SYLVIE DOUGLIS, BYLINE: NPR.
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ADRIAN MA, Host:
This is the INDICATOR FROM PLANETARY MONEY. I’m Adrian Ma.
WAILIN WONG, Host:
And I’m Wailin Wong. You know, for many people, myself included, going to the dentist comes with a bit of anxiety. But that wasn’t really the case for Kari Ann Kuntzelman, not even as a child.
KARI ANN KUNTZELMAN: I felt that strangely it was, like, a safe space. I had to have extractions and surgery and had no traumatic experience. It was kind of the opposite. And that’s really when I knew I wanted to do something in the dental field.
MA: That’s amazing. I feel that Kari Ann’s unusual bravery qualifies her to fight crime.
WONG: (Laughs) It’s like a superpower.
MA: Yes, absolutely. And that’s why when Kari Ann grew up, she considered becoming a dental hygienist. But then he found out about this job called dentist.
WONG: Now, you might think that this is someone who, for example, holds your hand while you have a tooth pulled. But a dentist is someone who is trained to do basic exams and cleanings, as well as some procedures usually reserved for dentists, like filling cavities and pulling teeth.
MA: Now, in countries like New Zealand or the UK, dentists have been practicing for years, some even for decades, but they are a much newer addition to the dental workforce in the US. There are only about 200 dentists and only five states where they currently practice.
WONG: That could change, albeit slowly, as some states see them as a cost-effective way to deliver care, especially in underserved areas. Wisconsin’s governor signed a law this year allowing dentists to be licensed there. Similar legislation is under consideration in Illinois and New York.
MA: But professional dental organizations have their own ideas about how to make dental care more accessible. So, after the break, we’ll break down the debate about this emerging profession in the US
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WONG: Let’s think about the different people you meet in your dental office. There is someone who can help you sit and take your x-rays. This is usually a dental assistant. Then there is someone who removes the plaque from your teeth and puts in fluoride. This is the dental hygienist. And then if you need a cavity filling or, God forbid, a root canal, that’s a job for the dentist.
MA: Now, if that office has a dentist, that person can clean your teeth and fill a cavity or do simple extractions. You would only see a dentist if you needed a more complicated procedure like having your wisdom teeth removed. Beth Mertz is a professor at the University of California, San Francisco and researches the health workforce with an emphasis on dentistry. He says that dentists are similar to nurses in the doctor’s office.
BETH MERTZ: They can do a lot of primary care or, you know, do all the basic health care that you need, but they didn’t go to medical school. They are not a doctor and there are certain specialized things they cannot do.
WONG: In the US, a typical dental treatment program takes three academic years versus two or four years for a typical hygiene program. A dental treatment program is much shorter and less expensive than dental school, which usually requires four years beyond a bachelor’s degree.
MA: The first state to introduce dentists was Alaska in 2005. Health officials identified a need for basic dental care in tribal communities, especially those in rural areas. Today, Alaska has its own three-year dental program through Ilisagvik College, the state’s lone tribal college, and most graduates are American Indian or Alaska Native.
WONG: Kari Ann Kuntzelman is one of those graduates. He is a member of the Chickasaw Nation of Oklahoma. And today, he is licensed to practice dentistry in Oregon. He is also president of the American Dental Therapy Association. And Kari Ann says having dentists in an underserved community can dramatically reduce the wait time for people to get care. It could be one week versus six months.
KUNDELMAN: If you don’t have, for example, a dentist or a dentist who lives in your community, which most of these communities don’t, they could go a long time without getting preventive services, let alone, like, services emergency type.
MA: Federal data shows that 58 million Americans live in areas with a shortage of dental health care providers. The government defines shortage as having one or fewer providers for every 5,000 people.
WONG: Poor insurance coverage is another barrier to accessing care. Over 20% of adults and 9% of children do not have dental insurance. That’s according to the American Dental Association.
But yes. And in a hearing this month, Vermont Sen. Bernie Sanders described the lack of affordable dental care in the US as absurd. He pointed out that gum disease has been linked to cardiovascular and digestive problems, and that dental health problems can actually cause children to miss school.
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BERNIE SANDERS: People are not getting high quality dental care. They risk living their lives in severe pain. We must understand that a major cause of absenteeism, interestingly enough, from school is a result of toothache and dental pain.
WONG: The access gap for tens of millions of Americans is not about the number of people working in dentistry. In fact, the dental workforce looks pretty healthy right now. Data from the American Dental Association shows that the number of graduates with dental degrees increased by 8% between 2019 and 2023. And the Bureau of Labor Statistics expects the number of dental hygienists to increase by 7% in the coming years.
MA: Beth Mertz at the University of California, San Francisco says the problem isn’t the number of dentists. It’s about how the dental care system in the US just doesn’t give dentists financial incentives to work in lower income communities.
MERTZ: I don’t think we have a shortage of dentists per se, but their incentives for where they practice are so tied to people’s ability to pay out of pocket for care that what you get are, you know, more affluent areas that have an oversupply of dentists and, in then you have areas like rural areas or low income areas that have no dentists or very little access to those dentists.
WONG: Beth says dentists help fill the gaps in these rural or low-income areas. Most dentists in the US are required by law to practice on tribal lands or in areas where people have trouble accessing dental care.
MA: Dentists must also work under the supervision of a dentist. But depending on the situation, this dentist does not need to be physically present. This could free up dentists to provide, for example, more mobile services in rural or tribal communities.
WONG: Beth says dentists can also help boost the productivity of a brick-and-mortar dental office. When they do simple fillings and extractions, dentists can focus on more complex procedures that pay more.
MERTZ: If you’re a dental practice and you’re using the people who work for you at the top of their scope as opposed to the bottom of their scope, that’s generally where the reimbursement levels are going to be.
MA: But the American Dental Association says dentists aren’t really the solution to more equitable oral care. Jane Grover is a senior director at the ADA, working with the association’s Council on Access Advocacy and Prevention. And he says just look at all the dentists and hygienists who are already working or about to enter the workforce.
JANE GROVER: If you have that dental workforce that’s growing, that’s diverting funds to a new program, a new member of the dental team is confusing.
WONG: Now, the ADA recognizes the problem of unequal access to dental care, but focuses on other solutions, such as supporting states to expand Medicaid coverage for adults and encouraging more dentists to accept Medicaid. Low reimbursement rates and red tape are often cited as reasons why dentists do not obtain this type of insurance.
MA: Another solution Jane mentions is loan repayment plans. These are national and state programs where dental graduates can get help with their student loans. And in return, they commit to practice for a certain amount of time in an underserved community or with low-income patients.
GROVER: So the opportunity to be of service in an underserved area and achieve loan repayment is very high. It is a very big motivation.
WONG: At the federal level, in 2022, an advisory committee issued a report on dental therapy and recommended that Congress allocate $6 million in annual funding for dental therapy training programs.
MA: And one of the benefits that the committee mentioned is that dental therapy provides a career path for people in dentistry from underrepresented backgrounds. They can then return to their communities and provide more culturally sensitive patient care.
WONG: Kari Ann Kuntzelman has experienced this firsthand as a dentist who has an indigenous background.
KUNTZELMAN: I serve my family. I serve my friends. My neighbors come to the clinic to see me. It kind of goes back, you know, when you have a provider who looks like you, who talks to you and has the same background, you’re more likely to feel comfortable and build that trusting relationship.
MA: And maybe feel a little less nervous at the dentist.
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WONG: This episode was created by Julia Ritchey with engineering by Kwesi Lee. Reviewed by Sierra Juarez. Kate Concannon is our editor and THE INDICATOR is an NPR production.
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