Would you let someone other than a dentist fill a tooth or perform an “uncomplicated” extraction? Sounds like a job for a dentist, doesn’t it? After all, dentists in the US have met very high educational and licensing requirements, and well – it’s your mouth we’re talking about.
Sadly, millions across the country don’t even have the choice. Why?
The US dentist shortage
In many parts of the nation, there is an uneven distribution of dentists, which is having serious consequences. A new dental school was opened in Maine in 2013. One of its missions? To “reverse the shortage of dentists in rural parts of the state, a trend that is expected to worsen,” NBC News San Diego reported
And Maine is hardly alone. People in rural parts of many states are coping with the dearth of dentists as well as they can, often by putting off or doing without necessary dental care.
Kaiser Health News reported early last year that 16% of Americans live in areas with an insufficient number of dentists. Federal guidelines, according to Kaiser, call for one dentist to every 5,000 people.
Here’s another way of looking at it: Approximately 45 million people in the US reside in areas that are experiencing a dentist shortage. And where there’s a shortage, it’s very hard to get dental care regardless of income or insurance.
Free dental care events
Dentists are working to address the problem. Though they may not be able to be in every neighborhood across the country, thousands of dentists each year give their time and resources to provide free dental care to those in need.
In addition to individual dental practices that open their doors to those in need, state and national dental associations, organizations like Remote Area Medical and Mission of Mercy, and many private donors work tirelessly to provide free dental care events. One such event was held in Seattle in October. It helped nearly 2,000 people over four days, according to The Seattle Times. In New York, however, city authorities cancelled a similar event in November citing public health concerns.
And remember, many of these types of events are not just about providing care for the uninsured. Across the US, insured and uninsured alike lack easy access to dental care due to the shortage or uneven distribution of dentists.
Dental therapists or mid-level dental practitioners
Dental care must be provided by licensed practitioners. But today, there are simply too few dentists to meet the needs in many parts of the country.
Even with more dental schools, future access to basic oral care isn’t guaranteed. In fact, the problem may grow worse. That’s because new dentists are more likely than ever to specialize. In 2012, the number of active, newly licensed dentists who were specialists was up 6% over 2008, NBC San Diego reported.
One possible cure for America’s dentist shortage may be on the horizon. There is a growing movement to create a new “mid-level” type of dental practitioner called a dental therapist. Proponents of this plan say dental therapists can help to increase care and free up dentists to do other, more critical work.
In most states today, dentists alone are able to do certain dental procedures, like fillings and “uncomplicated” extractions. That is changing, however. Dental therapists have been providing mid-level procedures in Alaska for the past 10 years.
Minnesota and Maine have recently approved the use of these mid-level dental practitioners. In addition, legislation around the use of dental therapists is being considered in California, Kansas, New Hampshire, New Mexico, and Washington.
Dental therapists are highly trained health care professionals. They typically are selected from their home communities, educated and then return to serve their communities…
In an opinion piece in favor of considering dental therapists in New Mexico, which was published by the Santa Fe New Mexican, Howard Rhoads, DDS explains, “Dental therapists are highly trained health care professionals. They typically are selected from their home communities, educated and then return to serve their communities…. They don’t do everything a dentist does, but they provide many of the most commonly needed services, starting with dental education, simple fillings and non-surgical extractions.”
Community Catalyst, a national, non-profit consumer advocacy organization, released a report in 2013 that found that where they are allowed, dental therapists are not only increasing access to dental care for children and low-income adults, they are also helping to reduce costs for dental practices.
Retail to the rescue?
Walmart continues to open health clinics within its retail locations, as NBCNews reported in August 2014. Some people predict that they or another big-box chain will eventually open in-store clinics that will offer dental services to underserved areas.
Walmart did try opening dental clinics in stores back in 2012. However, the company was sued over the idea in 2013.
In any event, for the idea of dental clinics in big-box stores to succeed on a national level, a retailer would still need to lure dentists to work in areas of the country that they have traditionally avoided – or fill many positions with a different type of oral care provider, such as a dental therapist.
Need for accreditation standards
Dental therapists are a reality today, but their use is out of the question in most of the country. Educational programs like the one at the University of Washington, which prepares dental therapists for work in Alaska, have set their own high standards for the therapists they train. For more states to open their doors to these mid-level practitioners, the next hurdle to overcome is the adoption of national standards for accreditation.
