Ninety-seven percent of Idaho suffers from a shortage of dentists. Almost half of Idahoans do not have dental coverage. Yet, low-cost, high-quality preventative dental care in Idaho is possible. All it would take to make basic dental care more affordable is for the Legislature to allow dental therapists to practice in Idaho.
Dental therapists are mid-level dental care providers, basically the physician’s assistants of dentistry. These providers are trained to do more than dental hygienists, whose training is primarily limited to tooth cleaning, but they don’t have the same expertise as dentists. Still, dental therapists can crown teeth, fill cavities, extract teeth and perform other minor operations. Dental therapists do not offer gum surgery, root canals or dental implants — those procedures are still provided by dentists and surgeons.
The implementation of dental therapists has already been successful elsewhere. Alaskan tribal clinics had the first dental therapists in 2004. Since then, a total of 18 states have allowed dental therapists to practice in some fashion within their borders. The first comprehensive study of dental therapists’ impact on health outcomes was published in 2017 by the University of Washington. Researchers found that tribal communities benefited greatly from dental therapists. A greater proportion of tribal members received preventative care and fewer had teeth extracted.
In Minnesota, two studies found similar results: Access and care increased while costs went down for patients. These successes could be applied to our state’s woes.
Last year, the Idaho Legislature expanded Medicaid to include preventative dental coverage. Proponents argued this would reduce costs as fewer patients would end up receiving emergency dental care under Medicaid. Critics argued it didn’t make sense to have taxpayers paying for dental coverage for folks on Medicaid when almost half of Idahoans do not have dental coverage of their own.
Dental therapists could alleviate the concerns of both parties. If therapists can provide preventative services rather than dentists, the state’s costs for covering these services will go down. For Idahoans who don’t have Medicaid coverage or access to private dental coverage, therapists could greatly increase access and affordability. As the state legislature looks to contain the costs of a burgeoning Medicaid program this coming year, dental therapists can provide part of the solution.
Allowing dental therapists to practice in Idaho would lower the barrier into the dental profession because therapists do not have to complete as much schooling as a dentist does. As such, there would be increased competition in the marketplace, leading to greater access and lower costs. Particularly in smaller rural communities, where there is not enough demand for multiple dentists, but too much for just one dentist, a therapist could meet that need.
But dental therapists do not have to be viewed as competitors to licensed dentists. Dental therapists provide minor procedures, and by covering patients who need those services, the therapists allow dentists to take on the more complex and profitable procedures. Rather than spending her day performing examinations and filling cavities, a dentist could focus on root canals, implants and more. This was the case in the dentists’ offices studied in Minnesota — each office saw its revenue increase as it could meet the needs of more patients.
The move toward dental therapy comes at a prescient time. As healthcare costs are soaring, dental therapy could be a win-win solution for Idahoans. Patients across the state win as they have better access to dental services. Taxpayers win as the costs of Medicaid dental services can be reduced, albeit slightly. Dentists win as they are freed up to provide more complex procedures they have been trained to do.
Legalizing dental therapy in Idaho should not be like pulling teeth. We all have something to gain.