Dentist: Practitioners could fill gaps in care

TOPEKA — A Kansas dentist who supports the use of registered practitioners to fill large gaps in dental services says the industry needs to solve the problem before public pressure forces the state to step in.

Daniel Minnis, a dentist from Pittsburg, says he knows he's in the minority among fellow dentists.

One reform option being studied in such places as Alaska and Minnesota is to increase the number of people trained to work in the oral health field. Efforts in those states were met with fierce opposition from dentists and the state and national associations representing them.

Fifteen Kansas counties have no dentist, and more than 80 are underserved by dentists. Minnis said those counties would benefit from the introduction of dental practitioners who would operate much like nurse practitioners and physician assistants do for medical doctors.

Minnis said dental practitioners would be state-regulated therapists who could cover the basics in community health offices and send complex cases to full-fledged dentists.

But with many dentists spending hundreds of thousands of dollars for education and facilities to operate their practices, it's not easy convincing them that it's in their best interest to welcome new competitors for their business.

"I'm aware of very few dentists who believe in the mid-level provider," Minnis said.

Kevin Robertson, executive director of the Kansas Dental Association, said there's risk in allowing Kansans to receive dental treatment from people who aren't trained as dentists.

"Providing access to all Kansans cannot be accomplished by simply creating a new dental therapist or other new dental provider whose inadequate training and education puts the very patients they are intended to help at serious risk," he said.

Robertson said the Kansas Dental Association is exploring ways to get more coverage to more people, including strategies such as expanding Medicaid dentistry programs for the poor, promoting fluoridation and preventative education and offering incentives for dentists to locate in underserved areas. Another option being discussed is requiring Kansas students enrolled in a cooperative agreement with the University of Missouri-Kansas City to work in rural counties after graduation.

No more than 25 percent of Kansas dentists accept low-income adults and children who are insured through Medicaid.

"Dental care is out of reach for far too many Kansans," said Anna Lambertson, executive director of the Kansas Health Consumer Coalition. "We're talking about farmers, small-business owners, families that have lost their jobs in this economy being unable to find a dentist."

The Kansas Health Policy Authority, which puts out an annual summary of active dentists in the state, said there were 1,353 dentists in Kansas serving an average client base of 2,083. But with two-thirds of the state's dentists concentrated in five counties, the statewide ratio can be deceiving.

Kansas is one of five states, along with Ohio, New Mexico, Washington and Vermont, taking part in the Dental Therapist Project funded by the W.K. Kellogg Foundation. The states are slated to share $16 million earmarked over the next four years to raise awareness of oral health challenges and lobby for adding dental therapists.

The Kansas Health Consumer Coalition, Kansas Action for Children and the Kansas Association for the Medically Underserved are collaborating on the campaign.

"We can't just continue to look the other way and hope the problem will get better on its own because it won't," said Shannon Cotsoradis, president of Kansas Action for Children. "We might not be able to solve a lot of the work force shortage problems in rural areas. But with the addition of a dental therapist to the team, we can solve this one."