Filling the Cavities in Missouri’s Dental Care

Missouri’s oral health is among the worst in the nation. The Centers for Disease Control ranked the state 47th in terms of the percentage of the population that visited a dentist last year, and 50 of Missouri’s 114 counties have a shortage of dental professionals. In response to this public health crisis, the Missouri Department of Health and Senior Services (DHSS) released its 2009 statewide oral health plan, which addressed the difficulty of recruiting dentists to rural areas. Although the plan points out that enabling improved oral hygiene and regular visits to a dental practitioner would narrow the disparity, it fails to address an underlying cause of Missouri’s dental predicament: the professional licensing law, and its restrictive definition of who can provide dental care in Missouri.

Alaska had a similar dental problem in its tribal areas, which had the worst rates of oral health in the country. Alaskan dental therapists — trained to do most basic dental work, like drilling and cleaning, but not oral surgery — became a much-needed solution to the problem. The American Dental Association (ADA) sued the Alaskan Native Tribal Health Consortium (ANTHC) as a result, and the two groups ultimately reached an agreement that limited the program’s scope. The ADA argued that dental therapists cannot adequately provide health care. However, a 2008 pilot study of the Alaskan program, funded by Texas A&M University, did not find any significant differences between the quality of care provided by dental therapists and dentists.

Other groups have argued that there are too many dentists already, and that opening the market to paraprofessionals is unnecessary. If dentists are so accessible, though, why are Missouri’s oral health outcomes so much lower than other states? Cost and access are both issues; even those who can conveniently reach a dentist may deem dental services to be too expensive when money is tight. Dental therapists, because they require less training, are able to provide comparable care for a wide range of dental services, at a more affordable rate. Those who need more than basic drilling and cleaning can be referred to a professional dentist. Dental therapists would not replace dentists; already, dental hygienists provide the majority of basic dental care before patients see a dentist. Also, in the same way that some people prefer to see a general practitioner rather than a nurse practitioner, some will always prefer a professional dentist to a paraprofessional. Dental therapists merely provide a less expensive alternative for those who cannot afford a professional dental checkup.

Dental therapists have been successful in England, Canada, and Australia at providing quality dental care. In Australia, dental therapists are proving their worth beyond the provision of basic oral care. A recent study found that nearly 94.6 percent of restorations performed by dental therapists were successful, and that patients were satisfied. Another study demonstrated that dental therapists can improve children’s oral health, especially in areas without proper coverage. Throughout the United States, new legislation is capitalizing on the international success of dental therapists; in the spring of 2009, Minnesota passed a bill creating a bachelor’s degree program in dental therapy.

Opening the market to dental therapists provides more than just quality, affordable health care. It also provides jobs, especially in depressed rural economies that have trouble attracting professional dentists on a permanent basis. A change in the law would benefit both those newly employed therapists and their patients, who would have significantly better access to dental care. This is an important contributing factor to general human welfare, because improving oral health helps to improve overall health. Recent studies have indicated that gum disease is correlated with increased risk — and is potentially a contributing factor — for other health problems, like heart disease.

Dental therapists provide an economical way to combat tooth decay, and public health officials have already suggested plans to implement training programs in the United States. The only obstacle to their introduction in Missouri — and to subsequent improvement in the oral health of Missourians — is the regulatory barrier of Missouri’s professional licensing law.

Caitlin Hartsell is a public health graduate student at Washington University and an intern for the Show-Me Institute.