A new class of dental therapists, working under the supervision of dentists, would be able to provide basic services under a bill that is halfway through the Oregon Legislature.
House Bill 2528 passed the House on a 38-17 vote Tuesday, April 27, and went to the Senate, where it may be further amended.
Oregon has been searching for alternatives to dental care for a decade, since the 2011 Legislature authorized the Oregon Health Authority to start pilot projects.
One such project started up in 2016, when the state agency allowed the Northwest Portland Area Indian Health Board to develop training of dental health aide therapists with the Alaska Dental Therapy Educational Program. The Alaska program, which started in 2004, also provided help for tribes in Washington, Idaho and Montana.
Therapists would be licensed by the Oregon Board of Dentistry, and practice under supervision of dentists, after they complete accredited educational programs. They would have to spend at least half their time working with underserved populations, or in areas with shortages of health professionals.
Therapists could do more than hygienists, who can remove plaque from teeth and perform exams, among other things.
Rep. Tawna Sanchez, a Democrat from Portland and the bill's floor manager, said only about 40% of Oregon dentists saw patients under Oregon's Medicaid program. That was before the onset of the coronavirus pandemic last year.
"More than 1 million Oregonians live in areas that have a shortage of dentists," Sanchez, the only Native American member of the current Legislature, said. "Low-income families in Oregon often lack access to basic dental care. Less than half the children and about one in four adults covered by Medicaid see a dentist each year.
"Increasing access to basic dental care reduces preventable cavities and other problems that turn into expensive trips to the emergency room and longterm health problems. Therapists in dental offices can serve more people, including those on Medicaid.
"There is no reason, other than a lack of access, for anyone to suffer the debilitating pain of cavities or infections from a lack of dental care."
Eight states license dental therapists.
But Rep. Cedric Hayden, a Republican from Lowell and a dentist, said the bill allows therapists to perform some procedures that should be left to dentists. Among his examples are the extraction of permanent teeth and work on live nerves, both of which may require painkillers stronger than Advil.
"I am serious about providing increased access. But I want to explain my concerns," he said.
"I am not suggesting a wider swath of providers prescribing narcotics. I am suggesting reducing some of the procedures put in at the last minute. Those are procedures that take a higher level of training."
He also referred to a personal experience he had in the Federated States of Micronesia with teeth implantation.
Hayden did vote for the bill in the Health Care Committee, led by Rep. Rachel Prusak, D-West Linn, a nurse practitioner, although he voted against it in the full House.
"There remains a small amount of work to be done on this bill," Prusak said. "We are confident it can happen in the Senate."
Sanchez said a better solution would be to encourage training of full-fledged dentists and physicians who could make a living while serving Oregonians without access to their services.
"I know of people who genuinely want to be a dentist and serve the community they live in, but they can't do that because it's very expensive," she said.
"Further down the road, I would like to make it easier for people to become professionals — dentists and doctors — in these rural areas so they can serve their communities. But for now, this is what we have."
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