I went to my dentist a month or two ago. I was shocked by the price for a deep teeth cleaning. A teeth cleaning is included with an annual membership and the deep cleaning is an upcharge from the basic cleaning. I suspect my dentists requires a deep cleaning as a way to charge as much for my free service as the service usually costs retail. I’m in and out of his office in less than 30 minutes usually.
At my last visit the annual membership fee was also due, so my total bill was enough to buy an iPhone 11 on eBay. I don’t think I even spoke to the dentist during the visit; I just met with the dental hygienist. Why was the price so high?
To answer that question I need to share another anecdote. About ten years ago I spoke at a health policy conference. In the exhibit hall outside the conference rooms were booths manned by exhibitors. One booth was a trade association of general dentists. I asked the lobbyists about their public policy agenda. They only had two pet issues they lobby for: 1) to protect the right of general dentists to perform specialty procedures. That is, protect them from specialists who would limit general dentists’ scope of practice to general dentistry. The second policy agenda: 2) protect general dentists from lesser-trained dental therapists who, if allowed to practice independently, could undercut their prices and reduce their income. I asked them what they thought of dental therapists. They assured me it was a bad idea.
I’ve written about dental therapists before but it’s a topic worth revisiting. Kaiser Health News reported on dental therapists who practice basic dentistry in Minnesota.
All six of Michelle Ehlert’s children have Medicaid plans that should cover their dental care. But for years, she and her husband paid for dental care out-of-pocket — sometimes thousands of dollars a year.
That all changed when Ehlert’s family found a clinic in neighboring Otter Tail County run by Apple Tree Dental, where dental therapists, who prioritize treating Medicaid recipients, provide much of the clinic’s care.
Now, “we actually go to the dentist like we’re scheduled to,” Ehlert said. “It really is indescribable how much of a difference it’s made.”
What are dental therapists compared to a dentist?
Dental therapists are licensed providers who offer basic care traditionally provided by dentists, including fillings and simple tooth extractions. Over a dozen states have turned to them to increase access to oral health care, and federal advisers say at least eight more are considering doing the same. Like Minnesota, some states have deployed therapists specifically to benefit underserved populations, such as rural residents, Medicaid recipients, and Native American tribes.
Dental therapy has existed abroad since 1921 but was first practiced in the U.S. in 2004 within the Alaska Tribal Health System. Today, only five college programs offer dental therapy training.
One problem with the program in Minnesota is it came with too many restrictions.
The new licensure came with strings attached, requiring the therapists to practice in areas that didn’t have enough dentists to serve the population, or to primarily treat low-income, uninsured, and underserved patients.
Under the supervision of a dentist, dental therapists can complete oral evaluations, fill cavities, and extract children’s baby teeth. In Minnesota, dental therapists with advanced training can treat patients without having a dentist on-site.
In other words, dental therapists are restricted in such a way they can’t undercut and compete with dentists unless it’s for patients dentists do not want. That is no accident. What dental associations claim is protecting patients is more about protecting dentists’ income against competition.
Across the border in Wisconsin, a bipartisan group of lawmakers introduced bills in 2017 and 2019 to create the license class. The Wisconsin Dental Association opposed the measures, arguing that the state should invest in its existing workforce rather than create another profession. Marquette University and the Academy of General Dentistry joined the association in its objection.
The most important routine dental service people need (in my opinion) is teeth cleaning once or twice a year. Cleanings are performed by dental hygienists under the supervision of a dentist, who may or may not inspect their work during any given cleaning. Instead of paying for an annual membership and an upcharge for three deep cleanings a year (a total cost of about $700 annually), I’d rather visit a dental therapist’s spartan office and pay $75 per visit. If he or she found something of concern they could refer me to a doctor of dental medicine. In most states that’s not allowed but it should be.
To read more about dental therapists’ educational training requirements, see: Dental Therapy | School of Dentistry (umn.edu)