Peter Galbraith Commentary: A Dentist's Argument for Licensed Dental Practitioners


Editor’s note: This commentary is by Dr. Peter Galbraith, who practiced dentistry in Vermont, served as a public health official in New York, Connecticut and Vermont, and was an adviser to several federal agencies including the Centers for Disease Control and the Food and Drug Administration. He lives in South Burlington.

In my career as a dentist in Vermont, I saw children who were gargling with kerosene to numb their pain and teenage girls anxiously awaiting their 16th birthday so that they could get all of their teeth removed and replaced with dentures.

This was around the time we created the “Tooth Fairy Program” which helped low-income Vermonters with the cost of care and the nonprofit Vermont Dental Care Program that operated eight mobile clinics around Vermont treating thousands of children. We took those steps to help address Vermont’s dental crisis, and they helped.

However, make no mistake, Vermont still has a dental care crisis. Tens of thousands of children and adults across our state suffer the pain and humiliation that often goes with untreated dental disease. The crisis exists primarily because there are not enough dentists or there are dentists but they offer little or no care to those without insurance or with Medicaid coverage.

In a state where we often rank at the top of national health indicators, Vermont ranks 30th in the nation when it comes to adults who have lost six or more teeth before age 65. Nearly 40 percent of children with Dr. Dynasaur coverage did not see a dentist in 2011.

Every year, far too many children 5 and under are hospitalized for dental treatment. Annually, an average of 6,000 emergency department visits are for dental care. As someone who treated people in the emergency room, I can tell you that we helped their pain or gave medicine for their infection but it was not the dental care that they critically needed.

Looking forward, the access problem will only get worse. Nearly 50 percent of Vermont’s dentists are over the age of 55, the highest rate in the nation. And an estimated 40,000 additional Vermonters have gained Medicaid insurance coverage due to health care reform and there simply isn’t care available.

Fortunately, an innovative and cost-effective option is being considered in the Vermont Legislature — the licensed dental practitioner (LDP). LDPs are midlevel dental professionals who will create a more complete dental care team that can treat more patients and help address our oral health crisis.

LDPs will go through an intensive educational program in Vermont that meets the standards set by the American Dental Association’s Commission on Dental Accreditation. LDPs will have the ability to provide preventive and restorative dental care to underserved Vermonters.

This is not a new idea — physician assistants and nurse practitioners have been helping primary care practices treat more patients in Vermont for years. And, LDPs will do the same for dental care. The LDP model has been successful in more than 50 countries and has been increasing access to high quality dental care in the United States for 10 years.

In Alaska, providers like LDPs called dental therapists, have increased access to care for 40,000 people. In Minnesota, the state department of health found that dental therapists have expanded access to care and are reducing wait times – especially for rural patients. The Journal of the American Dental Association has found that dental teams with dental therapists perform better than those without them and a review of more than 1,000 scientific papers and studies attested to the safe, effective care they provide.

Hearing this, you might be wondering why we don’t already have LDPs in Vermont. Who could possibly oppose a high quality professional that will improve peoples’ dental health? Well, there is only one opponent — the American Dental Association (ADA). The ADA and their state dental societies have successfully blocked this modern approach to dental care in what amounts to a turf battle. Unfortunately, this opposition has thus far been successful in Vermont while no other viable alternatives have been offered to relieve the pain and suffering of so many.

Our dental care crisis is a challenge. We need to meet the challenge with a professional who can provide care in our communities, in our health centers, school-based health clinics, and in our dentists’ offices, bringing care to people where they live and work.

That is what LDPs will do and why they are right for Vermont.