Debate On Licensing Mid-Level Dental Providers in Kansas Resumes
Advocates for allowing dental hygienists with advanced training to perform a broader range of procedures are now in their fifth year of trying to convince legislators to approve the necessary changes in state law.
Wearing bright yellow and black scarves, they rallied Wednesday morning and then headed for meetings with legislators to press their case for expanding access to services in a state where 95 of 105 counties have a shortage of dental providers .
Their challenge this year, as it has been every year since 2011, is to overcome opposition from the Kansas Dental Association, which maintains that allowing hygienists trained as dental therapists to perform an expanded but proscribed list of routine dental procedures would endanger patients.
When the licensure bill was first introduced in 2011, Paul Kittle, a pediatric dentist from Leavenworth, told legislators that allowing dental therapists to fill cavities and pull teeth would reduce dental care in Kansas to “third world” levels.
“We cannot allow any non-dentist — whether they be a dental hygienist, an expanded therapist or someone straight out of high school — to drill into the nerve on a primary tooth, to extract a solidly embedded or an abscessed primary molar,” Kittle said.
Kevin Robertson, executive director of the Kansas Dental Association, has said repeatedly that the 18 months of training that hygienists receive to become dental therapists “is simply not adequate” for them to learn the restorative and surgical procedures they would be allowed to perform under the proposed changes.
Analysts for the National Governors Association reviewed the findings of several studies for a January 2014 report and concluded the safety concerns of dentists were unfounded. Their report said a limited number of studies conducted in the United States “have shown safe and effective outcomes.” It went on to say, “International research provides stronger evidence that advanced-practice dental hygienists deliver safe, high-quality care.”
Dr. Kevin Nakagaki employs dental therapists in his St. Paul, Minn., practice. The Kansas Dental Project — a coalition of advocacy organizations headed by Kansas Action for Children and supported by several health foundations, including the Kansas Health Foundation — paid for Nakagaki to come to Kansas and take part in Wednesday’s kickoff of the coalition’s 2015 lobbying effort.
In his meetings with lawmakers, Nakagaki stressed his belief that dental therapists are better at some procedures than dentists because they’ve received more focused and intensive training.
“Dental therapists get to concentrate just on those restorative procedures that are in their skill set,” Nakagaki said. “So, when they come out, they’ve done many, many more of them than the dental students.”
Economics, not safety, is the main concern of dentists, said Dr. Daniel Minnis, of Pittsburg. They are worried about possible competition down the road, he said.
“I think that dentists are afraid that someday these registered dental therapists will go out on their own and be practicing across the street from us,” Minnis said. “I don’t think that is going to happen. I think the model works best when they’re working under our direct and indirect supervision.”
The fact that hygienists are not seeking to practice independently gives the legislation a chance, said Rep. Susan Concannon, a Beloit Republican and vice chair of the House Health and Human Services Committee.
“Probably a key to this particular issue is that you’re asking for a collaborative practice, not asking to go out on your own,” Concannon said during brief remarks at a luncheon sponsored by the dental project.
Still, advocates appear to face an uphill climb. It isn’t yet clear whether the licensure bill will even receive a hearing in the HHS committee, Concannon said.
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
Editor’s note: The Kansas Health Foundation is the primary funder of the Kansas Health Institute, the parent organization of the editorially independent KHI News Service.