Two new kinds of dental care providers could be authorized in Wisconsin soon, with the state Legislature taking up bipartisan proposals to allow dental therapists and workers known as expanded function dental auxiliaries.
Proponents say the moves would boost efficiency at dental clinics and access to dental care for the underserved in the state, which has a relatively low proportion of dentists who treat Medicaid patients.
“More providers in more places means the ability to see more patients and perform sorely needed dental care in shortage areas across the state,” state Sen. Mary Felzkowski, R-Irma, a lead sponsor of bills to allow the workers, said in March at a public hearing about dental therapists.
Dental therapists, mid-level practitioners similar to physician assistants, were long opposed by the Wisconsin Dental Association, or WDA. The dentist group argued that therapists’ ability to do fillings and oral exams would make them too much like dentists.
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After a bill was updated to require dental therapists to work in dental health professional shortage areas and under a dentist’s supervision for 2,000 hours before working more independently, among other changes, WDA dropped its opposition. The Senate passed the bill unanimously in April, and it awaits action in the Assembly.
Dentist therapists are authorized in 13 states, including Michigan and Minnesota, which became the first state to pass such legislation in 2009. The others are Alaska, Arizona, Connecticut, Idaho, Maine, Montana, Nevada, New Mexico, Oregon, Vermont and Washington.
Unlike dentists, dental therapists don’t do root canals, crowns, bridges or surgical extractions.
Felzkowski’s updates to the bill, which also include requiring dental therapists to graduate from an accredited training program and allowing dentists to work with no more than four dental therapists at a time, led WDA to become neutral on the measure.
“We looked at the political landscape,” said Chris Borgerding, WDA’s director of government services. “We thought it would pass with or without us.”
In Wisconsin, 32.3% of dentists participate in the Medicaid program for low-income patients, compared with 37.5% nationally, according to the American Dental Association’s Health Policy Institute.
The main reason many don’t is because they say Medicaid payments are too low. The state’s payments are 36.4% of what dentists say they get paid from private insurance, compared with 61.8% nationally, according to the ADA institute.
Many health care advocacy groups support the dental therapist bill, saying it would improve access for Medicaid patients. Borgerding said reimbursements also need to be increased.
“If dentists are losing money, they’re probably going to be less incentivized to hire a dental therapist,” he said.
WDA backs a bill circulated last month by Felzkowski and state Rep. Jon Plumer, R-Lodi, to create expanded function dental auxiliaries, or EFDAs. The measure, introduced in the state Senate Thursday, has nearly three dozen co-sponsors in both houses, including eight Democrats, said Patrick Gehl, a research assistant for Plumer.
Unlike dental assistants, who are not licensed or credentialed by the state and perform a limited range of tasks, EFDAs would be certified by the Dentistry Examining Board and required to have 70 hours of classroom instruction. They could help dentists complete restorations, apply sealants, take impressions and adjust dentures, among other duties.
While EFDAs would have more education than dental assistants, the training would be much less than for dental hygienists, who clean and polish teeth, along with providing oral health assessments and education.
“Adding these positions to oral health care teams in our state will allow dentists and dental hygienists to focus on practicing at the top of their scopes and allow more patients to be seen,” said Plumer, also a lead sponsor of the dental therapist bill. “Lack of access to dental services is an issue that affects urban and rural areas of Wisconsin.”
More than 20 states and the military allow EFDAs, Felzkowski and Plumer said.
Matt Crespin, associate director of the Children’s Health Alliance of Wisconsin and a dental hygienist, said the organization supports the addition of dental therapists and EFDAs. But the group is concerned that the EFDA bill would allow EFDAs to do some scaling, or removal of plaque and other hard debris, which he said they wouldn’t be trained to do as hygienists are.
Scaling “is not part of an EFDA scope,” Crespin said.
Borgerding called that stance “hypocritical” since dental hygienists have strongly supported authorizing dental therapists, who likewise would perform services dentists now provide.
“The technical colleges we’ve spoken to are willing and very ready to train EFDAs to adequately scale,” Borgerding said. “Any concern over that is just purely out of scope protection.”
[Editor's note: This story has been updated to correct the spelling of Patrick Gehl's last name.]