According to the Institute of Medicine, the U.S. dental care system fails one-third of all Americans – more than 100 million children and adults. I don’t know what the corresponding failure rate is for Washington state, but as a licensed dental hygienist who’s practiced here for 37 years, I can tell you this: It’s bad.
Despite the best efforts of hard-working dental professionals, too many Washingtonians – including those who are elderly, low-income, have special needs or live in rural areas – are not getting the dental care they need when they need it.
For the past 13 years, I have operated a mobile dental hygiene service for nursing home residents and people with disabilities and mental illness in eight counties in northwest Washington and on the Olympic Peninsula. Every day, I see people with broken and loose teeth, lost fillings, abscesses and other infections. Many of them are in great pain, yet most of their problems could have been prevented if only they’d been able to get care when they needed it.
The farther away you live from the greater Seattle metropolitan area, the worse the problem is. I have patients in Port Townsend, Sequim, Port Angeles and Forks, for example, who can’t find local dentists to treat them. Their local community dental clinic closed last year, and the Jamestown-S’Klallam Tribe’s dental clinic no longer sees elderly patients or adults with developmental disabilities because of the overwhelming needs of children and the volatility of Medicaid funding for adults.
These people have no alternative but to travel to Seattle or Bremerton for dental care, and that’s a significant hardship for them.
The elders I see in long-term care now are the beginning of the coming avalanche of baby boomers retiring. We can expect many will develop special needs that often come with aging and will have the same difficulties as those I see today.
Our dental care system is failing these folks, and it needs to be brought up to date. We should take a cue from the medical care system, where nurse practitioners and physician assistants have expanded and improved the availability of health care across the entire population, particularly for the elderly, low-income families and people in rural areas.
We can do something similar for dental care, by adding a new kind of mid-level provider to the dental care team called a licensed dental professional (LDP) and creating a training track for dental hygienists like me to become LDPs. These new providers would practice as part of a dentist-led team, working in communities that dentists aren’t reaching to provide essential preventive and routine dental care, including fillings and uncomplicated extractions.
Telemedicine, which has been used very successfully to help patients in rural communities get medical care from visiting nurses working with doctors in a clinic, could be used in much the same way to help those same patients get dental care from LDPs. I am already caring for many of my patients in group homes. If I were connected to a dentist via telecommunications, I could relay my assessments, photos and X-rays to the dentist for diagnosis and development of a treatment plan for me to implement with my patients.
This is a great opportunity for us to expand and modernize dental care in Washington state.
Many dentists are opposed to LDPs, claiming that they would compromise patient safety and provide poor-quality care. Fifty years ago, when the nursing profession came forward with a proposal for nurse practitioners, many physicians made exactly the same arguments. Today, nurse practitioners and other mid-level medical care providers are part of everyday health care.
In addition, mid-level providers are not new to dental care; they’re just new here. They’ve been practicing successfully in dozens of countries – including Canada, the United Kingdom and New Zealand – for nearly 100 years. They’ve been working very well in Alaska for the past six years, and now Minnesota is starting to use mid-level dental care providers. More than a dozen states are considering proposals to add some type of mid-level dental care providers to their dental teams.
Right now, our dental care system is letting too many Washingtonians down. We can do better – and we must. Adding LDPs to the dental care team will help us bring desperately needed dental care to rural, low-income and shut-in populations.
Let’s bring dental care into the 21st century. The time to do it is now.
Anita Rodriguez of Stanwood is a dental hygienist active with the Washington Dental Access Campaign.
JOIN THE DISCUSSION | Register here
We welcome comments. Please keep them civil, short and to the point. ALL CAPS, spam, obscene, profane, abusive and off topic comments will be deleted. Repeat offenders will be blocked. Thanks for taking part — and abiding by these simple rules. A thorough explanation of rules of conduct can be found in our Terms of Service. If you have any questions, including why your comment may not be showing immediately after you submit it, be sure to visit the commenting FAQ.