Using dental therapists in Wisconsin draws broad support, but Wisconsin Dental Association opposed

Guy Boulton
Milwaukee Journal Sentinel

Dental therapists, a profession between dental hygienist and dentist, have been approved in four states in the past year and now are allowed to practice to varying degrees in 12 states, including Michigan and Minnesota.

The state Senate Committee on Health and Human Services held a lengthy hearing Wednesday on a bill by Sen. David Craig (R-Town of Vernon) and Rep. Mary Felzkowski (R-Irma) on whether Wisconsin should join those states.

Supporters contend that dental therapists, who would work under the supervision of dentists, would help address one of the state’s more entrenched health problems: access to dental care in rural and urban areas for people who are covered by Badger Care Plus and other Medicaid programs and people who don’t have dental insurance.

They contend that dental therapists, whose salaries are roughly half those of dentists, are a more cost-effective way to provide some care to patients while freeing dentists to focus on more complex procedures.

Dental therapist, who often also are licensed dental hygienists, have the training to fill basic cavities, place temporary crowns, do nonsurgical extractions of severely diseased and loose teeth, and provide preventive care.

More than 50 groups, including the Wisconsin Hospital Association, Wisconsin Manufacturers & Commerce, Wisconsin Counties Association and Children’s Health Alliance of Wisconsin, support allowing them to practice in Wisconsin.

The supporters also cross the political spectrum, ranging from the Badger Institute and Americans for Prosperity Wisconsin to Kids Forward and Disability Rights Wisconsin.

 The Wisconsin Dental Association, Marquette University School of Dentistry and the Academy of General Dentistry oppose the bill.

They raise questions about the bill’s requirements on the training of dental therapist and allowing dental therapists to do nonsurgical extractions of teeth.

They also questioned whether allowing dental therapists would improve access to care, contending that the state needs to increase what state Medicaid programs pay dentists to improve access to dental care.

Most dentists in the state do not accept or see few patients covered by Medicaid programs because what Medicaid programs pay typically doesn’t cover their costs.

The low reimbursement rates are partly why Wisconsin ranks 45th among state in the percentage of children covered by Medicaid programs who saw a dentist in 2017.

Matt Rossetto, director of government services for the Wisconsin Dental Association, said Wisconsin has an adequate number of dentists but that they are clustered in urban areas.

The state, he said, has done little to expand coverage in rural areas.

But supporters of the bill noted that access to dental care also is a problem in urban areas.

Felzkowski noted that Minnesota, which approved dental therapists in 2009 and licensed its first in 2011, now has roughly 90 dental therapists.

Those dental therapists had 94,000 patient visits last year.

“That moves the needle,” Felzkowski said.

Minnesota requires that at least 50% of dental therapist patients be covered by Medicaid programs or that dental therapists practice in an underserved area.

The Wisconsin bill does not have the same requirement.

But supporters contend that dental therapists are most likely to be employed by community health centers, nonprofit dental clinics and private rural practices where dentists want to see more patients who are covered by Medicaid programs but cannot cover their costs because of the state’s lower reimbursement rates.

The Wisconsin Primary Health Care Association, which represents community health centers, for example, supports the bill.

Community health centers provide dental care to about 160,000 people in Wisconsin each year.

Christy Jo Fogarty of the Minnesota Dental Therapy Association said Minnesota now has more jobs for dental therapists than therapists and practices are offering signing bonuses to recruit them.

She estimated that dental therapists’ scope of practice — the care they can provide — is 10% to 12% of that of dentists.

Nonetheless, Minnesota has seen a reduction in visits to hospital emergency departments because of dental problems as well as a reduction in wait times for dental appointments.

Wisconsin hospitals saw 37,446 patients — an average of 720 a week — in their emergency departments for preventable dental conditions, such as abscesses, in 2017.

Under the bill, dental therapists would have to graduate from an accredited program. 

Northcentral Technical College in Wausau is interested in offering a program to train dental therapists. Lori Weyers, representing the school, said it would take two to three years to establish a program.