A gap between teeth can be fixed with money, access to dental care and time.

But fixing the gap of dental care providers in more rural areas is proving a little more difficult.

All of Southwest Michigan – Berrien, Cass and Van Buren counties – is a dental health shortage area, according to the U.S. Department of Health and Human Services. In fact, 78 of Michigan’s 83 counties have at least one dental shortage area.

This means there aren’t enough dentists to serve the residents of that county. Such shortages across the country have left millions of people without access to basic and necessary oral care.

Late last year then-Gov. Rick Snyder signed bipartisan legislation that aims to expand access to dental care for Michigan residents. SB 541 authorizes a mid-level dental provider called a “dental therapist” to perform a variety of routine procedures that previously were only performed by dentists.

Proponents of the legislation hope this will fill the gap, but opponents aren’t quite sure.

What people are saying

One of the opponents is the Michigan Dental Association (MDA).

In a written statement to The Herald-Palladium, MDA President Margaret Gingrich said the MDA opposed the creation of a dental therapist and still believes this is not a solution to Michigan’s access to care problem.

“However, the dental therapist is now law and the MDA will work to ensure that patient safety and care are paramount as the new law is implemented,” she wrote.

When asked if the MDA could expand on what it does believe to be a solution to the access to care problem, a spokeswoman said the MDA’s current focus is on the implementation of the law and ensuring patient safety.

Under the law, therapists can fill teeth, attach temporary crowns, and extract loose or diseased teeth, leaving more complicated procedures like root canals and reconstruction to dentists, according to a recent Associated Press article. But some dentists have argued that therapists lack the education and experience needed even to pull teeth.

“You might think extracting a tooth is very simple,” Peter Larrabee, a retired dentist who teaches at the University of New England, told AP. “It can kill you if you’re not in the right hands. It doesn’t happen very often, but it happens enough.”

Other opponents of dental therapists argue they create a segregated system that gives wealthy urbanites superior care and puts poor, rural residents on a lower tier. Some other reasons for opposition: competition and potential loss of profits.

Maryann McCarthy, a member of Lake Michigan College’s dental assisting faculty and the interim program chair, said she was against the law because some of things the law would allow dental therapists to do can already be done by registered dental assistants.

“Many of these tasks we’re already doing now,” she said. “I just personally think there are probably areas where this will be beneficial, but I’m not sure I see it here.”

Amy Zaagman, executive director of the Michigan Council for Maternal & Child Health, said it’s been a very mixed bag of responses to the law.

“Some see it as a threat but others see it as a great dental opportunity. Change is hard when it challenges the overall landscape,” she said.

The Michigan Council for Maternal & Child Health (MCMCH) has been one of the biggest supporters of the dental therapy law and even created a coalition of 18 state organizations, MI Dental Access, that advocated for its creation.

“These partners, like us, give voices to people who are underserved,” Zaagman said. “We advocate for pregnant women and children because, based on numbers, those two groups have unique challenges.”

She said other state organizations, like the Michigan Coalition Against Homelessness and the Michigan Disability Rights Coalition, each came to the table with a very specific perspective.

“We were very clear that dental therapists are just part of the solution,” Zaagman said. “It’s part of a long-term solution. There are still things that need to happen around the access to dental care in general like consumer education, larger clinics, different office hours and social determinations around transportation.”

She compared a dental therapist to a physician’s assistant, just filling the gap between a nurse and a doctor.

But there are still things that need to happen in Michigan for dental therapists to become a reality, like the state board of dentistry needing to pass licensing rules.

“Even if we we had someone who graduated from a dental therapy program in another state, they would need to be licensed in the state they practice,” Zaagman said. “But it’ll be sooner than we think. We should have a program, graduates and licensed folks out in the community providing additional options that don’t exist currently.”

Getting schooled

While the state works to create licensing rules, colleges and universities will need to decide whether to implement dental therapy programs.

Only two states, Alaska and Minnesota, have educational programs for dental therapists. Minnesota’s program is the only one offering master’s degrees, a level of education that satisfies many opponents. Dentists generally need a doctorate. Dental assistants and dental hygenists usually require a two-year degree.

LMC, Southwestern Michigan College and Andrews University offer dental assisting or pre-dentistry programs.

