Let dentists hire licensed dental therapists

Michael Van Beek, Mackinac Center for Public Policy

As the cost of health insurance premiums has risen, employers have found it increasingly difficult to provide employees with full medical benefits. A common way employers lower the cost of employee benefits is by reducing or eliminating dental insurance coverage. This is unfortunate because good oral health is a key component of a person’s overall wellbeing.

This being the case, it should be no surprise that not enough people in Michigan get the type of dental care they need. The Michigan Department of Health and Human Services says that 31 percent of adults in the state did not see a dentist in 2014. The price of dental care is clearly a deterrent, as this figure jumps to 60 percent for adults with a household income of less than $20,000 and for adults who do not have dental insurance.

But costs are not the only barrier to dental care. Access to dental professionals is inconsistent throughout Michigan. According to the U.S. Department of Health and Human Services, there were more than 200 dental shortage areas in Michigan in 2014 and at least one in all but a handful of counties. So, even if someone can afford to pay a dentist, they might not be able to find a convenient one nearby.

Skipping a regular trip to the dentist is like ignoring the check engine light on your dashboard. It might not seem important at the moment, but it can turn into a major problem later. And in the case of dental care, we all pay the costs when preventable issues develop into an emergency.

For instance, the Anderson Economic Group found that Michiganders made more than 7,000 trips to the emergency room in 2011 that could have been avoided with routine dental care. Hospitals were paid $15 million to treat these dental-related health problems, but AEG estimated that hospitals actually charged $58 million for these services. The quickest way for hospitals to make up that difference is to charge higher prices for other services the rest of us use.

Considering these challenges, Michigan policymakers should make dental care more affordable and accessible. This is easier said than done though, because legislators’ ability to reduce prices are limited and fraught with risks of creating harmful unintended consequences. But one idea that has a lot of merit is create a new type of provider, called a dental therapist. This concept was legislatively introduced by Sen. Mike Shirkey, R-Clarklake, in Senate Bill 1013.

Currently, there are two types of licensed dental care professionals operating in Michigan: dentists and dental hygienists. A dental therapist would be a midlevel provider, meaning they could provide more care than a dental hygienist but not as much as a dentist. Like current licensed providers, dental therapists would have to graduate from a state-approved, accredited dental program and pass a state exam. They could only work under the supervision of a dentist.

Dozens of developed countries rely on midlevel providers to supply dental care. Australia, England, Canada and the Netherlands use them and New Zealand has depended on them for almost a century. Studies from these countries indicate that dental therapists can provide high-quality preventive care. And many U.S. states are following suit: Minnesota, Maine and Vermont license dental therapists and 15 other states are considering legislation similar to Michigan’s Senate Bill 1013.

One final reason Michigan policymakers should consider creating a license for dental therapists: About half of the dentists in this state are set to retire within the next 10 to 15 years. This will only exacerbate the dental shortage problems, and the influx of newly minted dentists is unlikely to replace all those who retire. But if dentists have the option to supplement their work and expand their client base with dental therapists, these shortages could be dealt with more easily.

From both a public health perspective and a long-term fiscal perspective, it pays to provide more people with access to preventive dental care. Michigan is a large and diverse state geographically, which makes providing necessary dental care a challenge. But equipping dentists with the option of hiring dental therapists to meet these needs would go a long way to improving oral health in this state.


Michael Van Beek is director of research for the Mackinac Center for Public Policy.