Don’t send a therapist to do a dentist’s job

Recently, legislation was introduced advocating for dental therapists in Michigan, but it’s unclear the impact dental therapists can make in addressing barriers to dental care. A better idea is to build Michigan’s successful strategies using our current dental workforce.

Healthy Kids Dental has now been expanded into all Michigan counties, and all children are covered up to age 21. Under the traditional fee-for-service Medicaid program about 46 percent of children receive care, while under Healthy Kids Dental, we’ve been successful increasing that number to 61 percent. The Healthy Michigan Plan, Michigan’s Medicaid expansion program implemented in 2014, has seen similar utilization trends when compared to traditional Medicaid.

The dental therapist program proposed in Senate Bill 1013 is based on a Minnesota program which hasn’t proved to be successful. Since the law creating dental therapists passed in 2009, only 54 dental therapists have entered the workforce. Additionally, proponents claimed it would get providers into underserved rural areas. But in the seven years since creation, only seven dental therapists have gone into rural areas.

A recent study by the Health Policy Institute shows that in Michigan 35 percent of low-income people report having trouble finding a dentist. According to the same study, 44 percent of low-income Minnesotans say they have trouble finding a dentist, even with a dental therapist program in place since 2009. Michigan’s strategy has proven successful; Minnesota’s has not. There is no reason to think a dental therapist would have a positive impact here.

A better way to address access is to improve utilization of Michigan’s existing dental workforce. Currently there are 7,500 dentists, 10,300 registered dental hygienists and 1,700 dental assistants. Of the 10,300 hygienists, over half are unemployed or underemployed. What’s more, many dentists say they could see more patients. Why add another provider when there is so much underutilized capacity?

The Michigan Dental Association (MDA) supports solutions with better chances of helping fix the access problem and is working with Sen. Peter MacGregor, R-Rockford, to introduce a bill to allow individual dentists to send hygienists into underserved areas. If follow-up care is needed, patients would be referred to the dentist that sent in the hygienist. A key concern with the dental therapist model is it sends people who have much less training than a dentist to treat a population with the most complex dental and medical problems. The underserved should have access to the same quality care as people with insurance or who pay out of pocket.

Dr. Larry DeGroat is the president of the Michigan Dental Association.