Mid-Level Dental Practitioner Proposal Stirs Up Controversy

Tue, November 15, 2011

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KMUW / Briana O’Higgins

Controversial bills adjourned in the Kansas House and Senate to provide a mid-level dental practitioner in the state will be taken up again early next year.

Proponents say registered dental practitioners could address the shortage of dentists in Kansas, especially in rural areas. But opponents say if passed, the bills will compromise patient safety.

As proposed, the Registered Dental Practitioner, or RDP, would be a dental hygienist who goes through around 18 months of additional training to be able to perform some of the same restorative procedures as dentists. Similar levels of dental care have been established most recently in Minnesota and in 2005 in Alaska, and bills have been introduced in New Mexico, Vermont and Washington.

Registered dental hygienist and Kansas Dental Board member Denise Maus says the RDP would be able to perform simple extractions and fillings, addressing the dental shortage in the state

“The RDP would be able to reach individuals in rural areas and low income areas and also be able to treat Medicaid patients,” says Maus.

According to the Kansas Dental Project, a group comprised of three state non-profits, 93 Kansas counties don’t have enough dentists to serve their populations, and the existing population of dentists is nearing retirement, which will further compromise care.

“And so it is important that we have someone else to help them, much like the mid level provider in nursing helps with physicians with providing care to patients,” says Maus.

“First of all, there just simply is not a shortage of dentists in Kansas,” says Hale.

Dr. Hal Hale is president of the Kansas Dental Association and a general dentist in Wichita.

“Now, there is somewhat of a mal-distribution of dentists,” says Hale. “But a recent study has shown that between four and 14 dentists could solve most of that problem, because almost no one is 30 miles from a dentist in Kansas.”

The study, conducted on behalf of the State of Kansas Bureau of Oral health, recognizes four “dental deserts” in the state where residents live at least a half hour drive from a dentist, and a likelihood that that number will increase in the coming years. Dr. Hale says the Kansas Dental Association thinks the problem can be solved with fully trained dentists, rather than mid level practitioners.

“We’re trying to encourage more dentists to become Medicaid providers,” says Hale. “We are trying to get loan forgiveness for dentists who go to this area. We think we can solve the problem where we can get dentists in these four dental deserts that is much more practical and much safer to the profession then letting non-dentist providers loose on the public.”

Maus and other supporters say there is no reason to consider the RDP a threat to public safety, that they will likely pass a clinical exam identical to the exam taken by dentists in relation to the services they will be able to provide.

“They are going to be held to those same standards as a dentist is, in relation to education, so that by being treated by this person you are not going to get any less quality,” says Maus.

The bills creating the new dental practitioner will be taken up in the 2012 legislative session with additional support.

Fort Hayes State university last month announced they were interested in offering the states first bachelor’s degree for dental practitioners.

And the RDP has continuing support from the W.K. Kellogg foundation, which announced in 2010 $16 million to support efforts to create a mid-level dental practitioner in New Mexico, Ohio, Vermont, Washington and Kansas–not coincidentally all but Ohio introduced bills to their legislatures in 2011.

Dr. Hale says he wishes the Kellogg Foundation was interested in supporting different solutions to the RDP that might be better for Kansas, and that the Kansas Dental Association will be prepared to present alternatives to the legislature.

Most of all he says his organization, which represents 77 percent of dentists in the state, will do everything to protect their oath to do no harm.

“To sum it up, would you want your children treated by a dentist or a non dental provider?” says Hale. “I think that is the question. Where would you want your children to go?”

Funding for KMUW’s Sound Mind & Body series is made possible, in part, by Via Christi Health.