Pierce County needs better dental care. Dental therapists won’t solve the problem

As health care professionals, we are taught to carefully study facts, develop an accurate diagnosis and prescribe the correct course of treatment. Alejandro Narvaez’s recent opinion column regarding improving access to dental care misses the mark on all three parts of that process.

Washington state faces a serious dental access problem. However, the root cause is not a lack of dentists, but rather severe shortages of dental assistants and dental hygienists who are critical team members in providing primary dental care, from diagnosis to treatment.

Take Sea Mar, where Narvaez works. According to recent postings on the Sea Mar -Community Health Centers job board, there are nearly 70 openings for dental assistants and only five openings for dentists, two of which are part-time, none in Pierce County.

It’s no surprise that there are so many open assistant positions. According to a recent survey administered by the Washington State Department of Health, in Pierce County there are more than three dental assistant openings for every candidate looking for a position, and the average opening takes more than three-and-a-half months to fill.

The local outlook for hygienists is even worse, according to the same study. There are more than four openings for every job candidate and it takes more than four-and-a-half months to fill them.

Ignoring these facts allows the inaccurate diagnosis that dentists are at the root of the problem. Worse, it leads to the erroneous suggestion that authorizing lesser-trained dental therapists will solve Washington’s access to care issues.

It’s a seriously flawed idea. Dental therapists do not receive anywhere near the training of a licensed dentist or hygienist. While a hygienist typically completes at least four years of post-secondary education and a dentist eight, legislation being pushed in Washington — in the form of Senate Bill 5142 — would allow therapists to practice without graduate training or even an undergraduate degree. Under this bill, a therapist with only a high school diploma or GED and a couple years of limited training would be allowed to perform surgeries in which tissue is being irreversibly altered. There are no “simple procedures,” and a dental therapist isn’t prepared to deal with complications that can arise.

Patients have proven unsurprisingly hesitant to put their care in the hands of someone with so little training. That’s why the dental therapist “movement,” despite years of backing from special interests and assertions to the contrary, has failed to gain significant momentum.

While proponents point to other states passing dental therapy legislation, according to a review by the American Dental Association the reality is that there are only two where the type of dental therapists being proposed in Washington currently practice. And in one of those states, there is a single dental hygienist working under a provisional therapy license. In short, dental therapists have had virtually no impact on improving access to dental care.

Yet the tunnel vision of dental therapist proponents persists. For more than a decade, dentists have raised real concerns with the model. In response, proponents have taken every opportunity to attack these concerns and the dentists raising them.

They also have refused to engage in any meaningful discussion of alternatives aligned to the current standard of care. Washington faces a severe dental hygienist and assistant shortage that has a crippling effect on the delivery of care across the state, and the pandemic has made a difficult situation even worse. Expanding hygiene education capacity, removing unnecessary barriers to hygiene licensure, and creating a viable career ladder for dental assistants, the most diverse arm of the dental workforce, are just a few strategies to help increase access.

The other key in ensuring access for low-income and other underserved patients is for the State to recognize oral health care as the primary care that it is, and fund these services accordingly. It’s not to expect these patients to be seen by a new type of less-educated, less-skilled practitioner.

Still, dental therapist proponents continue to beat the same drum, ignoring these most pressing issues and overlooking or actively opposing common-sense solutions.

Yes, it’s true that too many Pierce County residents and too many Washingtonians lack access to dental care. But let’s look at the real issues and address them with strategic investments in proven solutions to provide all Washingtonians with better access to quality dental care.

John Lo, DMD, is a family dentist who practices in Lakewood and is a member of the Washington State Dental Association.

This story was originally published January 21, 2022 at 5:00 AM.