By Tim Carpenter
August 28, 2016
Four out of five counties in Kansas don’t have enough dentists to meet demand, and 14 of the state’s counties have no dentistry practitioners at all.
A surge in retirements among Kansas dentists is expected to expand service deserts in predominately rural areas and access challenges in urban centers. Dwindling compensation for dentists who see Medicaid patients — made worse by Gov. Sam Brownback’s recent 4 percent cut in reimbursements — limits oral health care options for low-income, elderly and disabled people throughout Kansas.
In early August, the Kansas Board of Regents raised the possibility to starting the state’s first school of dentistry at the University of Kansas Medical Center. Start-up costs were pegged at $43 million, and the idea doesn’t appear to be on a fast track given the state’s tax revenue problems.
A coalition of more than 50 advocacy groups suggests an alternative: Educate a corp of dental therapists to work under supervision of established dentists to help cover the service gap. The therapists would be trained at accredited schools and undergo licensing exams.
Graduates of the dental therapy programs would be eligible to perform routine or preventative care that included extractions, fillings and cleanings.
Mollie Day, a dentist who works at the Health Partnership Clinic in Olathe, said the concept endorsed by the coalition has met with success in other states and countries.
“Dental therapists will expand the opportunity for everybody in Kansas to have access to adequate oral health care,” she said.
The Kansas Dental Project’s coalition includes the Kansas chapter of Americans for Prosperity, Oral Health Kansas, Kansas Dental Hygienists’ Association, Disability Rights Center of Kansas, Kansas Action for Children and numerous health-related groups. The Kansas Dental Association is not part of the coalition, and didn’t respond to a request for comment about the dental therapy proposition.
Since 2011, the Kansas Dental Association has lobbied in opposition to a prescription for filling the service void by opening the dental field to a cadre of therapists who fill a role similar to that taken on by nurse practitioners and physician assistants in the medical field. The association’s representatives argued patients would be placed in danger if dental therapists as quality of care were reduced to third-world levels.
An undercurrent in the debate before Kansas lawmakers is threat of a new competitor in the dental marketplace, if the dental therapists were in the future allowed to set up independent practices.
Annie McKay, executive director of Kansas Action for Children, which heads the coalition, said research showed providers working as dental therapists would provide safe and quality care. She said dental therapy education programs would be accredited by the Commission on Dental Accreditation, the agency that certifies dental schools.
Deployment of these collaborative practitioners will allow existing dentists to expand operations on-site or at satellite facilities, she said.
McKay said hundreds of thousands of Kansans lacked access to regular dental care. Untreated dental problems can lead to an assortment of medical problems. Tooth decay is the top chronic childhood illness, she said.
“We can begin to fill the gap in dental care for the hundreds of thousands who don’t get it,” she said. “This is a low- to no-cost option for the state of Kansas. This is something that makes sense. It’s a job-creation program.”
She said dental therapists the state’s safety-net health clinics would be able to stretch funding to increase the number of patients served if there was an accessible alternative for basic dental care.