Dental Workers

As a way to expand dental care to people in poor and rural areas, some North Carolina dentists are pushing for the creation of a new kind of mid-level dental worker. Dr. Steven Slott, a Burlington dentist who founded a traveling free clinic, wants lawmakers to study the idea, which has been tried in Alaska and is gaining ground in several other states. "We have got to get something done in this state," Slott said. "There a huge problem." He noted that four counties have no dentists, six others have severe shortages, and even rich counties struggle to provide care to poor people. Slott said a mid-level worker could provide simple services more cheaply than regular dentists. Like nurse practitioners or physician assistants, a mid-level dental worker would have extra training and duties. Notably, the mid-level worker could perform uncomplicated extractions and fillings currently performed only by dentists; hygienists are restricted to such jobs as cleaning teeth.

But the idea is not widely embraced by dentist groups. The American Dental Association has opposed an advanced dental hygienist practitioner model and has fought to limit Alaska's efforts. The N.C. Dental Society has not taken a formal position on the growing trend. Dr. Alec Parker, executive director of the state society, said the group is open to considering the prospect of mid-level practitioners. A dental society newsletter raised concerns about the idea of mid-level practitioners as momentum across the nation has grown. Aside from Alaska, Minnesota has made the most headway, establishing a new university major for people to learn advanced skills. Connecticut, Maine and Washington are also pressing ahead to establish the new position. "In other words, they suggest allowing lesser-trained people provide oral health services on the underserved," the N.C. Dental Society newsletter stated.

Slott said there is no evidence that mid-level practitioners would provide subpar care, and he called for a study group to examine the available research and make a fact-based analysis. "If we saw a danger, we wouldn't have to proceed," Slott said. He said his efforts are in the formative stages, as he considers taking his request to legislators or forming a coalition of public health groups to push the idea. Slott said there is good precedence for overcoming concerns about a mid-level dental technician. In the 1960s, the radical notion of nurse practitioners and physician assistants rankled many doctors. Now, both types of health providers are considered integral. (Sarah Avery, THE NEWS & OBSERVER, 2/06/10).