The dental profession and the federal government should encourage laws allowing midlevel providers (MLPs), because there aren't enough dentists to provide care for the 5.3 million additional children who will be entitled to dental care under the Affordable Care Act's pediatric mandate in 2014, according to an opinion piece in the New York Times.
"Little is being done -- by the dental profession or by the federal or state governments -- to prepare for it," wrote former secretary of the U.S. Department of Health and Human Services, Louis Sullivan, MD.
While Dr. Sullivan believes more dentists are needed to address the unmet need in rural or poor areas, he suggests that a more immediate solution is to train dental therapists to provide preventive care and routine procedures like sealants, fillings, and simple extractions outside a traditional dentist's office. Dental therapists are common worldwide, he observes, yet they are legally allowed to practice only in Alaska and Minnesota. Legislation is pending in five more states.
"The dental profession has resisted efforts to allow midlevel providers to deliver this kind of care, and the government has so far failed to push for the change," Dr. Sullivan asserted. "It must do so now."
There were more than 830,000 visits to emergency rooms nationwide in 2009 for preventable dental problems, and nearly 50 million Americans live in underserved areas where dentists do not practice, according to Dr. Sullivan.
The federal government should train more dentists to address the long-term problem, even though it's unlikely that new recruits would practice in underserved areas, Dr. Sullivan wrote.
With only two years to prepare for millions more children who will be entitled to dental care from Medicaid and the Children's Health Insurance Program, public officials should foster the creation of MLPs, he wrote, and "dentists should embrace the opportunity to broaden the profession so they can expand services to those in need."
