When you live in a state like Vermont — population 625,000 — you tend to know lots of people, and lots of people know you.
“It’s your name on the sign, you are the one that’s held liable for all that occurs in the office,” said Dr. Judith Fisch, who now co-runs the family practice in Rutland, Vermont, that her father-in-law started back in 1962.
For six years, Fisch and most of the nearly 400 dentists here have fended off efforts to license dental therapists.
The idea behind dental therapists — who fall between a hygienist and a dentist — is that these new midlevel providers would swell the ranks of people who can drill, fill and extract, making it easier for people to care for their teeth.
That’s not how Fisch and many dentists around the country see it.
Critics drill the American Dental Association and local dental societies for protecting their turf.
But Fish said she’s not concerned about competition, she’s focused on the 3,500 people who come to the office every year.
“I care very much about my patients,” she said. “I would not be comfortable with my patients receiving their care from someone with less, or, in my opinion, an inadequate level of training.”
Under the bill in Vermont, a student must train for four years and receive 1,000 hours of direct supervision from a dentist.
Despite her opposition, Fisch and her colleagues may be losing ground. This summer, the agency that accredits dental schools is creating guidelines to train therapists, taking the bite out of patient safety arguments. And advocates convinced the Vermont Senate that, for too many people, it’s too hard to get a dental appointment.
But as the bill moves to the House, Dr. Stephen Pitmon said lawmakers will understand this whole idea is simply impractical.
“If I have a dental therapist who can only remove a very loose, wiggly tooth that’s blowing in the wind, but that patient needs two or three other teeth extracted, how is it efficient for the dental therapist to go in and take out the one tooth and then I need to come in and take out the next two teeth,” he said.
Pitmon and Fisch said if the goal is to make it easier for people to get dental care, then the state should pay dentists more to care for the poor.
As far as therapists go, Fisch suspects it would only bring headaches.
“All this energy and finances and time being put into something that — are we getting anywhere, are we solving anything?” she said.
In Minnesota — the only state that’s licensed therapists — waiting times for dental care went down and more people on Medicaid got appointments.
More than 10 states have introduced dental therapy legislation. And dentists have geared up. When they believe something is bad for their patients — or themselves — they will remind lawmakers again and again: It’s their name on that shingle.
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