OLYMPIA—Legislators have a solution to Washington state’s shortage of oral health providers: authorize dental therapists to work all across the state.
For too many Washington families, timely and routine oral health care is out of reach. In 37 out of the state’s 39 counties, too few dental professionals are meeting local needs.
“Every child and family needs timely, preventive health care to be at their best,” said Jon Gould, deputy director of Children’s Alliance. “Childhood experiences with tooth decay disrupt sleep, school performance, and a healthy diet. When a child’s mouth hurts, it’s hard to eat healthy or sit still in class.”
“Infections of the oral cavity have systemic consequences. An untreated cavity can cause chronic, potentially life-threatening conditions and a visit to the emergency room,” said Jennifer Zbaraschuk, a Sequim hygienist and president of the Washington Dental Hygienists’ Association. “Families need to see a dental professional long before that.”
By authorizing dental therapists, House Bill 1317 / Senate Bill 5392 will expand dental care access where it is most out of reach, providing timely, quality care to rural, low-income communities and communities of color, and to patients who are publicly insured or uninsured. The bill is sponsored by Sen. David Frockt (D-46) and Rep. Eileen Cody (D-34).
“We need to act—we can’t wait any longer—to modernize the oral health care system,” said Rep. Cody, Chair of the House Health Care & Wellness Committee. “Dental therapists offer a way to connect more kids and families with urgently needed oral health care.”
Guided by national industry-approved standards, dental therapists have been practicing safely and effectively in the United States for more than 10 years. Since 2016, Arizona, Maine, Vermont and Michigan have all followed Alaska and Minnesota in passing legislation allowing dental therapists to practice. Under HB 1317 / SB 5392, they would be licensed in Washington and held to the same high-quality standards as dentists, but trained to perform a much narrower range of commonly needed procedures.
Dental therapists are already working in Washington; the Swinomish Indian Tribal Community licensed their own dental therapist in 2016, and in 2017 state lawmakers authorized dental therapists to work on tribal lands throughout the state. Dental therapists have since been hired by the Port Gamble S’Klallam Tribe and the Lower Elwha Klallam Tribe. Six students from the Confederated Tribes of the Colville Reservation, Lummi Nation, Swinomish Indian Tribal Community, and Tulalip Tribes are studying in Alaska to become dental therapists; they will complete their educations and return to serve their communities over the next two years.
Last year, a comprehensive study by the University of Washington found that dental therapists in Alaska were decreasing adverse outcomes. For example, fewer children in the rural Native communities they served needed their four front teeth extracted, or needed other procedures requiring anesthesia.
Dental therapists also allow dentists and oral health clinics to expand their business. Adding just one dental therapist means a dental practice can take 2,000-3,000 more appointments a year—and leverage state dollars earmarked for clinics in underserved rural communities.
By increasing access to care, dental therapists can address the racial and economic disparities in the oral health care system.
People of color are less likely to receive routine and preventive care, and children of color have the highest rates of dental decay and the fewest experiences with a dental professional. People with special needs, elderly people in nursing homes, parents in low-income families and communities of color, and people who live in rural and tribal communities are also feeling the worst effects of our shortage of dental providers.
Approximately 1 in 2 Washington kids have the popular, cost-effective Apple Health for Kids coverage. Yet our state’s dental practices accept their form of coverage 30 percent less often than practices nationwide. As a result, nearly 400,000 Washington kids covered by Apple Health do not see a dentist each year.
“Kids and families are facing harmful inequities in access to care,” said Sen. David Frockt, sponsor of the Senate bill. “They urgently need us to fix them.”
“These unequal conditions can’t be ignored,” said Gould. “It’s high time we adopted this proven solution.”
Convened by Children’s Alliance, the Washington Dental Access Campaign unites more than 40 organizations, including health care associations, consumer advocates, dentists, dental hygienists, senior groups, tribal governments and educational institutions to push for statewide dental therapy to address Washington’s oral health care needs.