Decade of Difference: expansion of oral health workforce

HCF's Decade of Difference report cover

Ed. Note: This is a modified excerpt from our Decade of Difference report. Read more about the region’s health care workforce in our full report.

Important developments throughout the dental workforce have played an essential role in supporting the expansion of the area’s oral health safety capacity. Increasingly, dental schools are reaching out to engage students from underserved areas in the hope that the students will return to their communities upon graduation.

At the same time, a growing number of dental graduates are seeking work in clinics rather than setting up solo or partner practices. This change has been attributed to a desire among dentists to spend more time providing services and less managing the business side of dentistry. Another contributing factor has been the increased exposure to public clinic settings that students have received during their rotations.

“It used to be that we would have an advertisement for a children’s dentist in a clinic for a year without filling it,” said one provider. “Now we get 20 to 30 qualified applicants.”

In 2013, a new school of dentistry and oral health was established at A.T. Still University, a Kirksville, Missouri-based private graduate school focusing on health sciences. The program was created to help address disparities in oral health care in Missouri and across the nation. Under the school’s doctoral program, fourth-year students split their time between a St. Louis clinic and a community health center or other safety net clinic.

In Kansas, an extension of the scope of services that dental hygienists are allowed to provide also has contributed to enhanced access. Extended Care Permits (ECP) enable hygienists to place temporary fillings, use local anesthetics, extract baby teeth and provide other expanded duties. In 2009, 89 of 1,593 Kansas registered dental hygienists had ECPs. As of December 2012, a total of 143 ECPs were active at Kansas practice locations.

The ratio of dentists to population in the metropolitan counties on both sides of the state line continues to exceed levels used by the federal government to identify dental health provider shortage areas. That said, the proportion of private dentists in both Kansas and Missouri who accept Medicaid adult and children patients – approximately one in five — has remained virtually unchanged over the past decade.

Concerns exist about future capacity, given an aging dental workforce. In 28 Missouri counties, more than half of practicing dentists plan to retire within 10 years, according to the Missouri Department of Health and Senior Services.

One area that has seen positive policy developments has been the promotion of broader clinical roles for dental hygienists and dental assistants. In 2003, Kansas amended its Dental Practice Act to allow Extended Care Permits (ECPs) for dental hygienists. This change enabled dental hygienists to work in the community with the signature (rather than sponsorship) of a dentist.

In 2012, the law was expanded to permit hygienists to provide additional services, including temporary fillings and extraction of loose primary teeth. Since 2001, dental hygienists in Missouri who’ve been in practice for at least three years and who are working in a public health setting can provide fluoride treatments, teeth cleaning and sealants to Medicaid children without supervision of a dentist.

Read more >> 

This blog post is part of A Healthy 10.


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HCF's Local Health Buzz Blog aims to discuss health and health policy issues that impact the uninsured and underserved in our service area. To submit a blog, please contact HCF Communications Officers, Jennifer Sykes, at jsykes@hcfgkc.org.

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