Several groups throughout the state are pushing for a new kind of dental provider – called registered dental practitioners – in an effort to alleviate the state’s shortage of dentists.
Dental practitioners – also called dental therapists in some states – are between a hygienist and a dentist and can perform such procedures as cleanings and extractions under the supervision of a dentist.
“Mid-level dental providers are something that could change the workforce in Kansas. Nurse practitioners and physician’s assistants have done that for the medical community, so why shouldn’t the dental community have the same option?” said Christie Appelhanz, vice president of public affairs for Kansas Action for Children, which is a part of the Kansas Dental Project that supports dental practitioners.
Eighty-six of Kansas’ 105 counties qualify as dental health professional shortage areas, according to Kansas Department of Health and Environment data from January.
And 13 counties do not have a dentist at all, according to the Kansas Dental Project, which is funded by the Kansas Health Foundation, United Methodist Health Ministry Fund, Health Care Foundation of Greater Kansas City, REACH Healthcare Foundation and the W.K. Kellogg Foundation.
A proposed bill last legislative session to create registered dental practitioners did not receive a hearing or move forward, but advocates say they will try again.
The Kansas Dental Association opposed the most recent legislation, said Kevin Robertson, the association’s executive director.
“We believe the best solution to any ‘dental desert’ or access to care for individuals is to create more dentists and get them in the areas where they need to be,” Robertson said.
Robertson said he doesn’t think it’s likely dental practitioners would fill the needs in rural areas and that the same barriers that prevent some dentists from practicing in rural areas – cost and the number of patients – would also keep dental practitioners from locating in those communities.
“I’m not convinced you could get people in those areas. … It would create a two-tiered system for care and I don’t believe that’s appropriate either,” he said.
As of 2013, there were about 1,450 dentists in Kansas, Robertson said.
Wichita dentist Jason Wagle, who is past president of the Kansas Dental Association, said “a lot of dentists don’t necessarily see a need (for a mid-level) because they’re not overly busy.”
Wagle says he does not support allowing a mid-level dental practitioner to do any surgical procedures because a lot of those procedures are irreversible.
“I believe that a patient needs to have the best care possible, not something that could potentially harm the patient done by someone who doesn’t have the degree to do it,” Wagle said.
Kansas dentists have done many things to improve access to care over the years, Wagle said. Those steps include expanding practice for dental hygienists, getting legislation passed so dentists can have multiple practices, scholarships and loan payment programs for those who want to become dentists and practice in rural areas, and the Kansas Mission of Mercy, which provides a free dental clinic in a different city each year.
Jeff Glendening, state director of the Kansas chapter of Americans For Prosperity, a conservative advocacy group that endorses free market policy, supports the idea of registered dental practitioners.
“It’s a free market issue for us,” Glendening said. “It’s the government getting out of the way and letting the market decide who is best to provide that health care. In the end, as a result of that, you’ll have a lot of underserved areas in Kansas that will have better access to dental care than they have right now.”
Opponents “see that this might affect their livelihoods. I really don’t believe it will, but it’s not the government’s role to protect those,” Glendening said.
Because Kansas doesn’t have a dental school, the state doesn’t have a pipeline for a new dentist workforce, Appelhanz said.
Currently, the state of Kansas has a deal with Missouri. It trades designated spots for students who want to go to dental school at the University of Missouri-Kansas City for spots for Missouri students at Kansas universities’ engineering and architecture programs.
Kansas students get 85 Missouri dental school spots and Missouri students get 481 Kansas spots, he said.
Steve Arnold, associate dean and professor in the College of Health Professions at Wichita State, said that if the state allowed registered dental practitioners, Wichita State would want to pursue offering a degree program.
“I think Wichita State would aggressively pursue the academic program, and it makes a lot of sense to house it here,” Arnold said. “Any degree program related to oral health is going to increase providers.”
Wichita State has the only dental hygiene bachelor’s degree program in the state and it is also home to a one-year residency program for dental school graduates, Arnold said.
Some WSU employees have already drafted a proposed curriculum for dental mid-levels if the profession wins state recognition.
Push among tribes
States including Alaska, Minnesota and Maine allow licensed dental therapists, and several other states are considering legislation.
“This is a solution that in the U.S. was really driven by the tribal community in Alaska. So the tribes (in Kansas) have been interested from that perspective. For Native American populations, the needs are particularly great,” Appelhanz said.
Last fall, Steve Cadue, tribal council chairman for the Kickapoo Tribe, wrote a letter to Gov. Sam Brownback endorsing dental practitioners and to show support for the Kansas Dental Project.
“The issue of dental care has long been a challenge for tribes to maintain consistent, affordable and accessible care,” Cadue wrote. “With the advent of the Affordable Care Act the demand for dental care will likely not lessen, given the already growing shortage of practicing dentists in rural Kansas, the demand for both health and dental care could very well outpace the supply of doctors. We view the present as a time for action in order to be prepared for the needs of all people.”
State Rep. Ponka-We Victors, D-Wichita, who is affiliated with the Ponca Tribe and Tohono-O’odham Nation, said her experience with Indian Health Services has been poor.
“I’ve been through the process and there’s limited access to doctors, emergency physicians and dentists,” Victors said. “When you go into a regular dentist’s office you’re seen right away, but on an Indian reservation, a doctor will only be there a couple of times a week.”
“Sometimes, you have to get a number at 5 a.m. and they only allow numbers one through 10 to get an appointment. If you get there too late, you won’t be seen that day.”
Victors said she supports dental practitioners since she sees them as a way to better serve native people and those in rural areas.
“Who knows? Maybe it will not work,” she said. “But at least get a (legislative) hearing on it so everyone can hear both sides of the story.”