Opinion | Dental therapists won’t improve health care for Michigan’s most vulnerable

Debra Peters is president of Michigan Dental Association

Accessing health services can be complicated for patients with disabilities, but there are resources to help those in need of dental care.

The Michigan Donated Dental Services program has helped connect volunteer dentists with more than 6,400 Michiganders who are elderly, have a permanent disability or live with chronic illness.  The program, established in 1995, is a partnership between the Michigan Dental Association, the Michigan Department of Health and Human Services and Dental Lifeline Network. Treatment is donated by dentists and dental labs throughout the state.  To date, dentist volunteers have donated more than $22 million in comprehensive dental care.  The service is just one of more than 200 local and statewide programs that provide treatment at a reduced rate or free to underserved patients across the state. 

Adding more provider types to the workforce, as called for in Senate Bill 541, may seem like an easy solution.  But complex problems are rarely solved by easy solutions.  These are not patients who need simple extractions and cleanings.  Band-Aid treatments would only result in more visits for the patient, more cost, and potentially serious complications.

Another view: Opinion | I’m disabled, and it took me 15 years to find a dentist in Michigan

Patients with disabilities often have health challenges that may complicate their dental conditions, which are usually extensive.  How their dental conditions are treated may also affect their health conditions.  Treating these patients requires having good communication with their primary care physician and a deeper understanding of the relationship between their oral and overall health. 

These individuals are among the most complex to treat and due to the potentially life-threatening relationship between conditions, general dentists may refer them to specialists or dentists who have the most expertise in a given area.  As doctors of dental health, dentists receive extensive training related to overall health conditions to prepare for these challenges.  Dental therapists would not have this thorough training and would not have the skills to meet the true needs of these patients.    

With Michigan’s Medicaid expansion under the Affordable Care Act, many adults now have their coverage under the Healthy Michigan Plan.  Patients receive their coverage through the Medicaid health plans and payment is typically high enough to at least meet overhead so a majority of dentists are able to accept it.  Similarly, the state’s highly successful Healthy Kids Dental program, which provides dental coverage for all Medicaid-eligible children, has payment rates that make it possible for dentists to participate.

Now, in Michigan, there are dentists who have capacity to see more patients and there are dental hygienists who are underemployed or unemployed.  Stakeholders in the oral health and public health communities are working on creative, local solutions to ease the burdens underserved patients face and to ensure that they understand how their dental health can impact their overall health. 

One of these stakeholders is a federally qualified health center in Battle Creek, where hygienists work with OB/GYN staff and patients to make sure mothers receive needed dental care to support healthy pregnancies and education on the importance of early dental care for children and make sure they know how to access services. 

Other programs licensed by the state deploy hygienists to underserved communities to provide preventive care and do screenings.  Patients who need additional care are referred to supervising dentists for follow up.  Training for dentists in treating underserved populations has also been increased through residency programs and externships in community dental clinics.

A recent survey shows that most patients would not want to see a dental therapist for irreversible procedures.  Many low-income patients have extensive dental needs beyond a basic cleaning and preventive care, and would need to see a dentist to ensure they receive appropriate care.

The most effective solutions are those that efficiently use existing workforce and resources, and involve the patient base that will be served and the communities where they live.

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Wed, 10/03/2018 - 7:37am

The smell of red herring. Because Hygienists aren't blessed with 8 years of undergrad and dental school and have Dentist as an employer their work cleaning your teeth has no value and they can't recognize problems that will require further attention. Right?

Kathleen Hodges
Wed, 10/03/2018 - 8:52am

I worked in a federally qualified community health center (FQHC) and have firsthand knowledge of the extent of poor dental health with need for extensive dental care. Fortunately these healthcare clinics are also linked to dentists. They serve Medicaid and Medicare patients at or below poverty level and applying added hygienist support will not assist in improving access to necessary oral health or treatments. The waitlists remain long due to severe oral caries, fractured teeth and periodontal disease.

Jarrett Skorup
Wed, 10/03/2018 - 8:51am

This is a confusing op-ed and I would be very interested in seeing that full poll. Hygienists are highly trained and there are many more of them then there are dentists. I'm happy to hear that dentists are volunteering their time, but treating 6,400 people is a mere fraction of what is needed. Dental Hygienists are plenty qualified to handle the vast majority of issues and if they see something they can't handle, they can always refer. They have a far wider ability to practice in other states and all the evidence suggest that means lower costs and more coverage - though it does mean slightly less power for dentists.

Susan Bender
Thu, 10/04/2018 - 5:02pm

Debra Peters simply represents dentists who have a vested interest in a turf war. Dental hygienists are not mid-level practitioners. Dentistry does not have a mid-level practitioner as medicine does. I have yet to see an over-abundance of good looking teeth among the poor and after over 40 years working as a nurse-anesthetist, do not see physicians or dentists moving to rural areas. We need dentists but they should be utilized efficiently. Many procedures could be done by a mid-level practitioner who could be master's prepared after attending a bachelor's program.