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Originally published Wednesday, November 28, 2012 at 4:00 PM

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Op-ed: Dental therapists are not the right fit for Washington state

Creating a new class of dental therapists is not the right solution to improve oral care in Washington state, writes guest columnist Danny Warner.

Special to The Times

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ORAL disease is the most common chronic disease affecting children. The good news is that it is nearly 100 percent preventable, no matter your age. No one is more dedicated than Washington’s dentists, hygienists and other dental staff to seeing all Washingtonians free of dental decay and pain.

Recently, the idea of a new dental provider used in Alaska has been suggested as the magic bullet for improving dental access. [“Dental therapists could help people get care needed in Washington state,” Opinion, Oct. 11.] However, this proposed remedy is not a cure.

As a practicing dentist for more than 35 years, both in Washington and in rural Alaska, I know that no single solution will improve oral health for the most vulnerable. We need a multifaceted approach based on education, prevention, financing and innovative delivery. These solutions should be custom built to reflect the realities of Washington state, not rural Alaska.

Washington state has been on the leading edge of expanding the dental workforce. Washington was one of the first states to allow dental hygienists to perform restorative procedures and to create Expanded Function Dental Auxiliaries, new practitioners to assist dentists with dental restorations.

The Alaska dental-therapist model is not appropriate for Washington state but a supervised, dental extender could be. Any new model should have appropriate supervision by a dentist to ensure patient safety. Regardless of the outcome on this issue, it is disingenuous to claim a new workforce model is the solution to restoring the dental safety net. The problem is much too complex.

The primary problem with the dental safety net is inadequate funding. According to the Centers for Medicare and Medicaid Services, only 10 percent of dental care receives public financing, while medical care receives approximately 50 percent. Medicare does not have a dental benefit. Medicaid no longer provides most eligible adults nonemergency dental-care benefits. Grants that allowed community health centers to provide routine dental care for uninsured patients were eliminated in 2011. These actions mean the state pays only when the problem is at its worst.

Some believe dental therapists could be used to provide care to additional Medicaid patients and extend hours for community health centers. We can achieve the same result by employing more young, unemployed dentists looking for work in this struggling economy, or by increasing the number of dental residents who are already expanding capacity in community health centers. The problem is not due to a shortage of dentists but a shortage of dental funding.

We must also adequately fund inventive ideas to promote dental prevention. We need to teach people how to care for their teeth before problems develop that are painful and costly. Surveys show that half of the general public do not follow their dentists’ advice to floss daily and brush twice a day. Washington dentists are joining forces with the Ad Council and The Partnership for Healthy Mouths, Healthy Lives to change behaviors around preventive dental care. More information is available at: www.2min2x.org.

A better model for improving the dental safety net already exists for young children. Washington’s children have the second-lowest levels of untreated dental cavities in the nation. Since 2005, the rate of untreated dental cavities in Head Start preschoolers dropped from 25 percent to 13 percent, according to the Washington state Department of Health. These low levels of untreated decay are the direct result of innovative delivery models like the Access to Baby and Child Dentistryprogram and enhanced dental Medicaid reimbursement rates for young children.

Too often the existing model is penny-wise and pound-foolish. Adding another dental provider does nothing to address this. Our plan for treating kids is leading the nation. Let’s build on what’s working.

Danny Warner, a dentist, is the current president of the Washington State Dental Association, representing 4,000 dentists.


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