Natasha Fecteau’s mouth was a mess.
The Bremerton resident had an abscessed tooth that she routinely drained with a stab from a safety pin — until it swelled again and she had to repeat her crude procedure.
Fecteau had dental insurance through Medicaid, but dentist after dentist turned down her low-paying government plan. When she finally found a Tacoma dentist who accepted her insurance, it was too late. Another molar had to go.
Fecteau’s story illustrates a common complaint by health care advocates: Dental insurance doesn’t mean access to care.
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Part of the problem is that Washington has one of the nation’s lowest reimbursement rates for dental care provided through Medicaid, the state-administered health care program for low-income patients.
As a result, the state’s poor, particularly Native Americans and other minorities, generally have lousy oral health.
A coalition of state public health officials and others believe they have a solution: dental therapists.
These therapists, found in states such as Alaska and Minnesota, are the dental version of physician assistants — midlevel licensed health care professionals who can perform simple procedures, in this case doing cleanings, filling cavities, pulling teeth and the like.
Dental therapists are vastly cheaper to train and employ than dentists. Numerous studies have shown they provide quality care and can even boost revenue for many dentists.
In Olympia, the Washington Dental Access Campaign, a coalition of more than 40 health care, minority, union and social organizations, has been pressing lawmakers to allow therapists.
Some dentists and their trade group, the Washington State Dental Association, have thwarted five years of efforts to bring dental therapists to the state, according to interviews and a review of campaign-finance records by The Seattle Times.
Bracken Killpack, the state association’s executive director, said he believes therapists can pose risks to a patient because they are not trained to handle serious dental problems.
Washington’s dental lobby is following the lead of the American Dental Association, which has opposed therapists nationwide, calling them unneeded and unsafe.
Rather than create more dental caregivers, Killpack said, the state should address this public health need by raising rates for Medicaid dental-care reimbursement. State Medicaid pays 29 cents on the dollar for dental costs, with dentists absorbing the rest.
Experts agree that poor oral health can lead to far costlier diseases — including diabetes, heart disease and osteoporosis. Still, studies show tens of millions of Americans go without dental visits each year.
In Washington, about 1.7 million people receive Medicaid, a quarter of the population. Of those who are adults, 17 percent receive dental care.
Community health clinics and a state Medicaid effort aimed at children have improved access to dental care in some parts of the state. But Native American, minority and low-income children still suffer disproportionate rates of tooth decay. Among all ages, only 28 percent of Washington’s dental needs are met, according to federal data.
“There is a hidden opportunity for improving overall health by treating the infection in the mouth,” said Diane Oakes, deputy director of the Washington Dental Service Foundation.
But the state’s reimbursement rate for dental care (only four states have lower rates) has resulted in just three in 10 dentists here accepting Medicaid for adults, according to the foundation.
That leaves Medicaid patients with tooth pain, gum disease and other oral troubles in the hands of hospitals that often are ill-equipped to handle dental complications. In 2010, the Washington State Hospital Association said dental problems were the top reason uninsured people went to the emergency room.
Dr. Morgan Ball, the dentist who treated Fecteau, said he has worked up to 70 hours a week with Medicaid and other patients for the past three years at Comfort Dental in Tacoma.
Root canals, fillings, cleanings and other procedures paid for with Medicaid essentially equate to “free” care, he said. For a cleaning that typically costs more than $100, the state reimburses $24 to Comfort Dental, he said.
“It is not the dentists’ fault that nobody on Medicaid can find somebody to treat them,” said Ball, who worked on Fecteau. “If we did nothing but Medicaid, we would go out of business.”
Washington’s Medicaid reimbursement rate for dental care has not increased since at least 2007.
Dental therapists have worked in rural and tribal communities in Alaska for the past decade.
Therapists train for 3,000 hours over two years, said Mary Williard, director of the dental-therapists education program for the Alaska Native Tribal Health Consortium.
They learn 46 basic dental procedures such as exams, cleanings, sealants and simple tooth extractions that Williard said form the bulk of services for underserved communities.
In Minnesota, therapists for the past five years have increased the number of Medicaid patients seen at dental practices, raising revenue while decreasing wait times. Their malpractice insurance costs about $100 a year, records show.
With their shorter training, therapists in these two states typically work under the supervision of a licensed dentist. In Washington and other states, proposed legislation has followed suit.
Marc Cooper, who runs the Mastery Company, a dental consulting firm based in Woodinville, says dentists contend that therapists pose health risks to mask their real concern: Therapists might threaten dentists’ small-business model.
“Dentists are profit-driven,” Cooper said. Their concern is “drip theory. You put (therapists) in the rural areas. You put them on the reservation. Then pretty soon, they’ll come to the outskirts of suburbs.”
Killpack denied blocking therapists because they threaten his members’ business model.