Recent wheeling and dealing over bonding and budgets sidelined a pioneering health care proposal — creating the dental equivalent of a nurse-practitioner — to help address the state’s widespread gaps in dental care access. Do you think mid-level dental providers are a problem or a solution?
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I find it interesting that this proposal for an “Oral Health Practitioner” is forthcoming from Minnesota. I am an Arizona dentist with strong family ties to the rural western part of your state.
So why do I practice in the Southwest? There are principally 2 reason– (1) your 2% healthcare provider tax and (2) a dominant dental insurance company (Delta) which is very hostile to the dental community.
After the provider tax was implemented in the 1990’s, Minnesota lost 8% of its dentists over the succeeding decade. Simply put, this is an example of the “law of unintended consequences”. State legislators are so brilliant!!!
Give Minnesota’s dentists a level playing field with the rest of the country and your “access” problem may not go away, but it will be considerably improved. It is my opinion the seeds for the OHP fiasco were sown 15 years ago and now another poorly thought out “solution” is the result.
Richard Snow DDS
Access to care is a HUGE problem in every U.S. state. Dentists have priced themselves out of being allowed to keep their lucrative monopoly. Many are turning their practices into Spas for the wealthy, offering massages and botox.
Although dentists get “welfare for the rich” in the form of school and tuition government subsidies and are licensed by government entities supported by taxpayers, dentists are under the illusion they did it on their own.
Organized dentistry has allowed a dental health crisis to occur on their watch and they shouldn’t be trusted to come up with a solution, which invariably always is “gimme more money.”
80% of dentists refuse Medicaid patients. Most won’t live in lower-income areas. 108 million Americans don’t have dental insurance.
Organized dentistry also told us fluoridation would wipe out tooth decay. After 60 years of fluoridation, fluoridated dental products have become a multi-billion dollar international business but tooth decay is rising and UNtreated tooth decay is rising even more along with fluoride overdose symptoms - dental fluorosis or discolored teeth.
Dental therapists are a vital need in the U.S. If dentists are concerned about the quality of care these therapists will deliver, they’d better clean up their own acts.
I have never met anyone who doesn’t have a dentist horror story.
Unfortunately, organized dentistry, such as the American Dental Association, are heavily subsidized by fluoride and dental product manufacturers which gives them the money to lobby our legislators for laws that benefit themselves and their benefactors - which does not include you and me.
The Surgeon General identified this oral health crisis in 2000. Nothing has changed. Dental Therapists would start tomorrow if the ADA and its affiliate groups weren’t so politically powerful.
Thank you for your editorial on mid-level dental practitioners who could provide primary dental care only a dentist can provide now. The Oral Health Practitioner (OHP), the Minnesota model of a mid-level practitioner, promoted by the Safety Net Coalition, MnSCU and the Minnesota Dental Hygienists’ Association, is based dental therapists utilized in other countries such as New Zealand, where they have beern practicing for over 60 years.
The Minnesota Dental Association keeps repeating this is an unsafe, risky, and untested dental provider. In fact, several studies of dental therapists have shown safety and quality equal to a dentist at much lower cost to the client or state. In addition, the provision clearly states that the collaborative management agreement between the OHP and the supervising dentist would be a Minnesota dentist.
Unforeseen events can occur in the dental chair, as Dr Templeton points out. The OHP would refer a patient to a dentist in such circumstances, just as a dentist does now when faced with a situation beyond her/his capacity.
Another argument often heard by the dentists representing organized dentistry is that the OHP would be extracting teeth with only half the education of a dentist. The OHP would have equal education to the dental students for the services they will be taught to provide. Since OHP’s will not be learning the entire scope of practice of a dentist there is no need for four years of education.
In closing, please keep in mind the thousands of Minnesotans who cannot find a dentist who will provide them with dental care that only a dentist can provide now. We don’t need more dental providers who cannot drill and fill and remove diseased teeth. Dentists have put up tremendous opposition to the OHP but have offered nothing to meet this need other than a loan forgiveness program for new graduates. This is great but not enough. I hope the legislators have the courage they showed in passing the transportation bill to look past the fog of fear the dental association has created and pass the Oral Health Practitioner bill into law.
