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Friday, February 22, 2013

Dental Care Program Sparks Controversy In Minnesota

Millions of Americans are forgoing dental care, as a result of the cost and dentist shortages. There's a program in Minnesota aimed at addressing the problem, but critics say it compromises patient safety. (M. Spencer Green/AP)

Millions of Americans are forgoing dental care as a result of the cost and dentist shortages. A program in Minnesota is aimed at addressing the problem, but critics say it compromises patient safety. (M. Spencer Green/AP)

About 130 million Americans have no dental insurance, three times the number who don’t have general health insurance. And even when people have dental insurance, it covers so little that dentists think of it as a prepayment plan, rather than true insurance.

On top of the financial impediments, Nearly 50 million Americans live in areas with a dentist shortage.

The result is that millions of Americans are forgoing routine dental care, even when they are suffering acute pain.

Slate magazine’s June Thomas calls dental care the “other health care crisis.”

“Poor dental health is a serious problem,” Thomas told Here & Now’s Robin Young. “There is evidence connecting gum disease to diabetes, heart and lung ailments, and premature birth. Without good teeth, it’s very difficult to get many middle class jobs. And hard to chew nutritional food.”

Thomas went to Minnesota to report on a new program there, centered on training dental therapists to perform some of the functions of dentists.

The program has been successful, and a dozen other states are debating a version.

But critics, including dentists, say that patient safety is at stake, and they worry that it’s consigning people to lower-level dental care.

As one dentist put it, “I went to college and dental school for eight years in order to receive the education necessary to safely perform irreversible procedures upon the human body. It is clear that this level of education cannot be achieved in two or three years. Isn’t it interesting that the proponents of the low-level provider scheme intend that it be used for OTHER people’s healthcare, and not for their own?”

Would you be OK with a dental therapist filling your cavity instead of a dentist? Let us know on Facebook.


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  • Scott B

    Here in NY we have a lot of Nurse Practitioners (I use one, matter of fact, and she found my cancer a few years ago) and Physician’s Assistants that do a lot of work that used to only be provided by doctors. How would this be any different than that? They’re not  drilling or doing root canals. It sounds like it’s slightly more than a dental hygienist, and those already do a lot of what’s being discussed, pepending what the dentist they work for allows. 

    Medicaid for some proceedures and needs is rediculous, and often barbaric. They would rather have a recipient have all their teeth removed, and  often insist on it, rather than pay for the person to get just the few teeth they need removed replaced, if there is more than so-many teeth involved. 

  • Mike

    One guest said that ‘medicaid reimbursement is sometimes less than the cost of the care’.  I’ve always wanted to know why (health) care so expensive.  I just got a dental bill for exam, cleaning and x-rays:  $260 ;  that’s a lot– why so much? 

    In general the cost-of-living in the US is very high.   Why is a loaf of bread here $4.50, while in India it might be $0.05 (I don’t know that, I’m just guessing .05)?

    Maybe a good subject for a future segment (or segments)?

    • Sam

      In Arkansas, a loaf of bread is $3 and a dental exam, cleaning, and x-rays usually falls between $100-150.  So it’s a different world.  I know Alaska has very high dental fees (because of access, location, materials are more expensive).  Usually, every place with high dental fees has a high cost of living, and a high standard of living.  Poor areas do not charge $260 for a first time visit.  They would get no patients.

  • ajbe

    Clearly there is a need for extenders who can provide care in underserved areas.  However, given that the average dentist starts practice with $170,000 in student debt (and buying into or starting a practice is in addition to student debt), we must make sure any new programs don’t undermine dentists salaries to the point that fewer and fewer even enter the dental profession in the first place and exacerbate the shortage.

  • Sam

    I’m a dentist that’s been practicing for 3 years after college and dental school. Yes, I’m young and in debt, but I’m doing just fine.  It’s tricky to “live with” good debt, but that’s exactly what I’m doing.  When I hear about midlevel providers, I don’t immediately think, “how am I going to payoff my student loans?”  I think, “that’s kinda scary, glad it’s not here.”

    I’m in Arkansas where there are not midlevel providers.  Midlevel providers, however, DO drill.  They do fillings, not root canals.  They numb, drill out the decay, and place a direct restoration in the mouth, with an estimated life of 7-10 years, depending on the material.  I think some do extractions.  This is also called oral surgery.  Extractions are a scary procedure to delegate out.  Although the “drilling” might sound more difficult, any dentist will tell you that an extraction can be one of the most difficult procedures in the office.  Some dentists do not even extract teeth, preferring to refer out to an oral surgeon instead.  I like to extract most teeth in house, and it is, by far, the most likely service I am going to provide pro bono if someone just can’t afford it.  Most good dentists do pro bono work.  It makes you feel good, and if you’re doing ok financially, extracting teeth carries very little overhead (it just might be difficult).Dentists were the first to use nitrous oxide in analgesia, and were the first to make prevention over serious treatment mainstream.  Our costs have risen much more slowly than medicine, and revenues have been in decline since before the Great Recession.  Perhaps we have not tried all the ways to improve access to care. However, I think “baby steps” may be an order.  I would really prefer, for example, an expanded function hygienist to let me drill, and for he or she to fill the tooth…and let dentists keep taking teeth out.

  • JEngdahlJ

     dental insurance landscape will change
    in the coming years because of new  healthcare regulations. http://www.healthcaretownhall.com/?p=6038

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