental care, making them more likely to deliver prematurely, and it has been found that dental issues can lead to other health problems.
Through research, the organization discovered access to dental care is troublesome for people of all ages throughout the state and thought including dental therapists could contribute to a solution. Several states and tribes have implemented dental therapy, including Minnesota, which adopted the providers in 2009.
A state of Michigan report said in 2015, 25 percent of third-grade students had untreated dental disease and 11.4 percent had immediate dental care needs, with those in poverty more likely to be affected.
Zaagman said many people in poverty react to rather than prevent dental emergencies, forcing them to unnecessarily visit emergency rooms.
“They can walk into an emergency room and generally be treated, so folks try that when they have oral health crises, but there’s no dentist in the emergency room,” Zaagman said.
So, the patients receive temporary relief until meeting with a dental professional.
“It costs taxpayers money (and) doesn’t even get the person’s underlying issues,” Blackmon said.
While the state has about 8,000 dentists, many of them are concentrated in urban areas, leaving many rural areas underserved. Zaagman said 77 of 83 counties don’t have even one dentist for every 5,000 people.
“It doesn’t help someone in the U.P. that we have more than enough dentists in Oakland County,” Zaagman said.
She said it also can be difficult for patients in some areas to find providers who will accept publicly funded dental insurance, and this could lead to further issues.
The MCMCH said preventable dental care that led to operating room visits for children cost $7.9 million in 2011.
Opponents say there are better solutions than adding dental therapists that would not take years to develop, such as incentivizing dentists to work in rural areas or expanding the dental assistant role.
Debra Peters, Michigan Dental Association president and a practicing Grand Rapids dentist, said the organization believes including dental therapists that see publicly insured patients would not be a sustainable model, especially with a low Medicaid reimbursement rate, and establishing a program would cost money.
“I question where this money would come from in Michigan,” Peters said.
Both sides of the argument believe an increase in reimbursement rates and education is needed.
“We have a significant access problem, and it will probably take more than one solution to put a dent in it. Dental therapists aren’t going to solve the problem tomorrow, but they certainly aren’t going to hurt,” Zaagman said.
Peters also said the MDA believes Minnesota’s dental therapy efforts have not shown significant increases to access.
“It’s not a proven model,” Peters said.
Minnesota Department of Health has cataloged 35 reports, peer-reviewed journal articles and studies documenting the growth and impact of dental therapists on oral health access in the state, including reduced wait times and travel distances for underserved patients.
The state showed the providers are geographically distributed based on population, with 49 percent working for dental clinics and 47 percent working for community-based organizations.
Midwest Dental reported an estimated average monthly increase in revenues of $10,042 for offices that hired the providers.
Zaagman noted John Powers as a successful example of a Minnesota dentist who implemented dental therapists into his practice, increasing revenue from $600,000 to $1.9 million in five years.
Peters also added concern that a dental therapist would not have enough education to perform irreversible procedures, such as tooth extractions.
The bill indicates dental therapists, before receiving licensure, would need to complete an accredited dental therapy education program, an exam and 500 hours of supervision with a dentist.
While practicing licensed dental therapists would be required to be supervised by dentists, according to the bill, Peters is concerned the language does not state “direct supervision,” meaning the practicing licensed therapist would not need to be constantly watched when completing irreversible procedures.
Even if legislation is passed, there will not be a mandate to hire dental therapists, but Zaagman said she believes the new providers would be helpful to a needy portion of the population.
“We want to make sure that if someone is trying to seek care, they can find it,” she said.
“If privately practicing dentists don’t want a dental therapist, then they shouldn’t hire one, but they shouldn’t stand in the way of a clinic like Cherry Health having the ability to hire a dental therapist and increase access to care.”