Edwin Allgair: Licensed Dental Practitioners Can Help Address Dental Care Crisis in Vermont

For years, I watched people suffer in pain, contract dangerous infections, and lose their ability to chew their food and their desire to smile all from a preventable disease that as a dentist, I was trained to treat — tooth decay. The need in the rural Alaskan communities I served was too great, and the oral health providers too few. Until, 2005 when a new provider, like a nurse practitioner but for dental care, came on the scene and changed our world.

The licensed dental practitioner (LDP) that has been proposed in Vermont has the potential to do the same. LDPs would increase access to dental care by working in clinics, dental offices or off-site from their dentist supervisor providing care to people who can’t get the dental care they need. They would provide oral health education, preventive care, and routine dental care, like cleaning and fillings, to people who don’t have options for affordable dental care.

I know it’s tough to imagine the unknown – all kinds of questions arise. How would these new providers work? Are they safe? Do they provide good care?

I’m happy to provide some answers. I worked for nine years supervising eight midlevel providers in Alaska who each logged 1,500 patient encounters a year — with zero adverse complications or emergencies.

That’s right, zero.

My basic message to you is that midlevel providers practice high-quality care and expand access to dental care. They are an asset to the dental team and to the communities they serve.

Whether you are separated from dental care by an ocean, a mountain, or a dollar sign — the pain and the need are the same.


More than 90 years of practice around the world, including nearly 10 in the U.S., and evidence from thousands of research articles, including some from the Journal of the American Dental Association, have shown that dental midlevel providers are safe and effective. Equally as important, research has shown that they get dental care to those who need it and would otherwise go without it. That has certainly been the case in Alaska, where more than 40,000 people now have access to dental care thanks to our midlevel providers.

You may think that Alaska is too different from Vermont to matter. If you are in pain from an infected tooth or suffering from tooth decay — a dangerous infectious disease — and you can’t get dental care, it doesn’t matter where you live. Whether you are separated from dental care by an ocean, a mountain, or a dollar sign — the pain and the need are the same. Midlevel providers expand access to care. They have done it in Alaska, they have done it in Minnesota, and I believe they can do it in Vermont.

Allowing these providers to practice off-site from their supervising dentist is one of the keys to their success. It is how a midlevel provider can be in a school clinic doing preventive care when a dentist has to be in their office doing root canals. It is how hundreds of patients get care in their community when the dentist’s office is miles away, and it’s how dental care can be available at times when a traditional dental office is closed making it easier for working people who can’t get away from their jobs to get care.

Now, there is a lot of misinformation about LDPs working off-site from their supervising dentists and I want to clear that up. General supervision or remote supervision is safe and effective. There are written protocols that are used because they are best practices and will be part of the law. I communicated with my midlevel providers every single day, sometimes several times a day — I was fully informed and the midlevel providers were fully prepared. If at any time, a case became too complicated, and that happened — five times in nine years — the case was referred to a dentist for further treatment.

You may wonder why a dentist from so far away is sticking his nose into your state’s debate. I can tell you it’s because I have seen firsthand the suffering that comes from lack of access to dental care. I have seen high school students with full sets of dentures, children in terrible pain with infections and swelling, and adults in their 20s and 30s with no hope of keeping their teeth into middle age.

I have also seen what few others have — the ability of a common-sense solution like adding a midlevel provider to the dental team to change the game. To get care to people dentists don’t treat — people without dental insurance, people with Medicaid, people who can’t afford dental care even if they do have insurance and people who work hard but cannot afford to take time off to get to a dentist’s office Monday-Thursday from 8:30 a.m.-4:30 p.m.

Over nine years in Alaska, in rural communities not that different from those in Vermont — where people work hard without enough to show for it at the end of the day, I have watched midlevel providers change the dental health profiles of entire towns for the better. Welcome them into your communities to practice and I promise you, they can do the same for your state.


Editor’s note: This commentary is by Dr. Edwin Allgair, who is the past dental director at Yukon-Kuskokwim Health Corp., a dental clinic in Bethel, Alaska, with 48 satellite clinics. He helped developed the curriculum for the Alaskan dental health aide therapist certification, and has 14 years’ experience working remotely with community health aides. The advocacy group Voices for Vermont Kids facilitated the submission of his commentary to VTDigger.