In 2008, nearly 350,000 Minnesotans did not receive regular dental care. One of the major reasons was a lack of dentists to adequately treat the population. To meet their unmet needs, Minnesota policymakers embraced an innovative approach – enhance the dental team by adding a new member, a dental therapist, who can work in underserved and rural areas.
Last week, dental therapists in Minnesota finished taking their board examinations and are set to dive into helping dentists and the rest of the dental team help meet the unmet oral health needs of residents. The Minneapolis Star Tribune reported dental therapists will help “fill holes, literally and figuratively, in community settings where dentists aren’t going. Regular dental care is out of reach for about 350,000 low-income Minnesotans. And Minnesota’s ranking among the top five states for dental health masks an ugly truth — 80 percent of tooth decay is found in just 25 percent of our children, most of them low-income.”
Minnesota isn’t the only state with poor oral health. Just this week the Cleveland Plain Dealer reported that in Collinwood, Ohio, there is just one dentist to serve 28,000 residents. By accepted standards, this East Side Cleveland neighborhood should have the full-time equivalent of nine dentists. As a result of severe dental shortages in Ohio and other barriers to care such as cost, oral health is the top health need among children and low-income adults in the state according to the Ohio Department of Health.
Unmet oral health needs are not a new issue. More than a decade ago, Surgeon General David Satcher identified a “silent epidemic” of dental and oral diseases that burdens some population groups and called for a national effort to improve oral health among all Americans.
Oral health is essential to overall health, yet significant gains have not been made over the last decade to improve the oral health of the nation as a whole. Today, 49 million Americans live in communities without enough dentists and state dental policies fail one in five children. The two biggest barriers to oral health care for Americans continues to be the high cost of care and not enough providers to meet the needs of underserved communities.
While the problem is getting worse in places like Ohio, there is hope that states will embrace innovation as in the case of Minnesota or follow the trail blazed by Alaska Native communities who have taken tangible steps to improve the oral health of their community by adding dental therapists to the dental team.
While Alaskan policymakers struggled with the oral health crisis – a 1998 study found they had only 20 or so dentists to serve more than 200 hundred villages and 85,000 people, Alaska Natives responded by developing their own workforce to meet the needs of their communities. As I blogged here, dental therapists provide safe, competent care and help meet the unmet oral health needs of Alaska Natives.
Yet despite multiple studies and a recent Government Accountability Office (GAO) report that show dental therapists provide quality care and can increase access to care, opposition persists from organized dentistry that is based on little more than fear as noted by Dr. Frank Catalanotto at professor and chair at the University of Florida College of Dentistry.
Knowing that poor access to oral health care remains a critical priority that demands a real solution, in partnership with the W.K. Kellogg Foundation and partners in five states, Community Catalyst launched an effort to improve how dental care is delivered by enhancing the dental team in order to ensure millions of more Americans have access to care in their community.
Our efforts to bring dental care and dental therapists to underserved communities in Vermont, Kansas, New Mexico, Ohio, and Washington are gaining traction. And, as dental therapist begin to work on the ground in Minnesota, it will be tougher to ignore the need to enhance the dental workforce and the real benefits dental therapists will have underserved communities.
In New Mexico, Don Weideman, a hospital CEO from a small town, is excited by a bill that creates dental therapists because it could, “finally bring dental care a whole lot closer to home for thousands of people in rural communities throughout New Mexico… And as a hospital CEO, an employer whose workers have to take a whole day off to get dental care, a father whose kids miss a day of school every time they need to see a dentist and as a patient who waited more than four months to get a wisdom tooth pulled, I’m even more excited.”
In Kansas, local dentists Dr. Miner and Dr. Minnis were joined by Dr. Nagel in testifying in support of adding a mid-level provider, a registered dental practitioner to the team to enhance the dental team’s ability to treat patients in underserved and rural communities as well as to save lives. As the Kansas Health Institute notes, Sen. Roger Reitz (R-Manhattan), a physician and member of the committee, said their remarks had been, “spellbinding. This is good stuff,”
While no other state has joined Minnesota in passing legislation that increases access to care by putting providers in communities where there are none, we need to remember that real change, while it takes time, is not out of reach. Not that long ago, dental therapists were a distant concept in Alaska. Now, dental therapists are providing care to nearly 20,000 previously underserved Alaska Natives and soon dental therapists will begin working to provide 350,000 underserved Minnesotans with regular care.
As the gains against the oral health epidemic in Minnesota and Alaska’s Native Communities are highlighted, policymakers will work toward real solutions, such as dental therapists, that can improve oral health for their constituents.
— David Jordan, Director, Dental Access Project