Topeka Health care advocates in Kansas are pushing a bill this year that they say would increase access to dental and oral health care, especially in rural and under-served areas of the state, but the Kansas Dental Association is fighting hard to stop it.
The bill, which was formally introduced in the House on Wednesday, would allow midlevel practitioners known as dental therapists to be licensed and practice in Kansas, as long as they work under the supervision of a fully licensed dentist.
"We see this as an opportunity to add a new kind of provider that is not unlike what happened several years ago with the medical community with (physicians assistants) and nurse practitioners," said Denise Cyzman, executive director of the Kansas Association for the Medically Underserved, a group that represents safety net clinics around the state.
Cyzman noted that 83 percent of the counties in Kansas are designated as workforce shortage areas for dental care.
The bill would authorize the Kansas Dental Board to license dental therapists who have taken a required set of training courses and have passed a licensing exam. It also outlines the scope of dental procedures they would be allowed to perform, including minor drilling and filling and some types of tooth extractions.
They would not, however, be licensed for more complex procedures such as root canals, Cyzman said.
It would also require that dental therapists work "under the direct or general supervision of a Kansas licensed dentist pursuant to a written supervising agreement." And the only dentists allowed to work with dental therapists would be those who practice in a safety net clinic for low-income patients, or those enrolled as a Medicaid provider.
Direct supervision would require the therapist to work in the same office or facility as the dentist, while general supervision would only require the licensed dentist to be available when needed, Cyzman said.
"We think that it also frees up the dentist to do some of the more complex procedures that they're trained to do. That increases access across the board," Cyzman said.
The dental industry in Kansas, however, has for years opposed efforts to expand the scope of lower-level practitioners, including dental hygienists, and this year is no exception.
"We're opposed to dental therapists," said Kevin Robertson, executive director of the Kansas Dental Association. "We don't believe it's appropriate for someone other than a licensed dentist to provide surgical procedures to the public."
Robertson said KDA believes the best way to increase access in rural areas and for low-income people is to increase the reimbursement rates that Medicaid pays for dental care, rates that he said haven't been raised for at least 15 years.
"And then with the 4 percent cut, it's just making it really tough to afford to do Medicaid," he said, referring to the rate cut that Gov. Sam Brownback ordered as part of his allotment cut package to balance the budget last year.
In his State of the State address Jan. 10, Brownback also called for establishing a dental school at the University of Kansas Medical Center in Kansas City. Currently, there is no dental school in Kansas. Most dentists who practice in Kansas are trained at dental schools either at the University of Missouri-Kansas City, Creighton University in Omaha, Neb., or the University of Oklahoma.
Supporters of a KU dental school have said that a state-run dental school could establish outreach clinics in under-served areas. But neither the advocates for dental therapists nor the KDA is taking a position one way or the other on that idea.
Cyzman said it would take a number of years before the first graduating class of a KU dental school could enter practice, while allowing the licensure of dental therapists would expand the workforce more quickly.
And while there is also no training program for dental therapists in Kansas, Cyzman said universities and community colleges that now train dental hygienists and dental assistants have expressed willingness to add a dental therapy program to their curriculum.
Meanwhile Richardson said that if the state has money available for such a project, the KDA would prefer to see it invested in raising Medicaid reimbursement rates.
The bill is likely to be referred to the Health and Human Services Committee where it was introduced.
Rep. John Wilson, D-Lawrence, who is the ranking Democrat on that committee, said he supports the bill and doesn't think fully licensed dentists should be overly concerned.
"I think it's going to take all hands on deck to address oral health needs in Kansas," Wilson said. "With this bill, it would be a dentist-led health team, so the dentist would determine what procedure they would let a particular dental therapist handle."