At a recent mobile dental clinic, a large campervan parked outside St. Cecelia’s Church in Beaverton donated $ 20 for cleaning by health students at the University of the Pacific.
Gabriela, a 47-year-old mother of two who has asked the OPB not to use her last name because she is undocumented, was delighted with the service to her family. But she faced a problem: Years of delayed care meant she was left in excruciating pain, especially when she ate.
“I think the pain goes to your spine because the pain goes all over your body when the fork hits broken teeth or teeth that need root canal treatment,” she said. “This pain usually lasts me for an hour… it’s not pain that goes away easily.”
The hygienists were cleaning Gabriela’s teeth, but there was nothing more they could do for her. They are not dentists, so hygienists can only do preventative care. Dental hygienists need two years of post-secondary education, as opposed to the eight years required to become a dentist.
Bill 2528 would create a third type of dental license – a dental therapist – that would require more training than hygienists, but less than dentists. A therapist should complete three years of training and could perform basic dental procedures such as filling cavities and simple extractions, under the supervision of a dentist.
The aim is to reduce the cost of care and improve access, especially in rural areas where dentists are sometimes scarce. Oregon has the full-time equivalent of 0.49 dentists per 1,000 people, according to a 2019 report from the Oregon Bureau of Rural Health.
Thousands of Oregonians cannot get regular dental care. As a result, 30 percent of older Oregonians have lost six or more teeth. And bad teeth can have serious repercussions: if you can’t chew healthy fibrous foods, you’re more likely to eat soft, less nutritious foods. Children in pain cannot sleep and fall behind in school.
“We have found that it affects people’s ability to find jobs, because if you don’t have that winning smile, it’s really hard to feel confident in an interview, and it’s hard to go through those interviews. “said Dr. Miranda Davis, a dentist with the Indian Health Council of the Northwestern Portland area.
A wide range of Oregon health and dental organizations, children’s groups, educators, tribes and other organizations support the bill.
Ten years ago, staff at the Northwest Portland Area Indian Health Board began researching possible solutions to the lack of adequate dental care. They found that states like Minnesota and Alaska have licensed new types of dental therapists.
The idea was pitched in the Oregon Legislature as early as 2011, but it failed to catch on. In 2016, state lawmakers decided the Oregon Health Authority should study the idea.
This often happens in the Legislature. If someone opposes an idea – and they don’t have the voice to kill it – they submit a plan for study.
Pilot projects n ° 100 and n ° 300 are therefore in progress. Several therapists have been trained and work successfully under supervision. But they still have to prove their advantage, said Amy Coplen, director of the Pacific University School of Dental Hygiene.
“Each tooth has to be photographed several times. Each procedure has multiple aspects that needed to be reported to the Oregon Health Authority, ”Coplen said. “The pilots were a huge administrative burden, to prove things that have already been proven, honestly.”
Over one million Oregon residents live in areas with insufficient dentists. About 24 primary care service areas in rural Oregon – areas sometimes spanning hundreds of square miles – do not have a full-time dentist.
The main opposition to the Dental Therapist Bill comes from the Oregon Dental Association, which represents and lobbies on behalf of approximately 2,000 dentists. The bill would take some dental procedures and hand them over to therapists, although the ODA says it does not oppose the concept of dental therapy. They just think therapists need more education, closer supervision, and a narrower scope of practice than what this bill requires.
Take, for example, a dental therapist in Joseph, who could potentially do a simple tooth extraction under the supervision of a dentist in Portland. Even though many of us have moved a loose tooth, a simple extraction can quickly become complex, says Portland dentist Dr. Caroline Zeller. For example, if a patient begins to bleed profusely or a tooth needs to be cut, a dental therapist might need more immediate help than a dentist who is not in the same office can provide.
“Before starting a procedure, a provider should have the ability to handle the treatment and complications of that procedure,” Zeller said.
In this extraction scenario, the therapist might be a six-hour drive from the responsible dentist.
The dentists’ association also notes that people in the most vulnerable populations who could be served by dental therapists are also more likely to suffer from dental complications.
“When a tooth becomes difficult to remove, it most definitely is surgery,” Zeller said. “It is the most stressful procedure performed in a dental office on awake patients. And when we talk about vulnerable populations, we are talking about some of the most complicated health stories. Removing a tooth from such people is riskier than healthy ones.
She said more complicated procedures require treatment from a more trained individual, not less.
“Providers need to have sufficient training not to be mere robots. … They should be trained to understand the disease processes, anatomy and physiology of their patients, ”she said. “But if the goal is just to create technicians who focus more on using their hands than understanding, then the level of supervision and scope of practice should reflect that.
“Either provide them with sufficient training to prepare them for success, or protect them by increasing their level of supervision and reducing their scope of practice. “
Amendments dealing with details such as the training therapists will receive, the extent of their responsibilities and the oversight required were proposed by State Representative Tawna Sanchez, Democrat of Portland and main sponsor of the bill. The problem, she says, is that each new requirement reduces the practicality of dental therapists.
Requiring a therapist working in rural Oregon to work with an on-site dentist, for example, makes the cost prohibitive. There aren’t enough dentists already.
“We’ve tried to compromise, maybe not doing the best job at times, and I’ll admit being a little cranky about it every now and then,” Sanchez said. “But… I think we should make a commitment to making sure we have proper health care for the people of the state of Oregon.
“COVID-19 has impacted access to health care and dental care for Oregon residents statewide. But for many Oregonians, this inability to get basic dental care for themselves and their families existed before COVID – and will exist afterwards. “
Back in the church parking lot, Gabriela’s 15-year-old daughter walked out of the dental clinic with a bright smile. But Gabriela knows she’s unlikely to save the thousands of dollars needed to treat herself. Instead, she calls dental schools to find an appointment. It is far.
Even House Bill 2528 would not be of much help to him now because his teeth are too far apart. But it might have helped him a few years ago by making it easier for him to spot problems before they got so serious.
Health experts have been trying to license dental therapists for 10 years now. The latest bill sits on the House health care committee. To have a chance, it must be voted out of committee by Tuesday, April 13.