Wisconsin approves dental therapists to expand oral care

Dental therapists, mid-level providers whose level of care is between dentists and hygienists, will be allowed in Wisconsin, as Gov. Tony Evers on Wednesday plans to approve the workers and other dental care initiatives.

Wisconsin is joining 13 states, including Michigan and Minnesota, in authorizing dental therapists to expand access to dental care, especially for patients on Medicaid or without insurance and in rural areas. The providers can fill cavities, do oral exams and pull some teeth but can’t do more complex procedures such as root canals and crowns.

Dental services

Dentist Paula Duszynski checks Joseph Merit’s remaining teeth at a recent checkup. Merit, 72, of Lancaster, had several teeth pulled and got dentures through Access Community Health Centers in Dodgeville after some of his teeth became infected.

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Up to $2 million of the $20 million, already set aside for technical colleges in the current state budget, is for Northcentral Technical College in Wausau, where Evers is expected to sign the bills. The money will help that campus start a dental therapy training program and support its dental assistant and dental hygienist programs.

The initiatives “will move us forward in our work to address shortages and bolster our dental health care workforce while also closing gaps in access across the state,” Evers said in a statement.

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Long road to therapists

The Wisconsin Dental Association long opposed dental therapists, saying they would compete with dentists and not necessarily work in underserved areas. Bills to allow them were introduced at least three times before the state Legislature approved the bipartisan measure this month.

WDA dropped its opposition two years ago after restrictions were added. Those include requiring dental therapists to work in dental health professional shortage areas or see mostly underserved patients, such as those on Medicaid.

Dental therapists will also have to graduate from accredited training programs and work under a dentist’s supervision. The role is similar to how physician assistants work with doctors.

Dr. Patrick Tepe, a dentist in Verona on WDA’s legislative advocacy committee, said in November that dental therapists could especially help in public health settings such as the state’s 19 federally funded health centers.

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Dr. Tina Sopiwnik, a dentist and chief dental officer at one of the centers, Ashland-based NorthLakes Community Clinic, said the clinic has 13 dentists and could use at least seven more, especially in locations such as Hayward, Hurley, Iron River and Lakewood. If dental therapists were available, they could fill some of those slots, she said.

“A dental therapist could be used for all of the primary care, and dentists could do more comprehensive treatments, like root canals, crowns, dentures and implants,” Sopiwnik said.

Other states with dental therapists are Alaska, Arizona, Colorado, Connecticut, Idaho, Michigan, Minnesota, Maine, New Mexico, Nevada, Oregon, Vermont and Washington. Minnesota became the first state to pass such legislation, in 2009.

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It can be difficult for people on Medicaid to find dentists who will treat them. Dentists say that’s because the state-federal program doesn’t pay them enough to cover their costs.

Just 37.9% of Wisconsin dentists work with Medicaid or the federal Children’s Health Insurance Program, compared with 43% nationally, according to the American Dental Association’s Health Policy Institute. The state’s Medicaid payments for children are 33.6% of what dentists say they get paid from private insurance, compared with 61.4% nationally, the ADA institute says. For adults, it’s 33% in the state and 53.3% nationally.

Other bills

Under the other bills Evers plans to sign, technical colleges can apply to the Legislature’s joint finance committee for a share of the $20 million to start or expand dental staff training programs.

Marquette University, which runs the state’s only dental school, will get $350,000 a year to support recruitment and training of rural dentistry students, and graduates who work in shortage areas for 18 months will get scholarships.

Dentists and hygienists will be able to work in states that share a licensing agreement. People with dental insurance can designate a specific dental provider, which should prevent the need for them to pay for care before getting reimbursed by insurance.

Dental therapists will have to graduate from accredited training programs and work under a dentist’s supervision.

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