Four empty dental chairs.
It’s another busy day at the Health Partnership Clinic in Olathe, the only place in Johnson County where the poor can get treatment for free or with a modest donation.
The clinic’s lone dentist treats a dozen patients a day, but could see many more if she had more help.
“There’s an incredible demand out there,” said Jason Wesco, chief executive of the Health Partnership. “We just do what we can do with what we have and hope that’s good enough.”
The situation is symptomatic of the dentist shortage in Kansas, especially in urban areas with high concentrations of poor and in rural areas where the nearest dentist may be 30 minutes away.
Kansas doesn’t have a dental school, and 93 counties don’t have enough dentists to serve their residents. Thirteen of the state’s 105 counties have no dentist at all.
The problem is compounded because only about a quarter of the state’s roughly 1,400 dentists accept Medicaid, which is available for low-income children.
The need is obvious.
In February, more than 2,100 patients were treated during a two-day free dental clinic in Kansas City, Kan.
Hundreds more are flocking to emergency rooms for toothaches. Last year, the University of Kansas Hospital reported treating 1,678 dental-related cases in its ER. Shawnee Mission Medical Center reported treating more than 400 patients.
Kansas lawmakers have wrestled with the issue this year, but they rejected a plan that social service advocates believe would do the most good but that dentists say would put patients at risk.
At the urging of the dental industry, lawmakers killed a bill that would have created a midlevel provider — a registered dental therapist — who could perform some of the duties now handled by dentists, including filling cavities and pulling teeth. Other states have considered similar bills, but only Alaska and Minnesota have comparable laws.
Instead, the Legislature sent the governor a plan that’s less expansive, but one that critics say is a weak response to the dentist shortage.
Supporters pushing for the dental therapist legislation argued that it would make dental care more accessible in rural areas as well as in urban areas such as Johnson County or Kansas City, Kan.
Wesco said the law could have allowed him to hire a dental therapist who could relieve some of the clinic’s workload and open the doors to more patients.
“There may be plenty of dentists in Johnson County for people with money and insurance, but there aren’t for low-income people,” Wesco said.
So much so that some of the patients who visit the clinic — even those with rampant tooth decay — are eager to go under the dentist’s drill.
“They’re excited to be here. They want to be here,” said Ellen Berry, the Olathe clinic’s lone dentist, after she removed a full set of teeth from a patient.
Daniel Minnis, director of the Community Health Center of Southeast Kansas, told lawmakers that hiring a dental therapist might shorten the waiting time for patients from two months or more to several days.
“We will never be able to graduate enough dentists. We have to look at alternative work forces,” Minnis said.
Lawmakers, however, supported a narrower plan to allow dental hygienists to pull the loosest baby teeth and to scrape away tooth decay with a hand instrument.
“It’s another step in the right direction. It’s just not a big enough step,” Minnis said.
That proposal has the support of the Kansas Dental Association, which believes it’s safer than the proposal for registered dental therapists.
“We feel our approach is better because it better protects the public,” said Kevin Robertson, executive director for the dental association.
Robertson contended that the proposal for registered dental therapists went too far because it would have given hygienists the ability to provide types of oral treatment best left to dentists.
“The generally public doesn’t really understand that dentistry is a surgical procedure,” Robertson said.
“Whenever you’re cutting on tooth or you’re anesthetizing someone, there are some complications that a health-care provider needs to be aware that could come up.”
The Kansas Dental Project, a coalition of more than 40 groups, including many involved in health care, has been fighting for a midlevel provider. The new position would have been limited to dental hygienists who undergo 18 months of additional dental education in curriculum approved by the state’s Board of Regents.
Applicants also would have to pass a competency test approved by the state dental board and then work under the direct management of a dentist for 500 hours before they would be allowed to work under more general supervision.
Suzanne Wikle is director of policy and research for Kansas Action for Children, one of the groups pushing for a registered dental therapist law. She said concerns about the therapist bill have been overstated.
“We’re not proposing anything that would be a risk to public safety or anything that would provide substandard care,” Wikle said.
A worldwide study released last month by the W.K. Kellogg Foundation found that dental therapists, who practice in 54 countries and territories, made dental care more accessible and had a safe record.
The foundation, which has spent millions training dental therapists in Alaska, said that for more than 60 years studies have examined the quality of care provided by dental therapists. Those studies found that the care provided by dental therapists was comparable — and sometimes superior — to that provided by dentists.
The American Dental Association rebutted the Kellogg report, saying it was a compilation of publications and anecdotes about the prevalence and use of midlevel providers.
“It does not, however, rise to the level of a systematic literature review, nor does it adequately address some of the key indicators of whether and to what extent the use of therapists improves public oral health,” the ADA said.
“Rather than an evidence-based report, this article appears to be a 460-page advocacy document intended to support a predetermined conclusion.”
The bill backed by the state dental association also requires the Board of Regents to add more slots for Kansas residents at the University of Missouri-Kansas City dental school. Those students would have to work in underserved areas of Kansas for at least four years after graduation.
The bill also creates a special license for retired dentists who want to donate their time to treat patients who are poor or who live in areas where there aren’t enough dentists.
Even if, or when, the governor signs that bill, the debate on the registered dental therapist measure will not be over. Supporters vow to return to the Capitol.
“It’s one of those policy changes that takes a little time,” Wikle said. “We’ll be back next year.”