OPINION: Evidence grows in favor of dental mid-levels
Post Date: Oct 02 2015

By Tom Dennis − Editor, Grand Forks Herald
October 2, 2015
The handwriting is on the wall. And the message is worth reading, even though the words are written not in ink but in prescription-strength fluoride toothpaste:
Mid-level dental practitioners are going to be a part of North Dakota's future.
After all, they're already at work in Minnesota and are being considered by more and more states.
Plus, the need for the practitioners remains strong, while the evidence in favor of them continues to grow.
Mid-level dental practitioners — dental therapists in some references, advanced practice dental hygienists or dental hygiene practitioners in others — are the nurse practitioners of the dentistry field. They're not dentists, and neither are they dental hygienists. Instead, they're master's-degree or mid-level practitioners.
In Minnesota, Maine and Alaska as well as Canada and some 50 other countries, they're licensed to not only clean teeth but also fill cavities, pull teeth and place temporary crowns, while working under a dentist's supervision.
Earlier this year, the North Dakota Legislature rejected a bill that would have added North Dakota to the list. But as mentioned, the need remains, and the evidence continues to grow.
The need first:
In North Dakota, "only one in three (33 percent) of kids 20 years old and younger on Medicaid received dental care in 2013, leaving two-thirds (67 percent) without," a press release from North Dakotans for Dental Access reported this week.
"Among all states, North Dakota ranked fourth worst for the number of children on Medicaid receiving dental care.
"'While we're pleased to see a slight increase in the number of Medicaid patients receiving dental care, the number over the past decade has moved very little and remained much too low,' said Rachelle Gustafson, spokesperson for the group and immediate past president of the North Dakota Dental Hygienists' Association.
"It's clear we need some creative solutions to increase access because everyone deserves to receive regular dental care." And that's where mid-level practitioners come in.
Now, the evidence:
"In August of this year, the Commission on Dental Accreditation overwhelmingly voted to implement dental therapy education standards — a significant milestone for the profession," said Julie Stitzel, director of the Pew Children's Dental Campaign, in testimony on Sept. 29 before the Massachusetts Legislature's Joint Committee on Public Health.
"After more than three years of deliberation and a review of thousands of pages of research and data evaluating dental midlevel providers, CODA answered three fundamental questions. Are they safe? Yes. Do they have the ability to increase access to care to the public? Yes. Is the demand for this provider in the field substantial enough to create nationalized accreditation standards? Yes."
Moreover, Stitzel continued, "a joint report released last year by the Minnesota Board of Dentistry and Department of Health evaluating the impact of these providers concluded that they are increasing access to care for vulnerable populations and increasing the efficiency of clinics and dental offices. Further, patients and supervising dentists were more than satisfied with the care they delivered, and there is a growing demand to hire these providers. Finally the report indicated that they have the potential to decrease emergency room utilization for dental related issues."
One more quote, this one from a Sept. 25 editorial in the Boston Globe: "Massachusetts should join Alaska, Maine, and Minnesota in allowing an expanded role for dental hygienists." Sooner or later, North Dakota and the other 46 states also will join that list.
— Tom Dennis for the Herald

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