Florida is facing an oral care crisis. According to the U.S. Department of Health and Human Services, more than 5.5 million Floridians, over one quarter of the state’s population, reside in 232 communities designated as “Dental Care Health Professional Shortage Areas” (HPSAs). From Escambia to Monroe, not a single county in the state is immune from this problem.
Not even California and Texas, states with much larger populations, have as many people living in HPSAs as Florida does, and only Connecticut has a lower percentage of its residents that has their oral health care needs met. To remove Florida’s HPSA designation, Health and Human Services estimates an additional 1,200 dental practitioners would be needed across the state.
Fortunately, state lawmakers want to expand access to dental care by allowing dental therapists, hygienists, and assistants to offer oral care treatments. State Rep. Daniel Perez, R-Miami, recently introduced a proposal to permit midlevel providers to perform a variety of dental services, including the extracting of primary teeth, the managing of dental trauma, the applying of desensitizing medications, and many others. State Sen. Jeff Brandes, R-St. Petersburg, says these therapists would offer families who lack reliable access to dentists the opportunity to receive affordable oral care.
“This bill would allow Florida the opportunity to be a leader in reducing regulatory barriers by developing a more efficient and effective dental care delivery model,” Brandes said. “It would break down barriers to entry for care and, based on research, would provide better outcomes for Floridians.”
The case for expanding the scope of practice for these midlevel providers is stronger now than it has ever been. In the coming years, increasingly more Floridians will be reaching retirement age and demanding more dental treatments. At the same time, a growing number of dentists will also be reaching retirement age and hanging up their lab coats. A 2016 survey by the Florida Department of Health discovered 9 percent of practicing dentists in the state plan to close their practices within the next five years, listing retirement as their primary reason.
Midlevel providers can help satisfy Florida’s oral health care needs. Dental hygienists, therapists, and assistants already provide a variety of routine treatments under the supervision of dentists in private practices, as well as community settings such as schools and nursing homes. And unlike dentists who must train for four years and pay more than $270,000 for schooling, therapists and hygienists can get certified within two years and pay as little as $36,000. This allows midlevel providers to more easily enter the marketplace and provide less expensive treatments to patients.
Rural communities in particular stand to benefit from improved access to basic dental services. After Minnesota became the first state to license midlevel professionals in 2009, the state’s Office of Rural and Primary Care found one-third of all Minnesotans experienced a reduction in wait times required to receive dental care. Forty-eight percent of dental therapists were serving suburban and rural communities, where roughly 30 percent of Minnesotans live, showing dental therapists in the state were disproportionately practicing in and benefiting rural communities. ORPC concluded, “Patients visiting rural clinics were nearly two times more likely to experience a reduction in wait time compared to their urban counterparts” after they introduced dental hygienists and therapists.
Yet, despite this success, dental associations continue to vehemently oppose allowing midlevel professionals to assist dentists in their work. In the fall issue of the South Florida District Dental Association’s newsletter, the interest group warned a “hurricane” of “second-tier” providers threaten to expose patients to substandard care.
Nothing could be further from the truth. More than 1,100 studies across 26 countries have found dental hygienists and assistants provide patients safe and effective care. Even the American Dental Association’s Council on Scientific Affairs concluded that “the results of a variety of studies indicate that appropriately trained midlevel providers are capable of providing high-quality services, including irreversible procedures such as restorative care and dental extractions.”
Dental hygienists and therapists have proven to be safe and affordable providers of oral health care treatments in America and abroad. Lawmakers in the Sunshine State should free these qualified professionals to treat all Floridians, especially the most vulnerable.