I had to see my dentist a few months ago. Dr. Patel is a good guy, but he’s not a cheap date. I pay a $299 annual membership fee; in return I get two free cleanings and discounts on other services. This all sounds good except I was told my teeth cleaning needed to be deeper than normal cleanings ($145 extra). When I had a cavity that damaged a molar it was something like $429 to fill and fix. You get the picture. My dental care runs more than $1,000 a year without any real problems occurring during that time. I occasionally talk about finding a new, less expensive dentist but inertia keeps me going back.
Many Americans cannot afford to spend $1,000 a year on dental care for mostly routine maintenance. That’s not even counting unexpected costs like root canals, dental implants and crowns. Too many people put off dental care until it’s an emergency and their teeth need extensive care. Dental care is an unmet need for much of rural America, and in cities and suburbs as well. About two-thirds of dental shortage areas are in rural areas, home to about 58 million people.
Most dentists (like physicians) do not want to live in small towns in rural areas. Indeed, few dentists even want to work in areas that aren’t relatively affluent. Dental coverage is largely worthless and to be honest, if a service is not affordable when paying cash it is even less affordable over time when paying with insurance. Insurance merely allows patients to smooth the cost of dental care over time in return for a premium and rising dental inflation.
The problem of too few dentists is not an easy fix. A doctor of dental medicine (DDM) degree requires admission to a dental program, three years to complete dental school and student loans that approach $300,000. Though not a perfect solution there is a policy proposal to alleviate the dentist shortage and boost access to dental care. This is a degree known as dental therapists.
Dental therapists are licensed to fill cavities, place temporary crowns, extract diseased teeth and provide other basic preventive dental care, working under a dentist’s supervision. They have more training than a hygienist but not the advanced degree of a dentist.
Not all states authorize dental therapists to practice. Furthermore, dental therapist programs are few and far between.
More than a dozen states have authorized the licensing and practice of dental therapists, and the occupation is growing.Dozens of other countries have had dental therapists since the 1920s. But there weren’t any in the United States until about two decades ago, when Alaska Native students returned from training in New Zealand, ready to provide care to their remote tribal communities.
Not everyone is a fan of allowing a midlevel dental practitioner. Furthermore, people who oppose dental therapists are not just voting with their feet. They don’t want you to be able to see one either. I’m talking about dentists. When state governments authorize regulatory cartels, those cartels seek to protect their status.
Critics of dental therapy say state and federal policy should instead focus on supporting dentists.
I do support my dentist, to the tune of $1,000 a year. I’d like to be able to support his hygienist independently and most of my dental needs are minor and could easily be taken care of by a dental therapist. That reminds me of a conference I spoke at years ago. In the exhibit hall there was a trade association booth for community dentists. I asked about their public policy priorities. They said they had only two primary issues that they lobby for: 1) they want to protect general dentists’ legal right to perform specialty procedures. 2) they want to protect community dentists from having to compete with lessor-trained dental therapists.
Stated more bluntly, community dentists wanted to protect the right of a dentist who had not specialized in a specific area to be able to perform those procedures if they felt competent. That’s like when your dentist performs a root canal rather than referring you to an endodontist. At the same time, they wanted to prevent a dental therapist from being able to independently fill a simple cavity without working under a licensed dentist in a dentist’s office. What I’m describing is a scope of practice battle that is similar to what’s being debated across states with respect to whether nurse practitioners and physician assistants can practice independently.
If I just need my teeth cleaned, why should I pay for the services of a dentist and the overhead of a full-service dental office? A lot of low-income Americans do not have money for that kind of luxury. It makes sense to increase access to dental care. It also makes sense to have a range of skills, with varying price points, for those who need dental care.
If you want never to have another cavity, get a bag of xylitol crystals and use as mouthwash without swallowing. This was discovered in Scandinavia. Root canals/ endodontics leave dead teeth in the mouth which is not a good idea. Weston Price Foundation has more info on that.