Candy Hazen
Mid-level dental practitioners will contribute and support the problem of ongoing poor quality and poor access to dental care in Minnesota. Having lived in northern Minnesota for 15 years, I had to drive 2 hours one way to get to a Periodontist. Then after months of treatment, found that I could not even get anyone to make a mouth-guard nor do a regular cleaning of my teeth as required. After determining the best rated Dentist in the area, she pulled a tooth and made a flip that didn’t work as it kept breaking. The result of which is now $30,000 in damage to my teeth which all have to be pulled and since I have been informed that I cannot have dentures but need full implants. This is according to two specialists in St. Cloud, who actually both had different opinions but were supposed to be working together. I quit seeing them because I became scared and confused about my well-being. We literally moved 3 hours away to be nearer better Dentists. Not! We have since dropped our Delta Dental which took thousands of our money and would only pay $1200 of my procedure and I sit with my teeth Polidented in my mouth. I am only 54 and have 2.5 Degrees and cannot go to work so we live on my husband’s retirement.
Anyways, the problem is that the Dentists are not very good in outlying areas at all. So why would I want someone even less qualified. The outlying areas lack Specialists and competant Dentists and that is what they need as I have met many many people with missing or cobbled together teeth. There need to be incentives for real Specialists to come to areas from mid-way up on the State to the Canadian Border.
And as an added note, if anyone knows of someone who can help me, please let me know.
M M Smith
If I had to choose between using a Dental Hygenist or a Registered Dental Assistant (”RDA”) to assume a role “equivalent to a nurse practitioner,” I would choose a RDA, hands down. With all due respect to hygenist, licensed RDA’s have daily in the mouth experience and their capacity to perform many dental procedures is ligh years ahead of hygenists. A hygenist, virtually, sees no restorative or surgical procedures performed, and are primarly educated to clean teeth and promote oral hygiene.
Is a midlevel dental provider the same as a nurse practitioner? Unlike dentistry, today the medical profession suffers from being understaffed in the family practitioner area. This is because more and more physicians decide to specialize. In this unique situation, nurse practitioners fulfill a real need for help with patient care in the family practice arena. The dental profession has never been understaffed, and there has never been a need for a “mid-level provider.
In addition, nurse practitioners seldom work further away from their supervising doctor than a treatment room or two down the hall. And, while a nurse practitioner may be very good at one or two perscribed procedures, they lack the breath and depth of training to handle the more complex problems that always seem to come up. The same would hold true for a mid-level dental provider. The salary of a nurse practitioner though much lower than that of a family practice physician, one good physician can easily do the work of several nurse practitioners. This also makes the cost of a provider a rather mute point to aruge.
General dentists are not retiring because they are actually practicing longer these days. With their income incresingly controlled by insurance companies, dentists simply cannot afford to retire as early as they did 30 years ago. So, is there a shortage of dentists in the Twin Cities? Absolutely not! Is there a shortage of dentists willing to work in the areas outside the glitter of a “big city life?” Absolutely yes! If the State of Minnesota used 15% of their health care tax surplus to pay dentists to work in rural areas, would they do so? Absolutely yes! Is there a real need for a mid-level dental provider in Minnesota……what do you think?
Lloyd Wallin, DDS
Burnsville, MN
Lloyd A Wallin DDS
The Propasal of the Oral Health Practitioner I find is not needed.
If the State of Minnesota would remimburse dentists at a decent level for MA and other state funded programs. There would be many dentist more than happy to work in these rural areas. Including the dentists that already work in these small towns. There surely is NOT a shortage of dentsits in Minnesota or graduating out of the schools. I would also have to agree with Dr Wallin on I would sooner choose a dental assistant to assume the role of a Oral Health Practitioner. Over my years of practice I have worked with MANY hygensists. MAYBE a handful of them can not even take a simple impression and when they can they were ASSISTANTS first!
Shelly RDA
Shelly Christopherson, RDA
This use of a OHP is obviously filling an important need!
In response to Lloyd Wallin DDS,
you obviously have no idea what a nurse practitioner is or what one does! You are giving false information. NPs regulations due vary state by state, and Minnesota’s are more restrictive than most other states, but in many states NPs are independent primary care providers. They have their own practice, without physicians present. NPs bill under their own provider numbers.
Study after study after study proves outcomes are no different when compared to primary care physicians….
(one recent study found outcomes for diabetic patients better when an NP was a part of a group practice as compared to an all physician practice). Now NPs are moving towards doctoral degrees.
It is probably in your self interest not to like the idea of an OHP, but it is probably in the patients best interest to have options!
SD