Hutchinson ? Dental care is so sparse in some parts of Kansas that 13 counties have no dentists at all, and several proposals are being considered to address the issue.

The most controversial plan would allow a new type of dental worker, called a registered dental practitioner, to work in underserved areas and perform routines services such as cleanings and fillings under the supervision of a dentist. Complex procedures would be left to dentists, the Hutchinson News reported.

Fort Hays State University wants to offer a program to train registered dental practitioners. It would require approval from lawmakers and the Kansas Board of Regents.

But the Kansas Dental Association is objecting, raising concerns about safety and the creation of two levels of care. Instead, the group wants to encourage more dentists to accept Medicaid patients and create incentives for dentists to locate in rural areas.

“In the instance of extracting teeth, there are procedures that appear to be simple, but once you begin to perform the procedure you see other issues,” said Kevin Robertson, executive director of the Kansas Dental Association. “We fear that a practitioner could get into those issues that they aren’t familiar with and at that point they could be hundreds of miles from a dentist and don’t have anyone to back them up.”

Christie Appelhanz, vice president of public affairs for Kansas Action for Children, said mid-level providers practice in more than 50 countries around the world as well as in Alaska and Minnesota.

“There are no studies that show that mid-level providers do not provide safe care,” she said.

Fort Hays President Ed Hammond sent his faculty to Minnesota to learn about its dental therapist program. The university plans to use private funds to start the training program and will not request state funding.

“Almost everyone we’ve talked to recognizes the need and also sees the mid-level professional as a reasonable solution,” Hammond said.

Hammond said the economics of making a dental practice work in sparsely populated counties, where there is neither the volume of patients nor the income base to support a dentist, is tricky if not impossible.

“I’m not convinced that dentists who are going to school for seven years — with the limited practice and income capability — will be willing to locate in western Kansas,” he said. “Dentists want to go someplace where they can maximize the return on their investment. I don’t fault them for it, but then don’t stand in our way when we are looking for a solution that works.”