VT Digger - Peter Youngbaer: Dental Access Help Could be on the Way

VT Digger

At our free clinic in Barre, we treat hundreds of patients from nearly 50 different towns in central Vermont. I am in awe of all of the services our volunteers can provide — primary and preventive care, mental health, and diet and nutrition, just to name a few. But we can’t routinely give our patients the one kind of care many of them need most — regular dental care.

We do what we can. We have a hygienist who consults with us and dentists who will volunteer to take the most severe cases. For that, we are very grateful. But it’s not enough to meet the overwhelming need.

Unfortunately, our patients are not unique. Despite the fact that good oral health is vital to overall health, every year tens of thousands of Vermonters do not get the dental care they need. As a result they suffer in pain, miss work and school, and in severe cases suffer from life-threatening infections.

We have to address this crisis and we have to do it now.

There is a proposal in the Legislature to create a licensed dental practitioner (LDP) that would work for dental care very much like a nurse practitioner works for medical care. LDPs would be registered dental hygienists who would add several years of critical professional training onto the excellent dental hygiene education base they already have. Vermont Technical College, which already runs a superb dental hygiene program and clinic, has agreed to provide the education.

The LDP approach is not an experiment, as some have suggested. More than 50 other countries and several states have this model (sometimes called dental therapists) for practicing dentistry. Just to give one example, it has been a nationwide model in Canada since 1974. The safety record is excellent and the additional access to affordable care is most welcomed by consumers. It makes eminent sense for Vermont to do the same, bringing much-needed professional capacity to the ever-growing need for oral health care.

The time is right for LDPs in Vermont. Our dentist workforce is the oldest in the country. Nearly 50 percent are over age 55. Recruiting new dentists alone won’t solve the problem.

A few decades ago, the medical field faced a shortage of primary care doctors. This was addressed by the growth of the nurse practitioner profession. As the director of a free clinic, I can tell you that we could not meet the demand for patient care without the capacity given to us by both doctors and nurse practitioners.

Nurse practitioners have made primary care more accessible and affordable for people and LDPs can do the same for dental care.

In the medical field, many nurse practitioners have the authority to practice on their own, diagnose conditions, and prescribe medications. In contrast, the proposed LDP is not given as broad authority, but would operate under the general supervision of a dentist. This means they can work in a separate location from their supervising dentist, but are in regular contact by phone and other means for necessary consultation.

For a clinic like ours, this would mean that we could employ an LDP who could provide dental primary care right in our office. I can tell you, this would be a godsend to our patients — affordable high quality dental care in their own community.

Surely, LDPs are not a magic solution to every one of our state’s oral health problems. Dental insurance should be included in the Vermont Health Connect marketplace, dentists who treat Medicaid patients should be reimbursed at a higher rate, and we need better early public education on the importance of self-care and prevention.

More than anything right now, we have a crisis in access to dental care. What is most frustrating is this crisis is not an incurable disease — it’s a preventable health problem. We can do something about it by making sure all Vermonters have access to dental care.

Adding licensed dental practitioners to the dental team will make it possible for thousands of Vermonters who go without the dental care they need to get that care. It is an excellent investment in Vermont’s future.