A few years ago a coalition of a ctivists decided to tackle the problem of affordable access to dental care in Vermont. The problem was simple -- too many Vermonters cannot afford to keep their teeth in a healthy state because they cannot afford basic dental care. They also came to the conclusion that the state needs more dentists.
The solution would prove to be difficult because, as is case with all things related to health care reform, it all comes down to politics and money. Somewhere in the history of providing health care, and then insurance in this country, teeth and gums were left out of the mix.
Dentists have been able to remain mostly independent practitioners operating within a free market system. The technology, skill and expertise displayed by American dentists are among the best in the world. Sadly, the prices they charge for these expert services also are among the highest in the world.
When the Green Mountain Care Board was considering the benefits package for insurance plans in the new exchanges they received over 1,000 letters and e-mails urging them to include comprehensive dental care. They ran the numbers and decided that adult dental coverage was not affordable for the state.
If they had included a dental benefit it would have forced dentists to work in the same world as the rest of health care professionals and it would have marked the beginning of a major change in the way dental care is provided. Hopefully, that change will happen before I become worm food.
Back to the activists. They decided that they would try to pass a bill in Vermont establishing a new level of dental practitioner, a dental therapist, similar to a nurse practitioner or physician's assistant in the mainstream medical world.
When the first discussions about this bill took place there was a less than welcoming reception by Vermont dentists. They have softened their stance over the years, but it will still be a very steep uphill battle.
Dental therapists have proven successful in Alaska and Minnesota and they are improving the lives of thousands of people who previously went without dental care. Acceptance of this new role in Vermont will take more time.
There are two identical bills now in the Vermont House (H.273) and Senate (S.35) that establish the rules and regulations to create the new profession of dental therapist in the state. The bill was introduced a few years ago but did not move out of committees. This year there is more optimism that the bills will be brought to the House and Senate floors.
Dental therapists will be required to have a Bachelor's Degree and 400 hours of clinical training under the supervision of a dentist but there are exceptions to this educational requirement that could allow for one year of specialized training. Once they pass an exam and are licensed, they will then have to work under the supervision of a dentist.
The scope of practice for these new professionals is laid out in detail in the bill. A dental therapist is defined as:
"A person who provides oral health care services, including prevention, evaluation and assessment, education, palliative therapy, and restoration under the general supervision of a dentist within the parameters of a collaborative agreement shall be regarded as practicing as a dental practitioner within the meaning of this chapter.
"In addition to services permitted by the Board by rule, a licensed dental practitioner may perform the following oral health care services: oral health instruction and disease prevention education, including nutritional counseling and dietary analysis; partial periodontal charting, including periodontal screening exam, radiographing; dental prophylaxis, including removal of visible calculus; prescribing, dispensing, and administering analgesics, anti-inflammatories, and antibiotics; applying topical preventive or prophylactic agents, including fluoride varnishes, antimicrobial agents, and pit and fissure sealants; oral evaluation and assessment of dental disease; formulating an individualized treatment plan, including services within the dental practitioner's scope of practice and referral for services outside the dental practitioner's scope of practice; shall not perform a full periodontal charting; extractions of primary teeth; nonsurgical extractions of permanent teeth; emergency palliative treatment of dental pain; restoring primary and permanent teeth, not including permanent tooth crowns, bridges, or denture fabrication."
This is only a partial list but it provides an understanding of the new role. If you are a Vermonter who cannot pass the first stage of a job interview because you are afraid to open your mouth or you are someone who suffers from acute and chronic dental pain because you can't afford dental care, passage of this bill could be a life changer.
Now is the time to contact your state Representative or senator and let them know you want them to pass H.273 and S. 35.
Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at firstname.lastname@example.org.