McCarthy said LMC hasn’t had any requests for a dental therapy program, but if there was interest, they’d look into it.

Zaagman said MI Dental Access held an event earlier this year with interested educational institutions to get them more information about exploring what it would take for them to have a dental therapy curriculum.

“A lot of factors go into that,” she said. “Students interested, teachers, classroom space and equipment.”

Some states, like Minnesota, have had dental therapy programs for several years and are providing a great resource for these programs to get up and running in Michigan, according to Zaagman.

“We have got a lot of calls from all kinds of folks since the law’s passage,” she said. “Like consumers who are aware enough and curious on when they’ll be able to use the services, perspective students like hygienists who want to further their education and new students interested in the career path, and definitely from prospective employers.” 

Zaagman said this law will help federally qualified health centers that offer dental services.

“Since they’re running a big clinic, they have the room to add a new team member,” she said. “They’re also dealing with folk who have limited economic means, transporation issues and are already getting other health needs met at the center.”

InterCare Community Health Network is one of those groups that provides low-cost dental care services at its clinics. Patients can find dental services at all of its Southwest Michigan locations: Benton Harbor, Eau Claire and Bangor.

Velma Hendershott, InterCare president and CEO, said that the agency is always looking to augment and expand its services, and will certainly consider bringing on dental therapists when they’re available.

“There’s such a high need for dental care in our communities,” she said in a recent phone interview. “And the higher training could support the additional work, like emergency work and routine extractions. Those kinds of things would certainly make since, especially in our more rural areas.”

The shortage

Hendershott said InterCare, along with basically all health agencies, has felt a shortage of dental professionals. She said there is a shortage in almost all areas of health, but more recently there has been a real competition for primary care physicians.

“We do the best we can, but the volume of the need is more than any of us provide,” Hendershott said. “Whether it’s us or the state as a whole. Primary care, training programs, dental, mental health, any of those services tend to be a challenge to meet all of the need in all of our communities.”

She said recruitment is something the agency is always doing.

“It’s a continuous process,” Hendershott said. “People retire, cut back on hours, move on, et cetera. We’re always making sure we have people interested, interviewing and in the pipeline for when they’re done with their education.”

McCarthy said there are 40 students in LMC’s dental assisting program right now and there are usually those jobs available in dental offices.

Dental assistants and dental hygientists are a bit different in that hygienists clean teeth, examine patients for signs of oral diseases such as gingivitis, and provide other preventive dental care. Dental assistants perform a variety of patient care, as well as office and laboratory duties. Dental assistants are most often the ones who work chair-side as dentists examine and treat patients.

“Our program has on-the-job-trained assistants,” McCarthy said. “So once you complete the program and are registed, you have a larger scope of duties you can do in the office. The office becomes more efficient because you have people that can do many different things.”

McCarthy said teaching dental assisting is great because of those lightbulb moments when students get something.

“I love watching them glow and their self confidence grow as their knowledge increases,” she said. “When they finally get something, I’m just as excited for them as they are.”

Working in the dental field in general is rewarding too, according to McCarthy.

“You love your patients and they become your family,” she said. “Some come in and are scared to be in the dentist and (dental staff) can be a calming presence, then the patients aren’t so nervous and we can be there to take care of them.”

McCarthy said dental care has changed considerbly in the last 20 years, with technology and improved materials.

“We’re better able to help patients to save their teeth and we understand so much more, like that what’s going on in the mouth can be evidence of what’s going on in the whole body,” she said.

Hendershott said she believes allowing another level of provider, like a dental therapist, family nurse practitioner or physicians assistant, will always be helpful to promoting healthy mouths and lives.

“If (community health clinics) weren’t around – we are collectively in the U.S. serving 29 million people – where would those people fall? They’d show up at an emergency room,” Hendershott said. “That’s not the kind of care we want to be providing.”

InterCare annually sees about 18,000 unique users at all of its sites combined. Some are walking in with emergencies and some just need preventative and restorative care.

“Overall we’re looking for opportunities,” Hendershott said. “Dental therapists can support the dentist so patients, who some have gone years and years historically without care, can get quality oral health care.”

Contact: anewman@TheHP.com, 932-0357, Twitter: @HPANewman