FILE - dentist, dentistry, dental therapy

Dental therapy is nearing a tipping point in the United States, whether “Big Dentistry” likes it or not. That’s according to Kristin Mizzi Angelone, a dental policy expert with the Pew Charitable Trusts.

“There is an unprecedented level of activity in states across the country and from across the political spectrum, with more and more states and advocates identifying it as an effective way to increase access to dental care,” she told “It isn’t a matter of whether or not this will happen; the questions is ‘how long will it take’?”

Like nurse practitioners and physician assistants are to doctors, dental therapists are mid-level providers who can perform many of the same procedures as dentists, such as pulling teeth and filling cavities. And as with the medical profession, dental therapy has run into opposition from the profession’s top dental groups that continue rifling through an excuse rolodex to protect their turf.

But with fewer health insurance plans covering dental care and fewer dentists accepting Medicaid, there are more than 5,000 federally designated dental health care shortage areas, especially among low-income and rural Americans.

For many, it’s either the hospital emergency room as a last resort for dental care, or no care at all. The American Dental Association (ADA) reported in 2015 that dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds.

Yet the ADA and its state affiliates have consistently fought efforts in states to authorize dental therapy as a viable option for the underserved, despite success in at least 54 countries since 1921.

When Alaska began allowing dental therapists on remote tribal lands in 2004, the ADA and the Alaska Dental Society sued, citing substandard care and licensing violations. The groups eventually dropped the suit after a rebuke from a state judge, and since then more than 45,000 Native Alaskans have gotten dental care who otherwise may have not.

The dental lobby then began a whack-a-mole campaign to prevent dental therapy from taking hold in the lower 48 states.

The results have been mixed. In 2009, Minnesota legalized dental therapy and created degree programs. Since then, Vermont, Maine and tribal lands in Washington state have authorized the profession. Oregon also has a pilot program for Native Americans.

But efforts in North Dakota and Arizona stalled in recent months amid heavy criticism from state dental associations which derided dental therapy as unsafe.

Arizona state representative Regina Cobb, a dentist who is a past president of the Arizona Dental Association and member of the ADA’s lobbying arm, led the dental therapy defeat last December.

“Are we going to hand them an uneducated, untrained person, less trained than a dentist and say, ‘We’re going to give the most vulnerable population this person’?,” said Cobb in an interview with in January. “Do they deserve anything less than what I get when I walk into a dental office? I don’t think so.”

But the Arizona dental community seems to have enough safety problems among its own. A 2015 investigative series by a local television station found the state dental board kept the public in the dark about dentists who had been arrested, had drug or alcohol problems, or harmed patients, in 70 percent of cases. Rep. Cobb even defended the board on both the House floor and local television.

Whether it’s such embarrassing reports, or decades of clean safety records among dental therapists around the world and where allowed in the United States, the dental lobby opposition appears to have switched gears to access and money.

Now, the problem isn’t safety with dental therapists, but the two-tier system they create. During debate last year, a Vermont lawmaker read a letter from the Vermont Dental Society:

“We are convinced that this proposal, if enacted, will eventually create a two-tier system of dental care in Vermont with some patients seeing a dental therapist and others seeing a dentist.”

Michael Hamilton calls this excuse bunk. A senior research fellow in health care policy at the free-market Heartland Institute and co-author of “The case for licensing dental therapists in North Dakota,” Hamilton has testified in support of dental therapy before a number of state legislatures, most recently in Connecticut.

“The truth, however, is Connecticut already has a two-tiered system – a system of “haves” and “have nots.” Blocking dental therapy would preserve Connecticut’s two-tiered system,” he said in February.

Hamilton tells that the dental lobby is running out of reasons to oppose dental therapy, and predicts the tide will turn when dentists finally embrace the profession as a way to broaden their own opportunities.

“Because the only thing licensing dental therapists would do, is expand dentists’ own liberty to run their practices however they want to as small business owners, and treat patients according to their own professional judgement,” he said.

“Allowing therapists to practice increases the freedom of dentists to hire, train, and delegate according to each dentist’s professional judgment.”

Mizzi adds that 30 years ago, the idea of going to anyone other than a doctor for their routine health needs was unthinkable.

“But nurse practitioners and physician assistants have changed that dynamic in one generation. The parallels between that movement and dental therapy are obvious. It will take time, but dental therapists will become as common as nurse practitioners.”