A new class of dental therapists, working under the supervision of dentists, would provide basic services to patients under a bill that is headed to Gov. Kate Brown.
Oregon lawmakers passed House Bill 2528 — the House by a 45-11 vote Wednesday and the Senate by a 20-9 vote the previous day — after they narrowed the scope of practice and expanded training opportunities, according to its chief sponsor.
Rep. Tawna Sanchez, a Democrat from Portland and the Legislature’s only tribal member, said dental therapists would provide services to low-income people and rural residents who often lack access to it.
“This bill would create a mid-level dental care provider that would deliver appropriate dental care, with the scope of their training approved by the Commission on Dental Accreditation,” she said. “A licensed dental therapist would be supervised by a dentist to provide care that will allow many health care crises to be avoided and to ensure rural Oregonians they have the services they need.”
Dental therapists are akin to physician assistants in medicine. They will undergo the special training to perform the basics of dental care, such as exams, fillings and simple extractions of teeth. They will work under the supervision of a dentist. They will differ from dental hygienists, who clean teeth and perform exams.
”This bill reflects the evidence that unequivocally shows that where dental therapists are providing care, access is increased and oral health outcomes are improved,” Amy Coplen said. She is the director of Pacific University’s School of Dental Hygiene Studies, which is leading one of Oregon’s two dental therapy pilot projects.
Licenses for dental therapists who complete accredited programs will be issued by the Oregon Board of Dentistry starting in 2025. They would have to spend at least half their time working with underserved populations, or in areas with shortages of health professionals.
The Oregon Dental Association took no stand on the bill. But the Legislature’s two dentist members opposed it.
Senate Republican Leader Fred Girod of Lyons, who is retired, recounted an incident during which a patient had to go to the hospital after what turned out to be an overdose of insulin and other drugs in an apparent attempt to take his own life.
”He wouldn’t be alive today if that had been a dental therapist,” Girod said. “So ask yourself this question when you vote: Would you go to a dental therapist? If the answer is no, then don’t tell poor people to go to a dental therapist. Raise the reimbursement rate.”
As a state representative back in 1993, Girod voted for initial funding of the Oregon Health Plan, which promised to reimburse medical providers more fully for their services. Girod said that although he accepted Oregon Health Plan patients, other dentists did not — and state reimbursement rates were inadequate to cover his costs.
Before the onset of the coronavirus pandemic last year, Sanchez said in an April 27 debate, only about 40% of Oregon Health Plan recipients were able to see a dentist.
One of them, Rep. Cedric Hayden, R-Lowell, also complained about recent cuts by the Oregon Health Authority in payments for dental care.
Hayden, a dental surgeon and rancher, voted for the bill in committee, but against it both times in the full House.
Despite changes in both chambers, he said, “We got close. But I am still opposed to this bill.
“I have concerns about that rare occasion that could take place when the dentist isn’t in the building and that patients being provided (service) in our low-income or rural areas, as this bill specifically calls out, do not have the equity in health care that they would have had if the OHA hadn’t cut the budget.”
As a nurse practitioner, Rep. Rachel Prusak, D-West Linn, said she has seen patients administered antibiotics and painkillers to combat infection and alleviate pain until they can obtain dental care.
“We have to pass this bill that has been worked on for years,” Prusak, who leads the House Health Care Committee, said. “It is going to increase access to dental therapy in this state.”
Eight states now license dental therapists.
Oregon has been searching for alternatives to dental care for a decade, since the 2011 Legislature authorized the Oregon Health Authority to start pilot projects.
One such project started up in 2016, when the state agency allowed the Northwest Portland Area Indian Health Board to develop training of dental health aide therapists with the Alaska Dental Therapy Educational Program. The Alaska program, which started in 2004, also provided help for tribes in Washington, Idaho and Montana.
”We are ready to move out of the pilot stage,” Dr. Miranda Davis said in a statement. She is with the Northwest Portland Area Indian Health Board. “Dental therapists have been safely serving tribal communities here in Oregon since 2017. This bill paves the way for any underserved community in Oregon to benefit from care closer to home.”