Related Reforms Posted on September 12, 2017 | Op-Ed

Evidence Supporting Dental Therapy Continues to Mount

Many Arizonans know that it is often difficult to obtain dental care. Even if one is fortunate enough to get a timely appointment, the cost of dental services can be prohibitive. Receiving accessible and affordable dental care is an especially great challenge for those Arizonans living in the state’s vast rural areas, where dentists are few and far between.

Of the state’s 7 million residents, 2.4 million are living in areas designated as dental health professional shortage areas. A dental shortage area means that there one or fewer dentists per 5,000 people. To address this shortage, some are recommending that the Arizona legislators allow for the licensing of mid-level dental providers, or dental therapists, to deliver some of the services offered by dentists.

In Arizona, a dentist is allowed, per their Arizona license, to perform more than 400 procedures. Under a dental therapy license, a dental therapist would be allowed, after meeting the education and training requirements, to perform approximately 80 of those procedures, including fillings and tooth extractions.

Despite overwhelming evidence demonstrating the safety and patient satisfaction of dental therapists in other states and across the globe, the dental establishment has actively resisted this reform and usually cites unfounded concerns over patient safety.

The reality is that the safety and quality track record for dental therapists is long and well-documented. Dental therapists have been providing care for decades in more than 50 countries around the world and a growing number of states in the U.S.

More than 1,000 studies and evaluations confirm that dental therapists provide safe and high-quality care for dental patients. A recent study conducted by researchers at the University of Washington School of Dentistry examined communities both with and without dental therapists in communities of 58 Alaska Native tribes between 2006 and 2015 where dental therapists are allowed to practice on tribal lands.

Using data from 13 dental therapists who provided the equivalent of 9,012 days of treatment in those communities, the authors found that the increased dental therapy treatment days were associated with more preventive care, fewer tooth extractions for children under age 3, and fewer permanent tooth extractions for adults.

The authors concluded: “There appear to be clinically meaningful differences between communities with no Dental Therapists and communities with the highest number of Dental Therapist treatment days, with the latter communities exhibiting utilization patterns consistent with improved outcomes (e.g., more preventive care, fewer extractions, less general anesthesia).”

Given the severe shortage of dental providers across the Grand Canyon State, it has become increasingly important for Arizona lawmakers to focus their attention on providing access to affordable dental care. A coalition of Arizona groups called Dental Care for Arizona is seeking to bring the issue before the Arizona legislature by a legislative review committee. A similar application was made last year, but that effort was unfortunately blocked and was never introduced in the Arizona legislature.

The group has formally submitted another request. If approved later this year, this issue will come before the Arizona legislature.

Given the seemingly intractable problems of the lack of dental care access and affordability in Arizona, proposals to address the issue should be publicly debated and discussed before the legislature. Arizonans, through their elected representatives, should be allowed to learn about and publicly debate the best ways to address the health access issues facing their communities. A legislative review committee should not use their veto stamp to stop the discussion.

Naomi Lopez Bauman is director of healthcare policy at the Goldwater Institute and is a co-author, with John Davidson of the Texas Public Policy Foundation, of a recent study The Reform that Can Increase Dental Access and Affordability in Arizona.


Naomi Lopez Bauman, serves as the Director of Healthcare Policy for the Goldwater Institute. She most recently served as the Director of Research and the Director of Health Policy at ... Read

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