Boston University Statehouse Program
This article was also published in the Worcester Telegram & Gazette.
BOSTON – A battle over healthy teeth continues to split Worcester legislators on Beacon Hill, as debate continues over the best way to increase access to dental care for underserved populations.
Two bills, each sponsored by a Worcester state senator, would create a new class of midlevel dental professionals. While the training requirements and restrictions placed on these caregivers differ, the goal remains the same: to increase the availability of dental services.
“Most people forget that the mouth is really the window to the body and the body doesn’t stop at the neck,” said Sen. Harriette Chandler, D-Worcester, who sponsors one of the Senate bills. “Oral health care, dental care, is medical care.”
Ms. Chandler’s bill seeks to create a new profession in the Massachusetts dental industry. These dental therapists could work without the immediate supervision of a dentist and travel outside of the office to provide basic care to patients. Dental therapists would oversee procedures including filling cavities, pulling teeth and replacing a temporary crown. Ms. Chandler compares these providers to physicians’ assistants.
Hygienists will also be able to provide dental care to patients remotely, increasing the number of professionals able to perform certain procedures even before the first group of dental therapists could be trained.
Ms. Chandler proposed similar legislation last year. It passed in the Senate as an attachment to the state budget but failed to gather House support.
“Our bipartisan coalition agrees that with this legislation we have a solution – and after four years of debate, it’s time for this solution to become law,” Ms. Chandler said in a written statement.
By creating a new dental profession, Ms. Chandler’s bill hopes to expand dental options, allowing low-income residents to find care that best meets their needs and budget.
According to Neetu Singh from Health Care for All, dental therapists would require less training and earn less, making them more likely to accept payments from the state’s Medicaid provider, MassHealth.
Currently, the majority of dental providers do not accept MassHealth. In 2014, only 35 percent of dentists treated MassHealth patients, according to the Massachusetts Health Policy Commission. Further, a Pew Research Center study found 47 percent of children covered under MassHealth did not see a dentist in 2014.
The bill would also allow dental therapists to provide care at patients’ homes, targeting rural communities where dental offices are few.
“Care should be given in a community setting,” said Amy Rosenthal, executive director of Health Care for All. “You have the providers out in schools, nursing homes and (rural areas) for people who are not able to come into our clinics.”
While opponents of the bill agree that a midlevel care provider would increase access, some dentists, including those at the Massachusetts Dental Society, worry about the level of education the new profession should require.
Under Ms. Chandler’s bill, dental therapists would have three years of specialized education after high school. Dr. David Lustbader of the dental society says he worries that these professionals will not have enough training to perform certain procedures.
“Anything that’s invasive and irreversible, we want a dentist there,” Dr. Lustbader said.
The dental society proposed its own version of Ms. Chandler’s bill this session. The proposal would create midlevel care providers called dental practitioners. The new profession would require a bachelor’s degree as well as two years of additional education.
The MDS-backed bill would also mandate that a dentist be in the same building as practitioners and supervise them directly during irreversible procedures, like drilling and extracting teeth.
“People need to think how they want their own children or own relatives treated,” Dr. Lustbader said. “Would you want someone three years out of high school treating you with no supervision? Or would you rather have someone with a master’s (degree) under supervision (of a dentist)?”
According to Dr. Lustbader, getting dental therapists out to underserved communities is another area of concern. MDS’ bill requires that dental practitioners work in regions federally classified as dental practice shortage areas. Ms. Chandler’s bill does not include the same mandate.
Sen. Michael Moore, D-Millbury, said he chose to sponsor the MDS bill in order to create compromise between groups and increase dental care options.
″(MDS) is really receptive to compromise,” he said. “The overall goal is to get everyone at a table and get a version everyone supports.”
MDS’ proposal also includes additional provisions to increase awareness and use of dental services. For example, children must receive dental screenings before entering kindergarten.
Rep. James O’Day, D-West Boylston, also supports midlevel dental care professionals who would increase access to dental care statewide.
“There are very few dental programs out there for working families,” he said. “Those that are sort of in the middle of the pack have trouble affording dental care.”
However, Mr. O’Day said midlevel care providers should work in the same buildings as dentists, who have more training and can address complications.
According to Ms. Chandler, confining dental therapists to the confines of the office would limit their ability to deliver care to those in need. Training will be rigorous, she said, and would follow training standards already created by the Commission on Dental Accreditation.
“These are tough requirements, we’re going to keep them tough,” Ms. Chandler said. “We’re concerned mostly with access, that’s the bottom line.”
Dental therapists currently practice in three other states: Vermont, Minnesota and Maine.