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September 17, 2019

9/3/2019 7:26:00 AM
Bipartisan push for dental therapists grows
State's dental association opposes bill

Richard Moore
Investigative Reporter


Momentum built this past week for bipartisan legislation to enable dental therapists to work in Wisconsin - a bill supporters say would help increase access to dental care, especially in rural areas.

But the Wisconsin Dental Association is opposed to the legislation. The WDA says implementation could be costly and that there is no shortage of oral health professionals in the state.

Still support grew after a hearing last week on the legislation authored by Northwoods Rep. Mary Felzkowski (R-Irma) and Sen. David Craig (R-Vernon). The lawmakers say the legislation, which is backed by dozens of state, local, and national groups, would help stop an oral health crisis by allowing a dental therapist to work under the supervision of a dentist, similar to a physician assistant in medicine.

Dental therapists would help underserved populations, the lawmakers say, including children, veterans, and older Americans.

Supporters of the bill say 64 of 72 Wisconsin counties face dental care shortages, affecting 1.2 million residents. And, in Wisconsin, they claim, more than 41,000 emergency room visits for preventable dental conditions were reported by hospitals in the most recently available annual data, representing nearly $25 million in hospital charges.

"I have a former employee who has to drive two-and-a-half to three hours just to get dental care in Wisconsin," Felzkowski said. "This affects every single family in the state of Wisconsin. When you have a nine-year-old girl with 13 cavities in her mouth, her quality of life is not good."

Craig said the concept of dental therapists is nonpartisan and has been embraced by both conservatives and liberals.

One of those advocates at the hearing, Ann Lynch, the director of advocacy and education for the American Dental Hygienists' Association, said the concept has worked in Minnesota.

"When I meet dentists in Minnesota who initially opposed the legislation, they tell me they want to hire one or more dental therapists," Lynch said.

The committee is expected to vote on the legislation in an upcoming meeting.



WDA opposes

Dr. Patrick Tepe, a practicing dentist in Verona and president of the Wisconsin Dental Association, said earlier this year the plan would strain an already strained system. Tepe was talking about a state budget provision by Gov. Tony Evers to allow dental therapists.

Tepe said the WDA supported the vast majority of dental access programs proposed by Evers - such as loan repayment assistance for dentists serving rural areas, expansion of the Seal-A-Smile program, and increased funding for low-income dental clinics - but not the dental therapists position.

"While there is much to applaud in the governor's plan, we are concerned that one aspect - adding a new level of provider, the 'dental therapist,' to an already underfunded system - is being seen by some as a magic pill to bring dental access to Wisconsin's rural areas and inner cities," Tepe said. "With the exception of a handful of counties, workforce studies confirm our state has enough providers. What we need are adequate resources for the dentists, dental hygienists, community clinics and volunteer clinics already working in these areas to ensure all residents can access comprehensive, regular care."

In a paper asking lawmakers not to co-sponsor the bill, the WDA asked why a new class of provider was necessary when Wisconsin does not suffer from a shortage of oral health professionals, and it also questioned the wisdom of adding a new provider to the Medicaid program without an additional investment in what it called an already-underfunded system.

In addition, WDA contended, previous dental therapy programs have met with limited success.

"Minnesota's program, first passed in 2009 and the only one operating in the country, has resulted in only 85 dental therapists working in the state," the WDA stated. "Dental access in Minnesota has declined every year since the implementation of the program."

Dental therapist programs have also failed in Canada, the WDA contends.

"Despite 40 years of government subsidy, a previous dental therapy program designed to alleviate access to care issues in Canada failed, with the last school closing in 2011," the memo to lawmakers stated.

Finally, the WDA asserts, despite claims that the program comes at no additional cost to the taxpayer and is a "free market solution," dental therapy has required government subsidies to survive in every state and country in which it has been tried.

"Minnesota's DT program only started due to a $45 million grant from the federal government," the WDA stated. "Vermont's program recently sat dormant until a $400,000 grant from the federal government."

Other models have been limited entirely to tribal lands and Federally Qualified Health Centers, WDA argues, both of whom receive significant subsidies from the federal government, unlike private providers.



Badger Institute supports

But, in a column written for the Badger Institute, Ken Taylor, the executive director of Kids Forward, and Julie Grace, a policy analyst for the Badger Institute, argued that dental therapy would indeed provide access to many Wisconsinites who lack dental care.

"We have a dental access problem in our state," they wrote. "In 2017, only 43% of children receiving dental benefits through Medicaid received care. That's among the lowest rates of dental treatment nationwide for children who receive care through public insurance."

In 2018, Taylor and Grace wrote, more than 1.2 million residents - more than 20% of the state's population - lived in communities designated by the federal government as dental care shortage areas, while 64 of Wisconsin's 72 counties have at least one designated dental shortage area.

"Lack of dental care often leads to excessive, ineffective and costly visits to the emergency room," they wrote. "Children who lack access to dental care especially suffer. Studies have found that a child's academic performance is negatively affected by dental problems."

The simple solution, Taylor and Grace wrote, is dental therapy.

"Similar to nurse practitioners and doctors, dental therapists are licensed mid-level professionals who work under dentists to provide basic oral treatment at a lower cost," they wrote. "If dental therapists were allowed to practice in Wisconsin as both Gov. Tony Evers and some Republican legislators have proposed, the benefits would be wide-reaching and monumental."

And Taylor and Grace disputed the WDA's assessment that Minnesota's program is not successful.

"Since they began practicing there in 2011, patients are seeing reduced wait times, especially those in rural areas," they wrote. "Dental therapists also saw nearly 90% of uninsured or publicly insured patients, and research has shown that the quality of care received from dental therapists is at least as high as that received from a dentist."

According to a Pew survey, Taylor and Grace wrote, 71% of Americans said they would be willing to receive dental care from dental therapists. And, in addition to support from both Wisconsin Democrats and Republicans, the policy has the backing of health care groups and insurers, hospitals, local governments, schools, businesses, and think tanks.

"These days, it seems like there are few societal problems that can bring together such bipartisan support, but this is one of them," they wrote. "When groups as diverse as ours can agree that we are facing a problem and how to solve it, what can possibly stand in the way? Now is the time to pass this common-sense legislation and get people the dental care they deserve."

Richard Moore is the author of the forthcoming "Storyfinding: From the Journey to the Story" and can be reached at richardmoorebooks.com.



Reader Comments

Posted: Tuesday, September 3, 2019
Article comment by: Francine Smith

I live in Duluth, though I used to live in Oneida County. Dental therapists have been a disaster in Minnesota. Most dental therapists don't want to practice in rural areas any more than most dentists do. Nearly all practice in the Twin Cities and have done nothing to improve access to care in rural or underserved areas. It sounds like a good idea, but it doesn't work.



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