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Bill would solve Arizona’s dental health crisis


As of December 2017, more than 4.6 million Arizonans live in a federally designated dental health professional shortage area. In fact, compared to the rest of the United States, Arizona has the highest percentage of its population living in a federally-designated shortage area. And this crisis impacts every corner of our state, including large portions of all 15 counties, and all of Graham, Greenlee, La Paz, Santa Cruz and Yuma counties.

The shortage of available dental providers hits especially hard in poor neighborhoods, tribal communities and rural areas. Although children are covered for dental services under AHCCCS, sadly less than half received any dental care at all in 2016. A number of factors contribute to this crisis, but the key fact remains: Families living in rural and low-income areas are at the highest risk for poor oral health, have the fewest provider options, face longer wait times for appointments and travel farther to find a dentist. A child going without quality dental care is at much greater risk of serious health issues now and in the future.

Sen. Nancy Barto

Sen. Nancy Barto

Dental issues can also severely impact a child’s education and future success. Preventable tooth decay and the dental pain associated with it are major contributors to increased school absences, lack of confidence, poor self-esteem, and the inability to concentrate at school. While we all agree that a good education is key to pulling a child from poverty and putting him or her on the path to success, the lack of quality dental care makes those outcomes even harder.

This is why I have introduced legislation authorizing the licensure of a type of allied dental professional, called a dental therapist. By adding dental therapists to the existing team of dental care providers, we can bring more qualified dental professionals to rural and other communities in need and empower both private and nonprofit dental clinics that wish to expand their practices and serve more Arizonans. Dental therapists are proven to be an effective, and an integral part of the dental care delivery system. They have worked successfully in more than 50 countries since the 1920s, and in parts of the United States since 2004. More than 1,000 studies, reports and assessments confirm the safety and effectiveness of highly skilled dental therapists. Further, the Commission on Dental Accreditation — the national accrediting body for all dental education programs — spent six years studying the literature, reviewing the facts, and receiving public input before releasing national educational standards for dental therapists.

Dental therapists work under a supervisory relationship with a dentist, sometimes working in remote locations, or during hours when the dentist can’t be present. They communicate regularly with their supervising dentist using innovative telemedicine technologies. As professionals in a dentist-led team, dental therapists work much in the same way nurse practitioners and physician assistants do, extending the reach of physicians, allowing them to concentrate on patients with complex needs and more complicated procedures.

For the past 18 months, I have worked closely with the dental industry, health care providers, and community interests to develop this proposal. I have spoken with regional dental testing agencies, local dental educators, and reviewed countless studies on the safety of dental therapists and the impact they have had in other states to increase access to dental care for underserved children and adults. Only by working together will we be successful in adopting innovative solutions to enhance the accessibility of our existing dental care delivery model. I strongly urge my colleagues to join me in addressing this critical need. Dental therapists are a proven, actionable first step toward improving the overall health and wellness of our state, and a bright future for our children.

— Sen. Nancy Barto, R-Phoenix, chairs the Senate Health and Human Services Committee.


The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.


  1. Dental therapists are being given mythical powers in stories like this…but it is based on vapor. It is more like an urban myth, which has been repeated so many times that people believe it without questioning it. It is also one of those “too good to be true” scenarios which ought to be vetted thoroughly.
    This description of a utopian dental health model is not based on any country on this planet. There are countries that have had dental therapists for decades and they have the same problems that Arizona has. I cannot find info on any country that has had dental therapists and has solved all the problems that Arizona has. The promises are lies. They have never materialized anywhere…SB1377 does NOT legislate a solution. It just legislates dental therapists. Dental therapists are not a model of care, or a system of care, or a plan of action. What they do is entirely dependent on their employers. Same as employed dentists.
    I challenge you all (incl Sen Barto) to find a country that has had dental therapists and can boast that today they do not have the problems described above as Arizona’s problems.

  2. I did not mean to suggest that Sen. Barto was lying. I meant to say that she has been lied to. The organizations pushing for dental therapists in the US are making false statements and painting false pictures. They are exaggerating from a couple of specific, small truths and spinning large tales that are not backed up by any evidence. These entities are either ignorant of the history or they are naive about the small role of dental therapists, or they have a hidden agenda that purposely spreads their propaganda in order to make money somehow.
    It’s not that dental therapists cannot do the job they are trained to do, it is just that it takes public policies and funding for programs that address Arizona’s problems in order to expect resolution of the problems. The problems were never solved by simply adding dental therapists and seeing what happens next. Bills that do not connect their proposed solution to the problem should not be passed. Dental therapists are not a solution…they are lower-level, lower paid workers whose employment lowers the labor cost of their employers. In the private sector, the financial beneficiaries are the employers, with no reason to expect that patients will be charged lower fees. When a bill fails to strongly connect the solution to the problem, then the private sector is not even obligated to address the problems of the populace. And whenever the marketplace dictates the distribution of health care, the result is predictable: the most care is available to those needing it the least, and the least care is available to those needing it most. Thus, more care is available, but in the metro and suburban areas…not in the shortage areas…and not for lower fees to patients. The history of trying to solve these problems goes back over 50 years. The propaganda that pushes for dental therapists is ignoring what has not worked in the past. There is good historical evidence that the proposed approach will not effectively or efficiently address Arizona’s dental health problems. And there is no evidence that the dental health problems of any country were solved just by creating the occupation of dental therapy…and the fact is that countries with dental therapists still have the problems that Arizona has.

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