In Minnesota, the profession of dental therapy has aimed to serve people without access to dental care since its inception.
Dental therapists are mid-level providers, similar to a physician’s assistant or nurse practitioner in medicine. The goal of dental therapy is to increase dental care access in urban and rural areas.
They are required by law to work in settings that serve low-income and underserved populations or in a designated dental Health Professional Shortage Area, including clinics where 50% or more of patients seen by the dental therapist are enrolled in a Minnesota Health Care Program, have a medical disability or chronic condition, or have no health coverage and a gross family income under 200% of the federal poverty level.
Gaps in access
There are vast inequities in access to dental care across the nation. Between 2011 and 2016, 17% of children ages 2 to 5 from low-income households had untreated cavities in their primary teeth, which was three times the percentage of children from higher-income households, according to CDC data.
A portion of the reason could fall on those in the profession. In 2019, 40% of Minnesota’s 3,083 dentists did not accept public insurance.
“A lot of dentists don’t take public assistance insurance, and that is a huge barrier to people being able to get that care. So you have people that are driving two to three hours just to see a provider that will accept their insurance,” said Raelene Cabrera, a student in the University of Minnesota dental therapy program.
Many state and federal insurance programs rarely include dental benefits for adults, leaving many uninsured. In 2019, 20% of Americans had no dental coverage, and nearly 50% of those ages 65 and older reported not having dental insurance.
In 2017, 25.3% of Minnesotans were without dental insurance, and 15.5% of Minnesotans had foregone dental care within the past year due to cost, according to the 2017 Minnesota Health Access Survey.
Having more dental therapists has increased access to dental care because of the state’s requirement for 50% enrollment in medical assistance requirement.
Dental therapists provide preventive and routine restorative care, including filling cavities, placing temporary crowns and extracting diseased or loose teeth. With dental therapists taking on those cases, dentists can focus on other cases, Cabrera said.
“Dental therapists are able to provide more routine procedures and preventative treatments. That way the dentists are able to see more of those like complex cases or are able to do more of those complex treatments that are out of our scope of practice,” Cabrera said.
One study that examined a dental clinic in Minnesota found that having dental therapists on staff helped everyone increase the number of patients they saw and increased revenue for the clinic.
Minnesota became the first state to establish the dental therapy profession in 2009, with the first dental therapy students graduating in 2011. Since, the profession has been steadily growing. In 2018, there were 92 dental therapists in the state. As of March, Minnesota had 133 dental therapists.
The University of Minnesota’s program has around eight graduates a year, said Drew Christianson, a clinical associate professor at the University of Minnesota School of Dentistry. The program recently received accreditation from the Commission on Dental Accreditation, which only two other dental therapy programs in the nation have.
“To be put on that same level for standards allows the dental profession and the dental community to see that we’re outputting students at the same levels as the dental students and the dental hygiene students are kept at,” he said.
Christianson said as more geographic areas adopt dental therapy, graduating from an accredited program will allow students to practice in other states where licensing is required.