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Don’t follow Minnesota’s failed dental therapist experiment

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Earlier this decade, Minnesota lawmakers were convinced they had the solution for rural and low-income people not obtaining oral health care. Create a new mid-level provider called a dental therapist, and all would be right in the world.

What has happened instead should be a cautionary tale for Arizona, where an East Coast foundation is peddling the same off-target solution. While the Pew Foundation and its allies declare Minnesota’s dental therapist experiment a spectacular fireworks show, it’s really nothing more than a few people standing around waving sparklers.

Robert Roda

Robert Roda

Since that vote seven years ago, the percentage of Minnesota’s Medicaid children receiving any dental service has stubbornly remained around 41 percent. Adding almost 80 dental therapists didn’t budge the rate at all. Nor did it reduce dental costs. And now the federal government has put the state on notice: It is at risk of having federal Medicaid money withheld.

In contrast, 49 percent of Arizona kids on AHCCCS had a dental visit last year, about the national average. That’s still not high enough, but increasing the rate comes from understanding why kids aren’t getting oral health care. It’s not because of a lack of providers. We need real solutions that address real issues.

Minnesota shows us why. After seven years of expecting dental therapists to fix the problem, Minnesota’s elected officials are scrambling to get more children into dental chairs. Nowhere to be found is any suggestion to add more dental therapists.

Instead, the governor asked for a substantial increase in Medicaid dental reimbursement rates, which are so low that dentists won’t sign up. Legislators, having been assured dental therapists were the panacea, saw no need to raise those rates.

They’re just now realizing this was never a workforce problem; Minnesota has plenty of dentists. The Legislature there wasted time and energy creating a new kind of professional, while ignoring the real barriers to access.

Just as in Minnesota, Arizona does not face a workforce shortage. Indeed, 90 percent of publicly insured children live within 15 minutes of a dentist who accepts AHCCCS patients.

Higher reimbursement rates would help attract more Arizona dentists, but the bigger challenge is that AHCCCS limits the number of dentists who can sign up. I personally know dentists who would accept AHCCCS patients but have been turned down by the state’s contracted insurance plans. Adding dental therapists doesn’t fix that bottleneck.

Allowing any willing dentist into the program would increase access for children. And there’s more we should be doing, like focusing on the real challenges that parents face in getting their kids to a dental office. We should continue to be creative in expanding preventive services to avoid tooth decay in the first place.  We can effectively do this with our existing dental team and the solutions dentists advocated and legislators approved.

Dental therapists are a distraction. They solve nothing. Legislative efforts to bring this position to Arizona divert attention from the real issues and real solutions. They set us up to be the next Minnesota, scrambling a few years from now after we learn that Pew’s hollow promises only delayed the day of reckoning.

Let’s not go there. Let’s work together on solutions that will really make a difference.

— Dr. Robert Roda, a Scottsdale endodontist, is president of the Arizona Dental Association.

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

4 comments

  1. Another barrier is the SUBSTANTIAL legal risks faced by dentists who accept Medicaid. There are many cases of malicious prosecution of dentists, falsely accused of fraud. Even when acquitted, often taking YEARS, the dentist has lost everything… literally everything.

    Given the legal risks, I would not accept medicaid if they offered to pay me DOUBLE my regular fees. I’m not willing to gamble away my autonomy, security, and freedom. This risk is quite real. One need only to do a search for these cases.

  2. To build a workforce of that magnitude it takes more than seven years Dr. Roda. Dentists have had almost 20 years now (since stated in 2000 surgeon general report) to address oral healthcare access problems and little has changed. There is a huge need for dental care among both children and adults and the research IS there, you just have to look! Private practice is no longer enough. If the dental field wants more credibility among the medical field, it NEEDS to expand. That will help more people reach dental services. Get rid of the strict supervision levels on dental hygienists to get out there and do the work they do best as preventive oral health specialists and maybe you wont have to worry about dental therapists. Until then, this unfortunate war between dentists and dental hygienists will continue.

  3. There’s a war between hygienists and dentists??? LOL! I’ve been at this for 30 years, and I have not witnessed such a “war.” All is good on the home front here. 🙂

  4. If you get into the policy side of it, there’s a war. I never noticed it being in cushy private practices for the past 18 years until I started doing research and helping my association behind the scenes.

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