Dental therapy got a boost last week when the Biden-Sanders Unity Task Force released its policy recommendations, which include authorizing dental therapists:
“Democrats will support policies that increase the number of primary care practitioners, registered nurses, dentists, and dental therapists, especially in rural and low-income metropolitan areas, so it’s easier for every American to access preventive and primary health care.”
The Task Force submitted its report to the Democratic National Committee as recommendations on the party’s platform ahead of next month’s convention. While licensing laws for dental therapists must be passed at the state level, having a national endorsement for dental therapy as a key strategy to reduce health care costs while improving health care quality is significant.
Support for dental therapy has long been bipartisan and can even be found in the White House. In 2018, the Trump administration released a report that called out overly burdensome and anti-competitive scope-of-practice laws that restricted dental therapists and other health care providers stating “dental therapists and dental hygienists can safely and effectively provide some services offered by dentists.” The Trump administration even called out the role dental associations and dental boards play in opposing the authorization of new providers:
“When state regulators impose excessive entry barriers and undue restrictions on [scope-of-practice] for particular types of providers, they often are not responding to legitimate consumer protection concerns. There is a risk that healthcare professionals with overlapping skill sets will seek these restrictions; they view [scope-of-practice] restrictions as an easy, state-sanctioned opportunity to insulate themselves from competition. The risk of anti-competitive harm may be even greater when the regulatory board that imposes [scope-of-practice] restrictions on one occupation is controlled by members of another, overlapping occupation that provides complementary or substitute services, and the board members are themselves active market participants with a financial stake in the outcome.”
Support for dental therapy has always been incredibly bipartisan, with supporters including the Cato Institute, Americans for Tax Reform, Americans for Prosperity, Families USA, AARP chapters, the National Congress of American Indians and hundreds of other groups. Only one group has stood alone in its opposition to dental therapy: dental associations.
Despite the fact that dental therapists have been repeatedly proven to provide high-quality care and improve access to care, dental associations continue to fight efforts to pass and implement community-driven dental therapy laws. This is not a new phenomenon. Medical associations strongly opposed the introduction of nurse practitioners and physician assistants, but today, nurse practitioners and physician assistants are almost universally agreed to be key parts of the medical team. A similar shift is starting to happen in dentistry but the dental associations have not caught up. The American Dental Association’s Council on Scientific Affairs has acknowledged dental therapists can safely fill cavities and perform basic extractions. The American Dental Association’s Commission on Dental Accreditation (CODA) has adopted education standards for dental therapy programs. CODA already accredits education programs for dentists and dental hygienists and will hold all programs to the same standards. Some state dental associations are even slowly embracing evidence-based dental therapy policies. For example, just last year, the Connecticut State Dental Association advocated for their state to follow the recommendations of the National Model Act for Licensing or Certification of Dental Therapists. Despite these incremental shifts, most dental associations are standing directly in the way of these evidence-based, community-driven providers.
The need for an affordable, accessible, community-focused oral health care system has never been more pressing. Even before COVID-19 exacerbated the existing inequities in our oral health care system, dental care was out of reach for many Americans. Dr. Myechia Minter-Jordan, head of the DentaQuest Partnership for Oral Health Advancement, wrote a recent article on the effects of systemic racism in the oral health care system:
“Recent research from DentaQuest showed that over 74 million Americans lack access to dental coverage — four times the number of people who are medically uninsured. More than 45 million Americans live in areas without an adequate number of dentists. It shouldn’t surprise anyone that this gap in access disproportionately harms poor, black, and brown Americans.”
While additional reforms to the oral health care system are badly needed, authorizing dental therapists is a proven method of cost-effectively expanding access to care while diversifying the dental workforce. That’s why the Democratic party, the Trump administration and almost everyone else support it. It’s time for legislators to listen to the people and not the dental associations.