Are Mid-Level Providers a Threat to General Dentists?

Are Mid-Level Providers a Threat to General Dentists?

There are quite a few states, including Florida, that have proven to have inadequate access to dental care in low income areas according to the WK Kellogg Foundation and the Pew Trust. In their writings, the wrongly accuse the states of having too little dentists, when it is really the access that these areas are lacking.

Proper dental care is extremely important, and should be available to all families, regardless of their income. Dentists are needed everywhere, but with any profession, individuals move to places where they are more likely to be successful in their trade. Student loans burden dentists that have just made their way through schooling, and they are unable to take on the task of working in an underpopulated market, or for charitable purposes.

Access to care should be taken seriously by all, and we should be working together to mend this issue, rather than focusing on getting more dental providers. Leading the way in dental education and showing people how to get the help they need to get to their appointments is necessary for their dental health.

There are about sixty two dentists for every 100,000 people nationwide, with that number continuing to rise by about one and a half percent every year. That is incredible when you think about it- we need to get all of these people to see a dental professional!

Children who are considered poor or live in rural communities usually have not seen a dentist by age 12. By this time, they have grown in all of their teeth, and have even lost most of their baby teeth. The adult dental visits are also declining annually. Of course, pediatric dentistry inclusion and adult dentistry exclusion by the Affordable Care Act skew these statistics a bit. Either way, the fact remains that access to quality care needs funding, not more dental providers.

The roll out of Mid-Level Providers has accreditation standards that must be followed. The United States Department of Education has recognized the Commission of Dental Accreditation for this purpose. Three years of training after high school would results in the capability to do the following:

  • Identify oral and systematic issues that need further evaluation by dentists and give referrals.
  • Radiographic imaging.
  • Dispense and administer nonnarcotic medications that have been prescribed by a licensed healthcare provider.
  • Apply numbing medications and resins.
  • Change periodontal dressings.
  • Pull erupted primary teeth.
  • Prep and place direct restorations in primary or permanent teeth.
  • Pulp cap permanent teeth.
  • Minor adjustments and repairs on false teeth.
  • Removal of space maintainers.
  • Chart the oral cavity.
  • Oral health education and disease prevention techniques that include nutrition and dietary aspects.
  • Dental prophylaxis.
  • Apply topical preventative and prophylactic agents.
  • Make athletic mouth guards.
  • Administer local anesthetic.
  • Emergency palliative treatment for dental pain, as allowed by the terms herein.
  • Creation and placement f single tooth temporary crowns.
  • Prep and place performed crowns on primary teeth.
  • Suture removal.

Currently, professional with more than eight years of schooling perform these tasks. How is it possible that these Mid-Level providers will be able to accomplish these tasks successfully with so much less education and experience? Furthermore, there will be no incentive for an individual to run the full course of becoming a dentist with this type of short cut. This is simply a trade school education suited up in professional attire.

The American Dental Association represents dentists of all specialties, and believes that only dentists diagnose and treat dental disease and perform surgical procedures that may be irreversible. They are vocal with their opposition of the Mid-Level Provider idea, and are firm in their belief of the dental team concept. The dental theme concept is the idea in which all that are involved with providing care to patient be under the supervision of a licensed dentist. They are the gatekeepers of dental care when it comes to the visit, and the Mid-Level provider is a threat to that.

The different specialties performed be dentists are exclusive to each other. Dental therapists would benefit specialist the most, as they would be providing referrals for them. From the perspective of the general dentist, Mid-Level providers should work under a licensed dentist to ensure that all tasks are done properly and to the clients expectations.

Mid-Level Providers will essentially create less of a need for the general dentist. When thinking of it from a business point of view, two general practitioners could run an office of dental therapists who are in charge of administering the care to patients. This works out well from the corporate perspective, but creates a lower level of care for the patient, considering that those working on their teeth have much less experience and training than the general dentist. The quality of care is essential, and it seems as though it will be in the decline with the introduction of these providers.

Under the dental team concept, which provides the ideal way of oral health care delivery, according to  AGD and many other reputable sources, the following principles must be displayed in the workplace:

  • Dental services are provided by a licensed dentist, or under the supervision of a licensed dentist, in an environment known as the dental home. It does not matter what the social status of the patient is, or how the dental practice is run.
  • Procedures that require surgery to be corrected and may be irreversible can only be performed by the licensed dentist.
  • An increased number of auxiliaries in the dental home, where auxiliaries act within the uninterrupted or indirect supervision of a licensed dentist, increase the aptitude of the dental home.
  • Dental diseases are preventable and preventing them creates less of a cost for the patient. Resources should be established to educate patients about the importance of taking care of their teeth, and how to prevent diseases associated with not taking care of them properly.
  • Dentistry in the emergency field burdens the both the patient and the public with the costs associated with it. Collaboration between hospitals, medical doctors, and the dental home will help mitigate this, and will allow the patient to go from treatment to prevention. Dental referral and follow up is key to ensure prime dental health.
  • Any agreements arranged between dental and outside entities will not transfer local clinical decisions to anyone that is not a dentist in the state.
  • The needs of the patient are met through routine dental care provided by the dental home. This makes the patient know exactly where to go for dental care, without having to second guess their decisions. The dental home will also have all records needed to provide follow up care.

The AGD has always been in favor of increasing access to dental care, but Mid-Level Providers are not the answer.  Patients will not be receiving the best care, as these providers are not as skilled as licensed dentists.

House Bill 139, which was passed in Florida in 2016 to support dental care access accounts, allowed dentists to repay their student loan debt if they opened a practice and worked in a low class area for two years. This was a great step in alleviating the burden of debt on the dentist, and getting access for those in lower class areas in the state.

Hiring healthcare workers that aren’t accurately trained is not a good solution for getting the population more access to dental care. Education and funding are the prime necessities in getting these people the dental care that they so desperately need. Not just any dental care. Thorough, in depth, quality dental care.

 

Sources:
http://flagd.org/
http://flagd.org/wp-content/uploads/07011201-1.pdf