North Dakota is currently discussing the feasibility of implementing mid-level dental providers to assist with the massive need for dental services across the state.
The meeting was spearheaded by the Interim Legislative Health Services Committee, chaired by Sen. Judy Lee.The concept of mid-level dental practitioners is opposed by not only the National Dental Association (NDA), but also by the North Dakota Dental Association (NDDA). Dr. Murray Greer, president of the NDDA, is against the change, saying, “We feel we have a good system in place that’s working well.”On the other side of the argument are rural North Dakota communities, many of which are lacking qualified dental providers. “We have many, many places in the state where there are no dentists,” says Sen. Lee.
The NDA granted permission for mid-level practitioners for some portions of Alaska, claiming in 2010 that the state has “a unique geographical and isolated access issue.”
Sen. Lee argues that the underserved rural areas of North Dakota are suffering from precisely the same access issues, especially on the reservations.The concept of mid-level practitioners is firmly established and embraced in the medical community. Physician assistants and nurse practitioners have been valuable and often-utilized medical resources ever since the positions were developed.But the NDA says mid-level dental practitioners (also called “dental therapists”) require much less education and training before certification.
Proponents argue that dental therapists could be instrumental in relieving the current backlog of scheduled patients, leaving the dentists to perform the more complicated procedures for which they alone are trained.
Therapists could conceivably take over such procedures as extractions, where a tooth is permanently removed from the jaw, and fillings, where a fractured or decayed portion of a tooth is removed and repaired with either an amalgam (metal) or composite (tooth-colored) material.
Those opposed to the creation of mid-level positions offer another solution – expanding the training and responsibilities of those already in the dental profession, specifically hygienists and assistants. The newly-trained providers could travel to underserved communities and offer preventative care and education where it might be needed most.
Sen. Lee’s main concern is that more providers be available, in whatever capacity.
“Rather than having nobody looking at mouths,” she says, “I would like to have somebody looking at mouths.”