Licensing for basic dental work would help fill growing need

by: PHOTO COURTESY: CHILDREN'S DENTAL SERVICES - Minnesota advanced dental therapist Christy Jo Fogarty treats a young patient at a clinic run by Children's Dental Serivces. Dental therapists in Minnesota help more uninsured patients get dental treatment, but are not yet licensed in Oregon.Children’s Dental Services, a Minneapolis nonprofit that provides dental care to uninsured and low-income people throughout Minnesota, was able to serve 1,000 additional patients last year — kids and pregnant women who in previous years would not have had dental care at all.

That was possible, according to Executive Director Sarah Wovcha, because she was able to hire four dental therapists to supplement the work of her staff dentists. At $45 per hour she can hire more dental therapists than $75 per hour dentists, and more patients get seen.

Dental therapists are similar to nurse practitioners — able to do much of, but not all, the primary care work dentists or physicians do. But they aren’t licensed yet in Oregon. And those pushing for dental therapists in Oregon aren’t going to get help from the Oregon Health & Science University School of Dentistry, which has decided not to participate in training Oregon dental therapists in programs authorized by the Oregon Legislature last year.

Not that there isn’t need. At the Oregon Dental Association’s last two-day clinic at the Oregon Convention Center, volunteers provided free basic care to more than 2,000 people and more than 1,000 others were turned away. Oregon Health Plan enrollees do not get dental coverage. Last year more than 7,000 Portland emergency department visits were from people suffering dental pain who did not have a dentist of their own.

Oral disease can contribute to a host of maladies, including heart disease, and dental pain is the No. 1 cause of children missing school, according to Priscilla Lewis, director for community services and development for Providence Health Systems.

Oregon has some of the worst dental care statistics in the country, says Nichole Maher, president of the Portland-based Northwest Health Foundation. Maher says Oregon is facing an oral health crisis, especially in rural areas with no dentists and in poorer neighborhoods in the Portland area.

BIg hurdles stymie effort

Minnesota authorized dental therapists in 2009 and the first licensed therapists began practicing in 2011. Alaska has employed dental therapists in tribal health clinics in rural areas. A number of nonprofits have pushed for licensing of dental therapists in other states, including Oregon, but the national lobby for dentists has opposed the move.

In Minnesota, dental therapists can do basic drilling and replace fillings, but they cannot remove wisdom teeth. They can administer nitrous oxide or Novocaine but cannot fully sedate patients or perform root canals.

In 2011, the Oregon Legislature adopted a bill that establishing five-year pilot projects to test the dental therapist concept. The Legislature provided no funding and no guarantee that at the end of five years dental therapists would be able to gain licenses. But if an Oregon school wanted to train dental therapists, it could come back to the Legislature after five years to make the case for licensing.

Maher says her foundation is looking for educational institutions with which to partner to get dental therapist training started. Without state money, the challenge is great.

Minnesota model

Colleen Brickle, dean of health sciences at Normandale Community College in Minnesota, was instrumental in creating that state’s dental therapist program. Normandale, which previously trained dental hygienists, partnered with Metropolitan State University to offer a master’s of science degree in advanced dental therapy to students who already were hygienists.

Brickle says it can run as much as $1 million to put together a college-based dental therapy training program. That includes the costs of buying equipment and hiring dentists to teach and oversee students. Minnesota has 25 licensed dental therapists who have gone through about two years of training.

But it didn’t cost much at all to train dental therapists at the University of Minnesota School of Dentistry, says Karl Self, director of dental therapy there.

That’s because the school of dentistry already has the equipment and professors on hand — training dentists. Students intending to become therapists, Self says, take classes with the dental students. They just don’t take all the classes the dental students take.

“It’s not a significant investment,” Self says.

Self says dentists in Minnesota were “fearful” about licensing dental therapists before the program began, but that there have been no complaints against dental therapists who have been treating patients.

In fact, he’s convinced that therapists, by performing more of the routine dental work, will help dentists become better at the more complex surgeries such as root canals. It’s axiomatic in medicine, he says, that surgeons become better at procedures the more frequently they do them.

The Hill opts out

OHSU’s School of Dentistry, through an email response to a Tribune inquiry, made it clear that it was not going to set up a dental therapy training program.

“In large part due to declining state support, a conscious decision was made 10 years ago to focus solely on dentist education and leave the education of mid-level providers — including dental hygienists — to other entities like Pacific University and Mt. Hood Community College, with whom we enjoy a collaborative relationship,” wrote OHSU School of Dentistry Interim Dean Gary Chiodoa.

That leaves Maher with the task of approaching colleges which already have hygienists, but not all the expensive infrastructure needed to train dental therapists.

Still, Brickle says there are advantages to training therapists at the community college and university level. The master’s degree program at Metropolitan State costs students about $35,000 total, which is considerably less than the cost for therapists trained at the dental school, she says.

“There can be creative ways to do this without a dental school,” Brickle says.

Brickle also recommends the advanced dental therapist degree, which allows therapists to practice more widely and with less dentist supervision than basic dental therapists, making them more valuable to nonprofits.

Minnesota requires licensed dental therapists to serve primarily low-income patients, so virtually all have ended up with such safety-net clinics as Children’s Dental Services. Executive Director Wovcha says her nonprofit visits 350 locations around the state to provide dental care, and she needs some therapists who can work in remote locations without a dentist on site. Only the advanced dental therapists with master’s degrees can do that.

Maher’s goal is to have two partners identified this year so that fundraising can get started to finance the pilot projects. But without the dental school, she knows it won’t be easy.

“It’s tough to start anything like this,” Maher says. “We know what to do, but it gets very messy when politics and territory get involved.”

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