Yesterday, Maine Governor Paul LePage signed a bill authorizing mid-level dental providers to practice in the state. Mainers, like Americans in every state, face barriers to accessing affordable dental care in their communities. The bill is a step forward to increasing the capacity of the current dental delivery system, so it is able to offer more affordable care to the Mainers who need it. 

Unfortunately, the need for dental care in Maine is severe and the bill falls short in equipping the delivery system to reach people not currently served by a dentist. Maine mid-level providers need to be authorized to practice under the off-site supervision of dentists, which would allow the new providers to reach underserved populations in nursing homes, schools, doctor’s offices, hospitals and even at existing dental offices after normal operating hours. A better model in which mid-level providers practice under the off-site or general supervision of dentists is increasing access to care for Alaska Natives in rural Alaska, and reducing wait-times for patients enrolled in Medicaid and other underserved populations in Minnesota.

While the legislation in Maine did not give mid-level providers sufficient flexibility, its passage is evidence that consumers and community members advocating for improved oral health care can ultimately win against the contentious and misleading campaigns waged by state and national dental associations. In Maine, the Maine Dental Association and American Dental Association spent millions of dollars to defeat legislation aimed at improving access to oral health, but the truth about the need for a new evidence based provider prevailed. The passage of this legislation proves that policymakers are keenly aware of their constituents’ needs. National and state dental associations need to come to the table to help make dental workforce bills stronger, rather than detracting from progress.

The Maine Legislature is the second legislature in five years to change state scope of practice laws for mid-level dental providers—a move that puts the people’s interest and need for access to dental care before the special interests of the state dental association. 

With more than 181 million Americans going without a dental visit in 2010 and more than four out of ten children going without regular dental care, change is imminent across the country. Already, campaigns to increase access to dental care by adding a new provider to the dental care team are underway in California, Kansas, New Mexico, North Dakota, Ohio, New Hampshire, Vermont, and Washington. We expect more to be launched in the next year. We also expect more states to authorize mid-level dental providers because, like Maine, policymakers will recognize the needs of the people in their states before those of the state dental associations.

The evidence that mid-level dental providers increase access to care and provide care at the same level of dentists is undisputed – there are more than 1,100 articles demonstrating that dental therapists increase access to quality, safe care. Even the American Dental Association’s own study published in the January, 2013 edition of the Journal of the American Dental Association found, “A variety of studies indicate that appropriately trained midlevel providers are capable of providing high quality services.” The same American Dental Association report noted that dental teams with mid-level providers were more successful at providing services to populations with untreated decay than dental teams without mid-level providers (dentists alone).

As this debate unfolds across the country, dental associations would be wise to re-think continuing their oppose everything strategy  in other states. If they continue to ignore the need and evidence, what happened in Maine will repeat itself in other states. The legislative will is there, and it’s time for the professional organizations to come to the table. If state dental association and the American Dental Association come to the table they have the opportunity to be part of the solution and not the problem. They also have the opportunity to shape a solution that can help them see more patients and generate more revenue for their practices.

Mid-level dental providers increase access to care, help dentists see more patients and generate more money, and prevent more costly care down the line. State legislatures across the country are poised to make mid-level providers a reality because they are a smart, evidence-based solution. The question is: will the American Dental Association and state dental associations come to the table or continue to ignore the evidence that mid-level providers benefit their members and underserved vulnerable populations?