- The Washington Times - Sunday, December 27, 2009

MINNEAPOLIS | As a hygienist at the only nonprofit dental clinic in a wide swath of southern Minnesota, Jodi Hager sees close up what limited care means: children from poor families with decay in every tooth and adults weary from driving two hours to a place that will take their state insurance.

“I’ve gotten to know my patients over the years, and I see the need,” she said. “It’s hard after a while to look the other way. You want to do something for them, to do something to address this problem that you’re dealing with every day.”

That’s why Miss Hager, 40, is studying to become a dental therapist - a mid-level provider who can do simple invasive procedures currently done only by dentists. Dental therapists are common in Canada, Britain and 50 other countries, but Minnesota is the first U.S. state to license them widely. Alaska has had a small but growing program since 2003 that limits therapists to tribal lands.

Supporters say Minnesota’s program to train therapists, launched this year, should improve access to care by lowering the cost of providing it.

State Sen. Ann Lynch, Democrat from Rochester, pushed for legislation allowing dental therapists despite opposition from the American Dental Association and other groups. Mrs. Lynch said the therapists were necessary to help meet dental needs in rural Minnesota, in the inner city and among people on state-subsidized insurance.

Like other states, Minnesota’s rural areas can’t attract enough dentists. And many dentists won’t take enough patients on Medicaid or other government insurance because, dentists say, the programs don’t reimburse them enough to cover costs.

It’s a problem some fear will get worse as dental school classes shrink and dentists get older.

Shelly Gehshan, director of the nonprofit Pew Foundation’s Children’s Dental Campaign, said about a dozen state dental associations around the country are watching Minnesota’s model. “Minnesota is a couple of years ahead of a wave of activity across the states,” she said. “It’s an idea that is sweeping the country.”

In Connecticut, the state dental association approved a pilot project in November so it could learn more about the concept, the group’s president, Dr. Bruce Tandy, said.

At the University of Minnesota dental school, therapy students train side-by-side with dental students - same equipment, instructors and techniques, said Patrick Lloyd, the dental school dean. Though the future dentists ultimately go on to study more complex techniques than the therapists, the principle “is that they should work together and get an appreciation for each other’s competency and skill set,” Dr. Lloyd said.

After the first group of therapists graduates in 2011, they will work under the supervision of dentists but will be able to do simple invasive procedures that hygienists can’t - including drilling cavities, extracting baby teeth, removing stitches and capping nerves. Tasks such as diagnosing patients, planning treatment, performing root canals, surgical extractions, placing crowns and bridges, and implanting dental devices will be left to dentists.

The American Dental Association and other such groups opposed therapists for years, saying they fear the therapists would provide substandard care. Kathleen T. O’Loughlin, the ADA’s executive director, has been somewhat reassured that the therapists will be supervised by dentists, although it hasn’t endorsed Minnesota’s approach.

“We’re very supportive of anything that improves access to dental health care to vulnerable populations,” she said.

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