Between A Hygienist And A Dentist, A Hard Sell

It’s a nagging problem for rural areas: not enough dentists to provide adequate care for the population.

In Kansas and a few other states, advocates and some lawmakers want to solve this problem by creating a new level of dental care. A registered dental practitioner, or RDP, would have more training than a dental hygienist, but less than a dentist. Mid-level dental providers have been practicing in Alaska since 2005, and legislation has recently passed in Minnesota to establish the new level of care. Bills have been introduced in Ohio, New Mexico, Vermont and Washington.

In Kansas, bills were introduced in the state House and Senate during the 2011 legislative session, and are awaiting further action next year. And now Fort Hays State University, located in western Kansas, is offering to start training these mid-level dental providers–if and when state lawmakers give the idea the green light. 

“Two of the main things that an RDP will be able to do is extractions of … teeth, and basic restoration, so drill and fill,” said Cathy Harding, who heads the Kansas Association for the Medically Underserved. Harding says these providers can help address a shortage of dentists—especially in rural Kansas—that is severe and growing.

The new providers would operate much the way nurse practitioners and physician’s assistants do in medical clinics. RDPs would be required to work under the supervision of a licensed dentist. Harding says she’s thrilled that Fort Hays State has agreed to offer a four-year bachelor’s degree program for Registered Dental Practitioners, pending approval by the legislature and the Board of Regents.

But while Fort Hays State’s interest shows some momentum building for the proposal, the idea has formidable foes. The Kansas Dental Association opposes it, and the American Dental Association has expressed serious concerns about the concept. At a recent legislative hearing, two pediatric dentists testified that the RDPs would not have adequate training for procedures such as tooth extraction and filling cavities. They argue that this would mean a two-tiered system of care in Kansas–top quality care for those with the money to pay for dental services, and lower-quality care for those who can’t pay.

That is not the opinion of all Kansas dentists, however. Melinda Miner, who practices general dentistry in Hays, one of the larger communities in western Kansas, notes that the new providers would be under the direct supervision of a dentist. She says that dentist would be accountable for ensuring that the dental care provided by the RDP meets the appropriate standard of care.  Miner says she visited Alaska this summer and was impressed by the quality of care provided through a similar program there. 

Miner says she was “saddened” that the Kansas Dental Association opposed this new concept without first discussing it with their members.