Caitlin Hartsell
[Author's Note: I incorrectly reported that the agreement with the ADA ended Alaska's program; it is, in fact, still thriving, and the second class graduated this past week. Thanks to Fiona Brosnan of the ANTHC for this correction. — Caitlin Hartsell]

Oral health is a huge public health issue in Missouri: The state is 47th in the nation for the percentage of the population that visited a dentist last year. The St. Louis Post-Dispatch recently ran an article highlighting the lack of dentists in rural Missouri and its effect upon dental health.

Alaska had a similar dental problem in the tribal areas, which had the worst rates of oral health in the country. Alaskan dental therapists — trained to do most basic dental work, except for oral surgery — became a much-needed solution to the problem. The New York Times ran a story last year about that program:
After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities. Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. Johnson’s.

The American Dental Association (ADA) sued the Alaskan Native Tribal Health Consortium (ANTHC), and they ultimately reached an agreement that essentially ended the program. The ADA argued that dental therapists cannot adequately provide health care. Some groups have argued that there are too many dentists already; this site features a quote from a dentist in Missouri who argues that a dentist is at most an hour from all rural areas.

But, if dentists are so accessible, why are Missouri's oral health outcomes so low? Cost and access are both issues; even if a person can get to a dentist, they may deem dental services to be too expensive when money is tight. Dental therapists, because they need only two years of training rather than four post-college, are able to provide comparable care at a more affordable rate. Anyone who needs more than basic drilling and cleaning can then be referred to a professional dentist.

Dental therapists have been successful in England, Canada, and Australia at providing quality dental care. Dental therapists in Australia are proving their worth beyond just basic oral health care. A recent study found that 95 percent of restorations done by dental therapists were successful, and patients were satisfied.

Dental therapists provide more than just quality, affordable health care. They also provide jobs, especially in depressed economies in rural areas that have trouble attracting professional dentists on a permanent basis. Unemployment in Missouri, while lower than the national average, is still higher than 9 percent. A change in the law would benefit both those newly employed therapists and their patients, who would have significantly better access to dental care.

The health care reform debate has focused primarily on health insurance. The majority of people who have health insurance, though, still do not have dental coverage. The best way to improve the dental health of Missourians is to lower the cost in order to improve access. Dental therapists provide an economical way to combat tooth decay, and plans to implement training programs in the United States have already been suggested. The only obstacle to their introduction in Missouri — and to subsequent improvement in the oral health of Missourians — is the regulatory barrier of professional licensing.

About the Author

Caitlin Hartsell