Too many Oregonians — hundreds of thousands people, or more — don't have access to basic dental care.
As Oregon dentists, we understand the effects that has on people's oral health, their overall health, and their daily lives.
A bill that has been approved by the Oregon House of Representatives and is now being considered by the Oregon Senate would represent a huge step to combat that problem in Oregon. The bill, House Bill 2528, would increase access to basic dental care for many more Oregonians by allowing the state to license dental therapists — mid-level providers akin to physician assistants in medicine.
Dental therapists have safely and effectively provided basic dental care to people for decades. For the past 15 years in Alaska. For the past 10 years in Minnesota. For exactly 100 years now in New Zealand. And for the past four years as part of special pilot programs in Oregon.
And they could help many Oregonians now, who need the help.
More than 1 million Oregonians live in areas with a shortage of dentists. All but four counties in Oregon are considered to have a shortage of dentists. And 24 primary care service areas in rural Oregon — areas sometimes covering hundreds of square miles — have no full-time dentist at all, according to a 2020 report from the Oregon Office of Rural Health.
The lack of dental care in many communities has a profound effect on the oral and overall health of people in those communities. Untreated dental problems turn into lost teeth, lost days at work or school and unhealthy eating. They also turn into expensive visits to emergency rooms — visits that don't solve the underlying issues.
And the impact is especially profound among low-income families and communities of color:
• About 60 percent of children and only one-third of adults who are covered by the Oregon Health Plan (Oregon's Medicaid program) see a dentist each year.
• Black children had the lowest rate of access to preventive oral health services and the highest rate of emergency room visits for avoidable dental problems, according to a report from OHSU's Center for Health Systems Effectiveness.
• Oregon children of color have higher rates of cavities, untreated tooth decay and rampant decay than white children, according to the Oregon Health Authority's 2017 Oregon Smile Survey.
In states where they practice, dental therapists can help fill the gap in basic dental care. They may work out of a dentist's office, freeing the dentist to work on more complicated procedures. Or they may work in rural and underserved areas where there are no practicing dentists — but always under the supervision of a dentist with whom they have entered into a detailed collaborative agreement.
And because dental therapists often come from the communities they serve, they stay longer in those communities, offering culturally relevant care.
The dental therapy bill, HB 2528, is carefully written to ensure that only dental therapists with appropriate education and qualifications would be eligible for licensure. The bill:
• would ensure dental therapists are held to the same high standards of care that dentists are held to for every service they provide.
• would allow dental therapists to perform a limited number of the most routine procedures with the appropriate level of supervision; dental therapists would not be independent practitioners.
• would require dental therapists to work in underserved communities
We are part of a diverse group of health and dental care organizations, children's groups, educators, consumers and tribes that are advocating for the passage of HB 2528. We understand the evidence that supports the policy. We understand that the bill would allow qualified dental therapists to safely and effectively provide basic dental care to communities that need that care. And we understand how that will change the lives — and the health — of so many Oregonians.
It's time for the state to expand Oregonians' access to basic dental care by licensing dental therapists.
Miranda Davis, DDS, MPH, has been a tribal clinic dentist for 15 years and supervises dental therapists in Oregon. Gary Allen, DMD, MS, is vice president of clinical services for Advantage Dental.
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