Vermont Needs Dental Therapists
Vermonters think most people in our state can get the dental care they need — they are wrong.
There is an oral health crisis in Vermont —from the Northeast Kingdom to White River Junction and beyond, thousands of Vermonters every year go without the dental care they need.
Tooth decay is the number one chronic illness plaguing children today. You might think that isn’t the worst illness to have. You can go in, have the cavity filled, and be on your way in an hour or so. But think about the child who can’t get to a dentist, who can’t sleep at night because of the throbbing ache that won’t go away, or can’t bite into a piece of food without feeling sharp pain. Who can develop a life-threatening infection if she doesn’t get treatment.
Our most vulnerable citizens are at risk — children with Dr. Dynasaur, the elderly, people with low-incomes, and people in remote and rural communities.
Vermonters go without care for a myriad of reasons. They may live in a town with no practicing dentist or struggle to find a dentist that will take their insurance, especially if that insurance is Medicaid or Dr. Dynasaur. It can also be nearly impossible to find appointments in the evenings or on weekends so that you don’t have to miss work to get care.
Vermont’s dental care system is not sufficient to meet our needs. About half of the state’s dentists are age 55 or older. Vermont does not have a dental school, leaving us to recruit dentists from other states. And dental hygienists are limited in the care they can provide.
Amra Heco has worked as a dental hygienist for the past six years in a private practice in Burlington. She describes daily calls from from patients with Medicaid asking if they can get care, and every day, having to say: “We don’t take that insurance. I am sorry.”
“I shake my head every time I hear a colleague or state legislator say there isn’t a dental care problem in Vermont. They have no idea how big or pervasive it is. But I see it every day.”
Vermont Technical College Is Preparing to Meet Dental The Dental Challenge
Vermonters do not shrink from a challenge. The state successfully expanded Medicaid dental insurance coverage for pregnant women in 2012 and a push is underway by the Vermont Oral Health Care For All Coalition to authorize dental therapists — dental providers similar to nurse practitioners or physician assistants in medicine — to practice.
Vermont Technical College (Vermont Tech) is getting ready to implement a dental therapy education program as soon as dental therapists are authorized to practice in the state. The Vermont Tech program will actually exceed new standards set by Commission on Dental Accreditation (CODA), the national body that sets education standards for all dental profession tracks and recently approved dental therapy standards to be implemented across the country.
“Vermont Tech is committed to educating dental therapists to meet the oral health needs of underserved Vermonters. CODA accreditation will allow our students to access financial aid and join the dental workforce in a profession recognized by the national accreditation agency.”
Dan Smith, President, Vermont Tech
The CODA decision also means a dental therapist trained at Vermont Tech will be able to practice anywhere in the U.S. where dental therapists are allowed to work. Vermont will be home to one of the nation’s first dental therapy programs with the potential to draw students from other states, including Maine where dental therapists are able to practice but there is no education program to train them.
Vermont Tech currently trains the state’s dental hygienists. The new dental therapy track expands the hygienists’ training with an additional year of education and clinical practice at the same facility.
According to Ellen Grimes, who directs the clinic, “Hygienists will have another avenue to use the knowledge they have to help improve access to care. They will be able to help out socially, economically and morally, these are patients that really need our help.”
Barriers to care range from living in a rural area where dentists don’t practice, to not being able to come in during traditional daytime hours Monday through Friday, or not being able to afford the care.
Grimes suggests that dental therapists could remove those barriers for patients. Hiring dental therapists would help dentists expand traditional practice hours, by seeing patients at night or on the weekend. Dentists would also be able to see more Medicaid patients because dental therapists are less expensive to employ than dentists.
Vermont Tech’s hygiene clinic began seeing Medicaid patients just three years ago. This is where Amra refers Medicaid patients she can’t treat at the practice where she works. Even at the clinic’s reduced rates, there are still patients who can’t afford the care. That is no surprise given that Medicaid only covers $510 in dental services per adult per year. That’s the equivalent of maybe two fillings at best.
Vermont Tech is one of the few places that accepts Medicaid payment on a consistent basis, says Grimes. Even dentists who say that they accept Medicaid payment, generally see a limited number of Medicaid patients per year. Adding dental therapists to their teams would enable them to take on more Medicaid patients.
Dental Therapy Track a Win for the Dental Profession and Patients
Dentist Renay Ivens, who is a supervising dentist at the Vermont Tech Clinic, became a dentist after spending more than five years as a dental hygienist. She felt that she had hit a wall in what care she could provide to patients. It dawned on her that as a dentist she could provide the hygiene work, treat the problem and get the patient out of pain.
Some dentists have expressed skepticism about dental therapists and that these midlevel professionals will drain away their business. But a team-based approach, with dentists, hygienists, dental therapists and expanded function dental assistants working together makes sense for patients, dental professionals and the state of Vermont.
Dental therapists currently practice in Alaska, Minnesota and Washington. They are also authorized to practice in Maine. Close to a dozen states have put forward legislation to enable dental therapists to practice and Oregon state is in the process of approving two pilot projects for dental therapists to practice in Native American communities there. Dental therapists have been practicing successfully in close to 50 other countries for close to 100 years now.
