Florida Lawmakers Drill Into Competing Dental Bills

Jan 28, 2019

Dental therapists fall between a dentist and a dental hygienist. They can provide preventative and restorative care.
Credit Matthew Jones/flickr

Lawmakers are being asked to consider two competing proposals surrounding access to dental care. One would allow mid-level practitioners to be licensed, while the other would provide incentives to would-be dentists.

A coalition called Floridians for Dental Access wants the Florida Legislature to allow licenses for dental therapists.

Therapists have more training than a dental hygienist and less training than a dentist. They can perform services like filling cavities and pulling teeth.

“We have counties with no practicing dentists in those counties," says Sen. Jeff Brandes, R-St. Petersburg. "We have millions of people who are under served in this space, and this creates for us an opportunity to lead in the country by allowing dental therapists and to grow a new profession and create a new pathway for individuals in the state.”

His plea to reporters at the Capitol came as the James Madison Institute (JMI), a Tallahassee think tank, issued a policy brief focused on the need for dental therapists all over Florida.

“63 of the 67 counties have areas within the county that are designated as shortage areas for oral healthcare,” says Sal Nuzzo, JMI’s Vice President of Policy and co-author of the report. He says there aren’t enough dentists in Florida, and too few of them accept Medicaid. That's where dental therapists could help fill the gap.

“Mid-level providers are also able to provide that maintenance and restorative care at a far lower cost than a traditional dentist," Nuzzo says. "So if you’re just above the Medicaid levels but you don’t have traditional dental insurance, you’re able to get care at a much better rate.”

Nuzzo says there are areas of Florida where a dentist can’t be found within a one-hour drive. The issue got his attention when he heard about a 12-year-old Maryland boy on Medicaid who couldn’t get treatment for a tooth infection. A trip to the ER couldn’t save him.

“The infection had spread to his brain and he subsequently passed away, and that story just stuck with me. So, we began to look at…what are the policy implications behind this," Nuzzo says. "We came to discover that there are gross injustices in rural healthcare - with respect to oral healthcare.”

The Florida Dental Association is supporting a different proposal. Chief legislative officer Joe Anne Hart says the bill will help dentists who are just starting out while also fulfilling the needs of those on Medicaid.

“The bill creates a dental student loan repayment program that will incentivize dentists to go into these under served areas and work as full time Medicaid providers," Hart says. "The return on the investment for the state will be great because it will help reduce occurrences in the emergency room where we know they aren’t getting definitive care - only pain meds and antibiotics.”

Hart says creating a licensing program for a new type of dental provider will increase regulations and costs, and she says mid-level providers can’t compete with a dentist’s level of knowledge.

“Dental therapists are high school graduates that get three years of dental therapy training and then would be authorized to do irreversible surgical procedures such as extractions, partial root canals, and local anesthesia," Hart says. "What they are not trained (to do), as dentists are, is to look at other conditions related to an individual’s medical health, and to make sure that whatever is happening in their dental procedures does not impact their overall health.”

The James Madison Institute report cites federal data showing more than five and a half million Floridians live in areas with documented dentist shortages. 

If approved, dental therapists would work under the supervision of a dentist without that dentist having to be in the office. Dental therapists would be trained to perform approximately 100 procedures, which is twice as many as a dental hygienist.