Op-ed: Dental therapists could help people get care needed in Washington state
A new kind of dental provider could introduce flexibility and cost-efficiency to oral health care that nurse practitioners and physician assistants have brought to health care, writes guest columnist Alex Narváez.
Special to The Times
EACH week, children and adults with urgent problems that shouldn’t have happened are admitted to 14 dental clinics I operate. These include very young children with advanced cavities who have already had dental procedures under general anesthesia. We also see working parents who put up with dental pain on the job until they can’t take it anymore.
For far too many people, the current dental system isn’t working. Health insurance that covers dental care is scarce. Even for those who have it, affordable care is hard to find.
We dentists see only 55 percent of the public.That’s a lot of unmet need building up, to be fixed later at great expense after too much unnecessary pain.
A recent report by the American Dental Association indicates that from 1997 to 2009, the number of dental visits per year decreased by 4 percent. The number of people with dental insurance and people willing to pay out-of-pocket for dental services has also been decreasing.
This trend is worse in the elderly, less than a third of whom have dental insurance. As our aging population continues to expand, the need for affordable dental care will only grow.
There is a solution that community leaders and state officials are beginning to embrace. A new type of dental provider can introduce the same flexibility and cost-efficiency to oral health care that nurse practitioners and physician assistants have brought to health care.
A few weeks ago, I saw what I consider the future of dentistry in Alaska, where a new kind of midlevel provider, called a dental therapist, is working in rural Native American communities. Dental therapists in Alaska bring affordable, quality care to patients who need it. They are recruited from the local community for an intensive educational program that gives them expertise in a limited range of common services such as preventive care, simple extractions and fillings.
I watched dental therapists undergo the training necessary to guarantee that they’ll be extremely good at what they do. They can’t do everything a dentist does, but they are professionals, and they can provide many of the services our patients need most.
Washington state legislators set the rules under which health professionals work. If they allowed midlevel dental providers here in Washington, I could expand our clinics’ operating hours. Staying open into the evenings and on weekends would cost us nothing in capital expenditures, but would serve the many patients who can’t afford to take time off from work to see a dentist.
I could also spend more time educating my patients, so that they don’t develop serious, painful problems that force them to miss school or work. I want my patients to lead full, healthy lives — especially the children, whose learning and social development can be hindered by oral disease.
Latino children have the highest cavity rate of nearly any ethnic group. They also have one of the highest dropout rates. I believe that we dentists can help these students succeed academically by reducing the number of cavities they experience.
Midlevel dental providers could see more children and pregnant woman on Medicaid, expanding our service capacity. Our limited number of providers are trying to do everything — providing acute care so that patients don’t wind up in emergency rooms, preventive care to kids and pregnant moms, and regular care for people getting checkups.
But we dentists simply don’t have the capacity to deliver all the services that patients need. With dental therapists on our team, we could serve as the primary managers of oral disease, while the midlevel therapists would provide the most commonly needed services.
As a practicing dentist in Western Washington for 30 years, I have had the honor and privilege of helping tens of thousands of patients maintain healthy mouths. My chairs are full of parents, children and working people from the moment we open until the moment we close.
My staff and I work hard. But all too frequently, the problems we’re fixing could have been prevented if we had a more flexible, affordable oral-health-care system.
This would benefit everyone, not only patients, but dentists too. I don’t want to see another child undergo oral surgery for a disease that’s almost entirely preventable. If I can be a part of ending that, I can look in the mirror and say I made a difference.
Dr. Alex Narváez is dental director of Sea Mar Community Health Centers, which sees more than 54,000 patients annually.