Midlevel Providers Are Critical to Improving Oral Health | Commentary
Members of the American Dental Association will be fanning out across Capitol Hill this week in an effort to educate and influence lawmakers regarding what they think will improve access to dental care.
The ADA is right to call attention to the dental crisis in America and to push for greater education and reimbursement rates. The W.K. Kellogg Foundation, which has a long history of supporting efforts to improve oral health, shares its alarm that the lack of access to dental care in the United States has reached crisis proportions, especially among our children. We agree that the cost of that crisis — to individuals, families businesses and taxpayers — is enormous. Nearly 1 in 6 Americans lack appropriate access. Some can’t afford it, while others don’t have a dental provider in or near their communities. As a result, millions of Americans suffer in pain and miss school or work. Many make unnecessary trips to hospital emergency rooms when the pain becomes unbearable. In 2009 alone, more than 830,000 ER visits were attributed to preventable dental problems.
A major reason for the crisis is the fact that the current dental delivery system doesn’t meet the needs of fully a third of all Americans, with low-income children, people of color and people living in rural areas affected disproportionately. There simply are not enough dentists to meet even the current demand — the federal Health Resources and Services Administration estimates an additional 6,000 dentists would be needed to meet current need. The crisis will become even worse when as many as 5.3 million more children could become newly eligible for dental benefits under provisions of the Affordable Care Act next year.
Where we and many other organizations part company with the ADA is around looking comprehensively at solutions to improve oral health access and listening to communities about what they believe can be effective models of delivering oral health care to their members.
All solutions, from education to raising Medicaid reimbursement rates to adding midlevel providers to the dental team, are needed to improve oral health access. No one option should be overlooked in favor of another.
In many countries — and in Alaska and Minnesota, the first states to authorize them — mid-levels work as part of the dental team to provide preventive dental services, such as cleanings and fillings. They work with an offsite dentist, consulting via phone or telemedicine, which means that they can practice in remote and underserved areas that do not have dentists. In addition to providing routine dental care, they play a critical role in educating patients about the importance of good oral health.
The W.K. Kellogg Foundation first became aware of the important role dental therapists can play in improving access to care when we were asked by the Alaska Native Tribal Health Consortium several years ago to support their community solution to a very common problem in Alaska, where 72 percent of 6- to 8-year-old American Indian and Alaska Native children have untreated cavities. In 2005, Alaska became the first place to allow dental therapists. Minnesota followed in 2011. The results in both states have been impressive. Dental therapists have improved access to care to thousands of people in previously underserved areas and have done so in a safe and cost-effective way.
We applaud the ADA for calling attention to the severe dental access problem in this country. It is critical that people — especially our elected officials — understand how serious the oral health access problem is. But we also have to do more than educate people about the problem and its causes. We have to explore all options that have the potential to expand access, and that includes adding midlevel dental providers to the dental team.
At least a dozen states are now considering adding dental therapists to the dental team. Considering that tooth decay is the most common childhood illness, affecting nearly 60 percent of all children — more common than asthma — it is time for the ADA to drop its lobbying efforts against community-driven efforts and to formally recognize dental therapists not only as an important part of the dental team but also of a multipronged effort to solve this country’s oral health care crisis. Just as nurse practitioners have been able to expand access to care in the medical field,midlevel dental providers can help do the same in oral health by enabling dentists to reach more people, ensuring greater access to routine, preventive care.
Sterling K. Speirn is president of the W.K. Kellogg Foundation.