The future of dentistry in Wisconsin is up for grabs. A bill that would allow dental therapists—who perform surgical dental operations under the general supervision of dentists—to practice, will be debated by Wisconsin lawmakers this fall.
Sixty-four of 72 counties in Wisconsin have a shortage of dentists. According to federal data, 1.2 million Wisconsinites live in areas where there are dentist shortages. Even a majority of the Milwaukee County area has a shortage of dental care providers, according to the U.S. Health Resources and Human Services Administration.
Dental therapy is not a new profession. Often compared to a physician’s assistant, dental therapists currently operate in more than 50 countries. They often perform surgical operations, such as filling cavities, removing teeth and placing crowns.
Six states have approved laws that allow dental therapists to operate in the last year, bringing the total to 12, including Minnesota which has allowed them to operate since 2011. However, in those 12 states, four have approved "Dental Health Aide Therapists," which differ from dental therapists. These individuals practice only on federally-recognized tribal lands, or on members of tribal lands.
Supporters say dental therapists would help provide more dental care to rural areas that are underserved across the state. Opponents say this issue can be solved by evenly distributing dentists in rural and urban areas.
The Minnesota Example
Minnesota is one example many supporters use to show the benefits of this profession. Much like in Wisconsin, Minnesota has seen dental coverage shortages in urban populations as well. There is research that says that there are shortages in Minneapolis and St. Paul, according to Jane Koppelman, the senior manager of research for the Pew Dental Campaign.
“To turn this into only a rural issue is really misguided,” says Koppelman. “We have info that says that the Twin Cities has a lot of dental shortage areas, and dental therapists are closing the gap there and in rural areas.”
Many Minnesota-based dental practices send dental therapists hours away to work in low population areas. They often set up in schools, nursing homes or hospitals to perform operations. Forty-five percent of Minnesotans live outside of the Twin Cities area where 41 percent of dental therapists are employed.
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A 2014 report released by the Minnesota dental board and health department found that 14 clinics, which were employing dental therapists, saw an increase of 6,300 new patients; more than 80 percent of whom were publicly insured. Minnesota dental therapists have also provided more than 175,000 patient visits since 2017, according to data provided by The Pew Charitable Trusts.
Furthermore, data has shown that the personnel cost savings allowed the clinics to expand capacity and care for more underserved patients. Dental therapists make around half the hourly wage of a dentist, according to Drew Christianson, the clinical assistant professor for the school of dentistry at the University of Minnesota.
“The practices and clinics that have used dental therapists to reduce wait times expand the amount of chairs in their clinics, or help free up the dentist’s day-to-day tasks, have been the beneficiaries of this new provider,” says Christianson.
Koppelman also says she is seeing more Medicaid patients being served in Minnesota recently as well, which could be because of dental therapists.
“Practices that are employing dental therapists are able to serve more Medicaid patients because the labor costs of treating patients are lower,” she added.
Supporters
Currently, more than 50 groups have given their public support for allowing dental therapists to operate in Wisconsin. These groups, which include both conservative and liberal minded organizations, support Wisconsin’s legislation, which has also drawn large bipartisan support from lawmakers.
One of those groups is the Social Development Commission (SDC) in Milwaukee. George Hinton, CEO of the SDC, says dentists are not distributed evenly across Milwaukee.
“We may have a lot of doctors and dentists, but they’re not located in the areas where there are pockets of poor people,” says Hinton. “There are not nearly enough dental services for the community of our size.”
Supporters say dental therapists could also increase care to children, as 57 percent of children on Medicaid did not receive any dental care in Wisconsin in 2017. Matt Crespin, associate director of the Children’s Health Alliance of Wisconsin, says dental therapists could go directly into schools to provide care. Crespin oversees Wisconsin’s Seal-a-Smile program, which provides dental care to children in schools.
“If a dental therapist was deployed as part of these teams (Seal-a-Smile), a significant amount of the procedures these children need could be done right at their school as part of this program,” he says.
Opposition
One group opposing the legislation is the Wisconsin Dental Association (WDA). They say they that even though they believe the legislation has good intentions, they think the problem lies in the distribution of dentists across the state.
“We don’t believe dental therapists are unsafe,” said Matt Rossetto, director of government services for the WDA, “but we don’t have a numbers problem, it’s a distribution problem.”
Rossetto says he would like to work with legislators to address this problem, adding that he knows that there are more dentists focused in urban and suburban areas in Wisconsin. The WDA also says that Wisconsin’s Medicaid reimbursement rates are currently the third lowest in the nation for children’s dental care and the fifth lowest in the nation for adult dental care.
The WDA wants more funding for dental care as well. According to state data, Wisconsin spent less than 1 percent on dental care in 2011 — in terms of the amount the state spends on services provided to Medicaid recipients.
“There are ways to better the current workforce than by simply creating a new one,” says Rossetto.
What’s Next?
Wisconsin’s state Senate Committee on Health and Human Services held a hearing on the bill last August. Republican Rep. Mary Felzkowski introduced the bill last spring. The bill currently has 35 co-sponsors. It will be debated by lawmakers this fall. If approved, there are several schools across Wisconsin that say they would be able to license dental therapists, including Northcentral Technical College in Wausau.
