Improving access to dental care for all Michiganians is an important health issue the Michigan Dental Association (MDA) and our 5,900 members across both peninsulas are deeply committed to. But a bill recently introduced in the Legislature and supported in “Dental therapists enhance care,” Sept. 14, won’t get the job done, and could actually create other problems.
The legislation, Senate Bill 541, would add midlevel dental providers called dental therapists. But Michigan already has a more than necessary workforce in place to provide strong oral health care with 7,500 licensed dentists, 1,700 registered dental assistants, and 10,300 registered dental hygienists (many of whom are unemployed).
In both health and oral care, addressing the root cause — rather than a superficial or temporary treatment — is essential to a positive, sustained outcome. That’s why the MDA can’t support this legislation. There are clearly other factors affecting access to care in the Great Lakes State. A shortage of dental providers is not one of them.
These factors include a lack of understanding of the need for good oral health, a mal-distribution of providers and poorly funded public health programs (particularly for adults). In fact, last fall, when this policy was first floated legislatively, all sides agreed that the No. 1 challenge impacting access was the low Medicaid reimbursement rate for adult patients.
Proponents of the dental therapist cite neighboring Minnesota as the example of what dental therapists can do. That program claimed dental therapists would get care to rural, underserved areas. Yet today, only nine of its 76 dental therapists (barely 10 percent) have done so. Dental therapists are not going into these areas for the same reason dentists aren’t going into these areas — they simply can’t make it financially. Dental therapy starts us down a path of creating two tiers of care. One for those who have insurance or can afford to go to a dentist, and one for those who can’t and must be cared for by a provider with far less training.
While dental therapists receive some extra instruction to perform irreversible procedures such as basic drilling of teeth and simple extractions, their training does not prepare them to deliver the same level of care provided by a dentist.
Additionaly, neither of the state’s two dental schools is interested in starting up this type of program.
Solutions supported by our members include expansion of the PA 161 hygiene program to allow greater outreach by dental hygienists within their current scope of practice, more effective use of registered dental assistants, increases in the adult Medicaid reimbursement rate and more resources devoted to recruitment of dentists into remote areas. Michiganians need and deserve dental care, because oral health is an integral part of overall health and wellness. The MDA is committed to ensuring equitable access to care for all.
Dr. Michele Tulak-Gorecki
president, Michigan Dental Association