by Dr. Murray Feldstein
February 14, 2018
SB 1377 would enable mid-level healthcare providers, called dental therapists, to be licensed in Arizona. Some opponents are misinformed, claiming that dental therapists would not be properly educated and trained.
The reality is that dental therapists will be required to take the exact same test that dentists take for the approximately 80 procedures they will be licensed to perform. Fully licensed dentists are tested for approximately 400 procedures. The law requires dental therapists sign a collaborative agreement with a supervising dentist.
FACT: SB 1377, like any licensing law, mandates only the minimum requirements. This bill states that a dental therapist must complete a minimum of two years of training in a program approved by the American Dental Association’s Commission on Dental Accreditation (CODA), the same organization that accredits the nation’s dental schools. In actual practice, programs accredited by CODA require longer training programs than mandated by law.
Dental therapists master common procedures needed by people who are currently unable to gain access to a dentist. These include routine dental exams which are especially important for preventing gum disease, decay, toothaches, and abscesses. Abscesses can cause high fever, extreme pain, threaten pregnancies, and even result in death. Dental therapists are trained to fill cavities, place temporary crowns, and extract loose teeth in specifically defined circumstances.
In comparison, in their four years of required minimum training, dentists learn over 400 procedures. In practice, family dentists may never do many of the procedures they learned, referring the patient instead to dental specialists. In reality, the training for dental therapists is more efficient for learning how to treat the most common conditions and emergencies.
FACT: When dentists compare their years of training to the requirements under the proposed law, they often include their undergraduate college years, even though their license doesn’t require this. However, most dental schools do require it for admission. In essence, dentists count their time spent on spring break, literature classes, and music appreciation as part of their dental training, even though they ignore the years dental therapists spend in the military, a similar undergraduate program, or community college.
Many dentists do go on to take additional specialty training. Again, this is not needed for licensure. Specialists perform procedures that neither dental therapists nor general dentists do. Specialty training increases the years of dental education. However, it does not imply that dental therapists or general dentists receive too little training.
FACT: SB 1377 mandates that dental therapists must enter into a collaborative agreement with a supervising dentist. This dentist, who knows the dental therapist’s particular abilities, may choose to limit their allowable procedures even more than the law permits. This is an additional safeguard similar to the way hospitals may choose to limit the privileges of physicians, even though physicians are licensed to do more.
Dental therapists have practiced around the world for nearly a hundred years and are now licensed in a handful of states. Their safety and effectiveness as members of the healthcare team is well-documented.
Opponents who believe that dental therapists are dangerous should present facts to support their opinions. Legislators in both parties have pledged to improve healthcare access. Hopefully they will work across the aisle and pass SB 1377.
Dr. Murray Feldstein, MD is a visiting fellow at the Goldwater Institute.