Compromise Would Use Dental Therapists To Expand Access To Oral Health Care In Mass.

(Daniel Frank/Unsplash)
(Daniel Frank/Unsplash)

Lawmakers believe they have landed a deal to create a new mid-level dental therapist profession that could expand access to oral health care by increasing the number of providers and requiring them to serve harder-to-reach populations.

The compromise struck between dentists, hygienists, health care advocates and lawmakers could resolve a long-simmering policy fight over how to expand access to oral health care without jeopardizing the quality of care or threatening the dentistry profession, which requires years of education and training.

The bill, which emerged from the Joint Committee on Public Health Tuesday night, proposes to authorize the licensure of dental therapists, who, after a period of education and training, would be allowed to perform certain oral health functions -- such as oral health screenings, mouthguard fabrications and radiograph readings — on their own.

More complex procedures like non-surgical tooth extractions would require onsite oversight by a dentist.

"By authorizing dental therapists to practice in Massachusetts, we are increasing the number of providers who have the training and flexibility necessary to reach our underserved residents and treat everyday dental problems, ensuring individuals get the care they need before problems persist," Rep. Kate Hogan, co-chair of the Public Health Committee said in a statement.

Members of the committee voted in a poll that closed at 7 p.m. on Tuesday to recommend the compromise legislation.

The expansion of access to oral health care has been a priority for Senate President Harriette Chandler.

Under the bill, dental therapists would be required to graduate from an accredited dental program that awards master's degrees in the field, pass a board approved clinical evaluation, and complete 2,500 hours (or two years) of practice under the direct supervision of a dentist.

The Board of Registration in Dentistry would have until 2020 to approve a clinical exam.

Once a dental therapist has completed those requirements, they would be authorized to practice under "general supervision" without an onsite dentist, but some procedures, such as placement of a tooth crown, capping or extractions, would require onsite supervision.

Those restrictions would be subject to review by the Department of Public Health and the Board of Registration in Dentistry, which would be directed to decide after January 2021 but by Dec. 1, 2022 whether to expand the scope of practice for dental therapists.

Dental therapists would also be required to maintain a "patient panel" with at least 50 percent of their clients coming from underserved populations, including MassHealth recipients, residency in a dental health professional shortage area, nursing or veteran home patients or low-income, uninsured.

"Preventative care should be the cornerstone of our approach to healthcare, including dental care," Sen. Jason Lewis, the co-chair of the Public Health Committee, said in a statement.

Supporters of legislation this session to expand the oral health provider universe say 47 percent of children on MassHealth, or 290,000 kids, did not see a dentist in 2014, while many low-income individuals, including seniors, are losing their teeth due to a lack of care.

Tension has existed, however, between the Massachusetts Dental Society and advocates of the new dental therapists licenses.

The society wanted to see direct supervision of dental therapists, while Chandler and Sen. Smitty Pignatelli had proposed legislation requiring just 500 hours of training under a certified dentist before they could work under general supervision.

Massachusetts Dental Society President Dr. David Lustbader said Tuesday the compromise bill strikes the right balance between the promotion of preventative care and appropriate standards.

"This outcome represents a real win for Massachusetts because it allows for a comprehensive approach to improving overall dental health for underserved populations. In addition to appropriately trained and supervised dental therapists, the legislation allows for community health workers and local boards of health to receive important oral health education, and for all public school students' parents or legal guardians to be alerted to the importance of oral health screenings for children," Lustbader said in a statement.

The committee said over 500,000 people in Massachusetts live in federally designated dental provider shortage areas.

Gov. Charlie Baker's administration has been generally supportive of the concept of dental therapists as way to fill the access gap for oral health care.

Health and Human Services Secretary Marylou Sudders told the Public Health Committee in September that establishing a new mid-level practitioner would be "the right thing to do," though it remains to be seen whether the administration can support the details of the compromise.

While out of the Public Health Committee, the legislation will likely be reviewed by additional committees and would need to pass the full House and Senate to reach Baker's desk.

Formal sessions, where controversial bills are considered, are scheduled to end this year on July 31.

This article was originally published on April 25, 2018.



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