March 12, 2019
By: Michael Carroll
Florida lawmakers this month will be brushing up on the topic of licensing dental therapists, a classification of mid-level dental professionals who are seen by advocates as part of the solution to reducing dental care shortages in the state.
Two state Senate bills about the issue were introduced this month. Their aim is to begin the process of providing training programs for dental therapists, who would receive three years of dental training and be able to perform basic treatments, including the extraction of primary teeth, taking X-rays, diagnosis and applying sealants.
Supporters of dental therapy, including a coalition of 50 groups called Floridians for Dental Access, see the training of dental therapists as a way to expand access to dental care in shortage areas and among Medicaid patients. About 25 percent of Floridians – more than 5.5 million – are residents of regions where the federal government has identified shortages of dental services, according to the James Madison Institute in Tallahassee, which supports licensing dental therapists.
The Florida Dental Association (FDA) opposes the idea, arguing that such programs require a significant amount of money and time to launch. Better ideas, according to the FDA, are college loan forgiveness programs for dentists who practice in shortage areas and increasing reimbursement rates for dental services performed through Medicaid.
“Florida has a horrible access-to-dental-care problem,” Dr. Frank Catalanotto, a health services researcher and supporter of the dental therapy bills, told Watchdog.org. None of the FDA’s solutions will make a dent in the problem, he added.
If the Florida bills pass this year, the state’s dental therapy programs would be required to follow the Commission on Dental Accreditation (CODA) standards, according to Catalanotto. The dental therapists who graduate in future years will accumulate less college debt and will be less expensive to employ, he said.
“We have two state colleges committed to offering the program,” Catalanotto said, adding that the therapists would be able to perform 80 dental procedures, compared to 500 for dentists, after completing their three years of post-high school training.
“With that and using state colleges, you start to attract students of color and students of impoverished backgrounds,” he said.
Dental therapists would also be able to work under the general supervision of dentists, but they could see patients on days when dentists are not in the office, Catalanotto said. In addition, therapists would have access to portable equipment, meaning they could travel to schools or nursing homes to help the under-served, he said.
“They can take care of three-fourths of the needs of these patients,” Catalanotto said, noting that currently only 18 percent of Florida dentists take Medicaid patients.
The FDA’s concerns about dental therapists relate to the association not wanting to lose the monopoly dentists have in providing many oral-care services in the state, he said.
“They don’t want anything that chips away at that monopoly,” Catalanotto said.
Dentists should actually benefit from the introduction of dental therapists in Florida, he said, explaining that the therapists will allow dentists to perform more expensive, high-end dental procedures.
“It frees them up to do more complex dentistry, and studies show they’re making more money” where dental therapists are licensed, Catalanotto said.
Florida emergency rooms received 166,000 visits resulting from dental pain in 2016, he said, and there were more than 4,000 hospitalizations that year due to life-threatening oral-health situations.
Poor dental health among children is especially problematic because studies have shown it can affect how children perform in school, according to Catalanotto.
Dr. Jolene Paramore, the FDA’s president, questioned the effectiveness of dental therapy programs.
“In Minnesota, the only state with a functioning dental therapy program, dental therapists are still largely practicing in metro areas,” Paramore told Watchdog.org in an email, “and the state recently risked losing federal funding for its medical assistance program because not enough children covered by Medicaid are receiving preventative dental care.”
Better solutions are contained in other legislation, House Bill 465 and Senate Bill 716, she said. One key provision of those bills would be to establish a dental student loan repayment program for those dentists who agree to work as Medicaid providers in shortage areas, according to Paramore.
“If the proposed dental student loan repayment program is implemented for five years, there will be capacity to treat more than one million patients during that time,” she said.
Many dentists in such loan-forgiveness programs might remain in under-served areas even after the agreement ends, according to Paramore.
“We’ve also seen that dentists who participate in dental student loan repayment programs will stay and continue serving in these areas, even establishing their own dental practices, which in turn contributes to the local economy and workforce,” she said.
But Sal Nuzzo, vice president of policy for the James Madison Institute, predicted that once the dental therapy program is established in Florida, dentists would accept it.
“When the program has been implemented … the only challenge that they have is graduating enough dental therapists because dentists want to hire them,” Nuzzo told Watchdog.org.
Combining student loan forgiveness with the addition of dental therapists may be necessary to deal with the extent of the shortage of dental services in Florida, he said. Currently, there are 52 dentists per 100,000 Florida residents, compared to a national average of 61.1 dentists per 100,000 people, according to a recent report posted on the institute’s website.
“There has to be a multifaceted approach to this,” Nuzzo said.