Eliminating turf battles among dental professionals could go a long way toward improving oral health in Missouri, according to a new report commissioned by three area healthcare foundations.

Improving the state’s many lagging indicators “will require open minds, as open checkbooks may not be plentiful,” concluded the 44-page report issued recently by the Health Care Foundation of Greater Kansas City, REACH Healthcare Foundation, and the Missouri Foundation for Health.

Though making no recommendations, the report outlined how states such as Alaska and Minnesota have augmented their oral health workforce by licensing mid-level providers to provide basic care under the supervision of a dentist. Similar efforts have proved controversial in Missouri and Kansas.

According to the report, Missouri’s oral health challenges include:

• Scoring 41st and 33rd, respectively, among all states in the percentage of adults who had seen a dentist or had their teeth cleaned within the past 12 months, according to 2010 data from the U.S. Centers for Disease Control and Prevention.
• Among the nearly 700,000 children eligible to receive screening, diagnosis, and treatment through Medicaid in fiscal year 2010, less than one third received any dental service.
• Seven of the state’s 114 counties have no dentists, according to the state dental board, and several others having just one.
• According to the Kaiser Family Foundation, Missouri in 2007 had 4.8 dentists per 10,000 residents (compared with 6.0 nationwide), but that the number dropped to 2.9 per 10,000 residents in rural areas.

The findings about the shortage of dentists follow a June 21 report to the Kansas Board of Regents, which recommended the board consider building a dental school to address a lack of dentists in the state.

In Alaska, the report for the Missouri foundations said, early evaluation of the state’s dental health aide therapists have determined that the licensees have provided safe and appropriate services to roughly 35,000 consumers who previously had no access to care.

According to the report, applicants must have two years of post-high school education to qualify for the training program. They perform duties such as filling cavities and performing uncomplicated extractions.
Workforce issues go beyond dentists opposing expanded responsibilities for support staff, said Wendy Frosh, the New Hampshire-based consultant who wrote the report.

Hygienists are also reluctant to cede any duties to assistants. And, she added:

“Everybody is scared when you start talking about people like dental therapists. Because you sort of let the cat out of the bag, and here’s this new professional trained in this very limited scope of practice, but it steps on peoples’ toes because – ‘Ooh, that’s part of why I thought I was unique.’”

Frosh said a dentist made a heartening comment when the foundations gathered members of the oral health community to discuss the report at a Wednesday meeting in Columbia. The dentist, she said, noted that all parties must set aside self-interest, if they are really serious about the common good.

As executive director of the Missouri Coalition for Oral Health, Gary Harbison knows how divisive the debate about mid-level providers can be.

His organization includes the Missouri Dental Association and the Missouri Dental Hygienists’ Association, and Harbison said the coalition is neutral on the issue of alternative workforce credentialing because its members could not agree on the issue.

“Our position is that we have no position,” he said.

In Kansas, supporters of establishing a registered practitioner model have met resistance from the Kansas Dental Association.

Meanwhile, according to the foundation report, legislative efforts to establish a Minnesota-style system of dental therapists and advanced dental therapists have gone nowhere in Missouri, despite a positive recommendation from the state dental board.

The foundation report illustrates that no single strategy alone will improve oral health in Missouri, said Bill Moore, vice president of programs, policy and evaluation at the REACH Foundation.

Simply educating the public about the importance of good dental hygiene and routine trips to the dentist could go a long way in addressing the problem, he said.

As far as REACH is concerned, Moore said, “We happen to believe there is a growing body of evidence that supports a variety of different solutions.”

And, he added, “Workforce is one of them. We are not going to back away from workforce.”

The Health Care Foundation of Greater Kansas City is proud to partner with the Kansas Health Institute news service to provide weekly health stories about health and policy issues impacting the greater Kansas City region. This News Service is an editorially independent program of the Kansas Health Institute and the Health Care Foundation of Greater Kansas City and is committed to objective coverage of health issues.