Oregon pilots dental programs

Jan. 10--Oregon Sen. Laurie Monnes Anderson, D-Gresham, knows she has not made any friends among the state's dentists.

The retired public health nurse said she is in a minority of officials in Oregon pushing for new models of oral health care, including the use of dental therapists.

She said it makes sense to look outside of the traditional dental care delivery box, especially considering the state of oral health among Oregon's poorest residents.

"The business model of the dental community in Oregon is that they get to pick and choose patients," she said. "They say the low-income (patients) don't take care of their teeth, so they put their heads in the sand."

Oregon has been more open than some states, however, in exploring the use of dental therapists -- trained dental professionals who are typically able to drill and fill teeth, pull them or clean them.

The Oregon Dental Association was supportive of legislation in 2011 authorizing the state's health authority to launch pilot programs designed to encourage development of innovative oral health practices for populations shown to suffer the most from dental disease and had the most lack access to dental care.

Project participants had to produce plans intended to expand oral health care in the state in ways that allowed for quality and efficiency. That also included the use of dental therapists.

ODA spokeswoman Christina Swartz Bodamer said her organization eagerly anticipates data that will come from the trial programs.

"We supported pilot projects so we can test out new ideas to see if they work specifically in Oregon," she said. "Our goal is to find innovative ways of providing access to care for those that have none -- not just new avenues of care for those who already have it -- and truly improve the oral health of Oregonians as all dental disease is preventable."

Expectations are high, she added, noting the new ideas coming out of the 2011 bill must show less cost to the state while maintaining safety to patients.

In 2013, 45 percent of Oregon children enrolled in Medicaid had visited a dentist, a significant increase compared to 28 percent in 2000.

"At that same time reimbursement rates were cut significantly," Swartz Bodamer noted. "In 2013 they were well below the national average. In fact, only six states have lower Medicaid reimbursement rates."

Currently, dental therapists are not licensed in Oregon, but two Native American tribes in the Coos Bay area are seeking state permission to approve a pilot project allowing dental therapists to treat members, according to a recent article in The Lund Report, a nonprofit health newsletter based in Oregon.

The Confederated Tribes of the Umatilla Indian Reservation in Northeast Oregon is not considering using dental therapists at this time, a staff member not authorized to speak on the record said.

The Yellowhawk Health Center, where tribal members receive medical and dental care, is adequately staffed for the time being with three dentists, said Tony Bass, the dentist who oversees dental care there.

Sen. Monnes Anderson said she is encouraged at seeing Native American tribes take a proactive stand to improve oral health for their members, many of whom suffer greatly from dental decay. As she understands it, about three dozen countries around the world already use a dental therapist model and no bad outcomes have been reported.

It's not her first time to take on organized dentistry, she said. In 2011, she fought to expand the practice of dental hygienists in Oregon and require insurance companies to pay for care provided through hygienists.

That experience revealed deep acrimony from dental associations regarding non-dentists doing traditional work traditionally done by their members, Monnes Anderson said.

"I was pulling teeth like crazy just to get them in the room on this."

Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.

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