State Updates
See what’s happening around the country on oral health access issues and mid-level dental providers.
Choose a blue state for an update
Washington
In Washington, children from low-income families, children of color, children who don’t speak English and families for whom English is a second language have a harder time accessing care, and have higher levels of untreated cavities and other forms of dental disease as a result. With this ongoing oral health issue, a bill introducing a mid-level dental care provider attracted considerable attention in the latest legislative session. Although the proposal did not make it to the full Senate for debate in 2012, it has sparked a much larger conversation on the status of dental care access in Washington and the potential benefits of mid-level providers.
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California
A state bill that would allow California to study the benefits of mid-level providers was passed by the state Senate and is pending assignment to an Assembly committee. The measure is expected to be heard before the end of the legislative session on August 31, 2012.
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Minnesota
The use of dental therapists in Minnesota is on the rise, but it has also put many dentists on edge, concerned about competition from providers who can charge less for their services.
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Kansas
Kansas’ ongoing dentist shortage has the state looking for ways to fill the dental access gaps, especially for those in rural areas. Kansas lawmakers considered legislation that would have created a mid-level provider—a registered dental therapist—who could perform some of the duties now handled by dentists; however, lawmakers elected to expand roles of the dental hygienist at this time. One problem in Kansas is a shortage of dentists: 93 Kansas counties don’t have enough dentists to serve their residents and 13 counties have no dentist at all. Another problem is the lack of participation among dentists in the state’s Medicaid program (only one in four dentists see patients covered by Medicaid), which affects lower income Kansans. Children of color are more likely to be affected: 40 percent of black children in Kansas live in poverty, as do 36 percent of American Indian/Alaska Native children and 32 percent of Hispanic children.
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Louisiana
Emergency room visits are the problem in Louisiana. State hospitals spend millions of dollars on patients who visit emergency rooms seeking pain relief from toothaches. State health department data show that, for the past two fiscal years, Louisiana has spent about $1.7 million a year on emergency room treatment and pain relief for Medicaid patients who had dental problems.
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Vermont
The FY13 House budget included the Vermont Oral Health Care for All Coalition’s request to expand the dental benefits for pregnant women on Dr. Dynasaur. Also, state policymakers may consider legislation that looks to add mid-level providers to the existing dental team—a possible approach to addressing the lack of access to dental care in Vermont. Increasing access to care is important to all Vermonters and particularly racial and ethnic minorities—a population that has doubled in the past 20 years and continues to grow. According to recent data, the greatest disparities in access to health care are found among American Indian/Alaskan Native groups.
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New Hampshire
The New Hampshire Legislature passed a bill to allow public health dental hygienists who receive additional training to apply sealants and provide other basic services that only dentists can currently provide.
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Maine
State legislators have been looking into adding a dental provider that could offer services under the supervision of a dentist and a recent poll found that nearly 80 percent of Maine residents support the idea. Data shows that nearly 500,000 residents live in areas with a confirmed dentist shortage.
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New Mexico
Health Action New Mexico is preparing to conduct extensive community outreach on the state’s oral health care access crisis and the potential of the dental therapist model to help solve this problem. In addition, Health Action New Mexico recently presented to representatives on the Navajo Nation on the benefits of the dental therapist model for Tribal nations, where access to oral health care is difficult. Nearly half of all Native American children in New Mexico have untreated tooth decay.
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Ohio
The dental care shortage impacts rural Ohioans and people of color the hardest. Data show that Appalachian and other rural Ohioans are less likely to have a recent dental visit than suburban and metropolitan county residents. Similarly, only 50 percent of African American and Hispanic residents have had a dental visit in the past year. In response, UHCAN Ohio continues to meet with professional organizations like the Ohio Dental Association, educators and other stakeholders and to speak at local town hall meetings to educate members of the dental profession and the community at large about the benefits of adding mid-level dental providers to the dental team.
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Alaska
The Alaska Native Tribal Health Consortium currently operates a program to train dental therapists to perform routine care in rural Alaska. The training program has helped more than 35,000 Alaska Natives, who did not have access to routine dental care before, get the care that they need. While Alaska begins recruiting its next class of dental health aide therapists, more than a dozen other states are exploring the program as a way to address their own dental access issues.
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Missouri
Missouri’s dentist shortage is an ongoing problem. According to the Pew Center on the States, the state still needs to employ more than 230 dentists to adequately manage Missouri’s oral health needs. In 2011, the Missouri Dental Board became the first dental board in the U.S. to endorse a proposal for mid-level providers. State policymakers are still considering the proposal.
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Florida
State hospitals in Florida are spending millions of dollars on patients who visit emergency rooms seeking pain relief from toothaches. In 2010, Florida had more than 115,000 hospitals ER visits for dental problems, which produced charges exceeding $88 million, according to a recent report by the Pew Center on the States.
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Oregon
Oregon passed a bill last year that allows for a dental therapist pilot program, to address the severe dental provider shortages. Twenty-three of 36 counties in Oregon do not have a sufficient number of dentists to adequately treat their respective populations.
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Connecticut
Connecticut continues to debate over a proposal that would create a pilot project so that dental therapists would be allowed to perform certain procedures, such as administering local anesthesia, drilling teeth, putting in fillings, performing routine extractions, reading X-rays, and prescribing some drugs—all while working under the general supervision of a dentist.