…the potential of dental therapy education programs deserved quickly adopted, reasonable accreditation standards…
In documents filed with the Commission on Dental Accreditation (CODA) in late November, the American Dental Hygienists’ Association (ADHA) and the U.S. Federal Trade Commission (FTC) both shared their beliefs that “the potential of dental therapy education programs deserved quickly adopted, reasonable accreditation standards…”. CODA will meet in February to consider proposed standards for dental therapy education programs.
Now, back to our original question: Would you let someone other than a dentist fill a tooth or perform an extraction? If so, do you feel more states should follow Alaska, Minnesota, and Maine and approve the use of dental therapists? Please share your thoughts in the comments below.
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Sources and recommended reading:
- BringMeTheNews: Free massive dental clinic in Mankato to attract thousands
- DrBicuspid.com: ADA brief on barriers to care misleading
- EurekAlert! First analysis of dental therapists finds increase in access for children, low-income adults
- Huffington Post: Dear New York City’s Uninsured: Screw You, Love Governor Cuomo
- Kaiser Health News: Are There Enough Doctors For The Newly Insured?
- NBCNews: Big Box Health Care: Are You Ready for Walmart Care Clinics?
- NBC San Diego, California Faced with Dentist Shortage: Study
- Santa Fe New Mexican: Reader View: State needs better dental care
- Seattle Times: Guest Opinion: Don’t wait for dental care to become a crisis
- USA Today: More states consider licensing mid-level dental care providers
If you’ve been putting off a vacation and socking away money for dental care instead, there may be a way for you to carry out both goals: dental travel. A branch of medical tourism, dental travel or tourism is enjoying a solid upward trajectory worldwide.
Dental travel is not for everyone. And we can assure you it’s not something we’ll be exploring in person. Nevertheless, the Deloitte Center for Health Solutions has estimated that between the years 2012 and 2017, participation by U.S. patients traveling to other countries for medical care will grow from a low of around 8 million to anywhere from 11 to 23 million.
Why travel for dental care?
Just as some businesses outsource work to areas where labor is more affordable, dental tourists take advantage of global competitiveness to achieve cost savings by traveling to less developed areas to have dental procedures performed. If you’re a US-based dentist or hygienist, you probably think the whole idea sucks – sucks even more than the suction tube you use to keep patients’ mouths dry while you work.
…dental tourists take advantage of global competitiveness to achieve cost savings by traveling to less developed areas…
For consumers, on the other hand, there are alluring reasons to explore further. For example, in the U.S., consumers may pay in the neighborhood of $3000 to $5000 for implants and a crown. In Mexico or El Salvador – which are just 2 of the nearly 50 countries that list medical tourism as a part of their national economies – the same procedures may cost consumers closer to $1000.
Not all fun in the sun…
Many people have had positive experiences with dental tourism, as the rampant growth of the industry attests. As you can probably imagine, though, it definitely pays to do your homework if you’re thinking of jumping on the dental tourism wagon.
If you’ve done much traveling, then you know: things sometimes go awry. When you’re traveling simply for enjoyment, it’s easy to take little glitches or misunderstandings in stride. They’re just part of the territory. But where health care procedures are concerned, glitches and misunderstandings are never a good thing.
Probably the biggest red-flag and best reason for avoiding dental travel, period, is the fact that different countries have different educational and licensing requirements for dentists and varying standards where hygiene is concerned. Not to mention unfamiliar laws and regulations.
Add to that the possible confusion of dealing with a second language or foreign cultural customs, and you can see that it takes a certain kind of person to really make a go of it as a dental tourist.
The cruise director is ready to see you now…
In addition to doctors, dentists, and other health care professionals, many travel agencies and online sites cater to this growing trend. Search for “dental travel,” and literally millions of links come up. You may need to take a little time off just to research all the available options adequately.
Take the time to research providers carefully. Read up on all aspects of dental travel in online reviews and recommendations. Find out all you can about the pros and cons of various destinations for this type of travel. Talk to others who have tried combining travel with medical or dental care.
…understand exactly what you may be getting into, and what recourse you may have if things don’t go as planned.
Finally – and perhaps most importantly – be sure you take the time to understand exactly what you may be getting into, and what recourse you may have if things don’t go as planned. After all, it’s hardly a “vacation in the sun” – so to speak – when a dental restoration or other procedure fails as soon as – or even before – you complete the return trip home.
Been there, done that? Have you had a positive – or not so positive – experience with dental travel? We’d love to hear your comments on this growing trend in health care.
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