Dentists Push Back Against Bill That Would Allow 'Dental Therapists' To Practice

Apr 3, 2015

Dental problems will send about 6,000 Vermonters to the emergency room this year. And advocates say it’s because low-income patients can’t find a dentist to treat them. But the Vermont State Dental Society says a plan to improve access by adding a new class of dental professional is a move in the wrong direction.

It’s not that Vermont doesn’t have enough dentists. The nearly 400 that are here should be more than enough to care for a state of about 660,000 people.

But not everyone has such an easy time making an appointment. And the people having the toughest time getting care are the low-income Vermonters on Medicaid.

“Vermont has a serious access to dental care issue,” says Sheila Reed, head of Vermonters for Oral Health Care for All.

Reed says the reimbursement rates for the government-funded insurance program don’t cover the cost of providing dental care.

"There just are not the dentists out there that will accept these patients [on Medicare]. They cannot find care." - Sheila Reed, Vermonters for Oral Health Care for All

“And there just are not the dentists out there that will accept these patients,” Reed says. “They cannot find care.”

Senate lawmakers voted on Friday to create a new kind of dental profession. The new class of professionals would be able to perform more routine procedures that involve drilling, filling, and restorative work – things only a licensed dentist can do now.

Reed says dental therapists, as they’d be known, will provide the lower-cost alternative needed to bring the cost of care in line with Medicaid rates.

Reed says it would solve problems for doctors like one she spoke with in Addison County, who said he had two empty dentist chairs, but couldn’t afford to bring on another licensed dentist.

“Frankly, the dental therapist is paid less than a dentist, and because of our very low Medicaid rates, he can only afford to employ the dental therapist,” Reed says.

Dental therapists would be able to perform procedures that involve drilling, filling, and restorative work - things only a licensed dentist can do now - and will provide a lower-cost alternative.

But Vaughn Collins, executive director of the Vermont State Dental Society, says dentists don’t think the training required to attain a degree in dental therapy will ensure the skills necessary to perform the procedures.

Dental therapists would complete a program at Vermont Technical College, which already offers a dental hygienist program.

“It seems like in our opinion that the level of training they’re getting is not really sufficient for the kind of patient care we would like to deliver,” Collins says. “We really believe that every Vermonter deserves to see a fully licensed dentists, and not just a dental therapist.”

Collins says the access problem isn’t severe enough to warrant the kind of legislation approved by the Senate. According to the National Survey of Children’s Health, Vermont ranks first for fewest oral health care problems, and also saw more children per capita get dental care in the last year than in any other state.

"The level of training they're getting is not really sufficient for the kind of patient care we would like to deliver." - Vaughn Collins, Vermont State Dental Society executive director

Windham Sen. Jeannette White says Vermont has modeled its dental therapist bill from a program in place in Minnesota. White says dental therapists there have improved access for lower-income residents of that state, without any documented adverse impacts on patient health.

And with tens of thousands of Vermonters newly enrolled in Medicaid in recent years, Reed says more residents than ever are at risk of losing access to dental care.

Reed also says that Vermont has the oldest dentist workforce in the country, and that dental therapists will help fill the empty chairs those dentists will soon leave behind.

The bill now heads to the House.