Lt. Gov. Dianne Primavera and Sen. Dominick Moreno at an oral health discussion.

Colorado Lt. Gov. Dianne Primavera and state Sen. Dominick Moreno, D-Commerce City, speak at a discussion about dental therapy as a viable solution to oral health needs Oct. 21.

Colorado state Sen. Dominick Moreno and the Polis administration expressed interest Monday in the licensure of dental therapists in Colorado to improve access to oral healthcare.

“With most Colorado counties designated as dental health professional shortage areas, we decided we must take action,” Lt. Gov. Dianne Primavera said. “We must acknowledge that 53 million Americans are struggling to afford dental care and we need to address the cost.”

At a discussion organized by The Pew Charitable Trusts and attended largely by dental industry professionals and lobbyists, Danae Seyffer, a clinical assistant professor at the University of Minnesota, described her state’s experience as the first to legislatively permit dental therapy as a profession.

“We still need dentists to be there and part of our team. We’re another added tool in the toolbox,” she said.

Seyffer described how under Minnesota’s legislation, the approximately 100 dental therapists in her state must either serve in an area with a shortage of providers or take on Medicaid patients 50% of the time.

Moreno, D-Commerce City, said that while he has not yet authored any bill to legislate dental therapists into existence as a means of improving oral health, he is “searching for potential solutions.”

“Honestly, anything that we can do to increase the number of providers in our state I think will have beneficial outcomes for lower-income communities and rural communities,” he said. 

Twelve states have passed laws permitting dental therapists to serve all or some of their populations. While other countries use dental therapists to bring access to oral healthcare to remote populations, American dentists have lobbied against allowing therapists to operate here.

“Dentists can do everything, 100% of the procedures out there. Dental therapists can do about 20 to 25% of those procedures,” Seyffer said. She can do any type of filling, install steel crowns and perform extraction of primary teeth. She cannot, however, clean teeth, which is something that dental hygienists can do.

The push for dental therapists is in part due to their lower cost: They spend less on schooling and get paid less per hour than dentists, while still receiving an advanced education.

A 2018 report from the Colorado Department of Public Health and Environment called cavities among youth a “silencing epidemic,” so named because “their potential [is] silenced when adults don't listen or the day-to-day pain becomes normal to them.”

The department found that students of color had significantly higher rates of tooth decay than their white counterparts, with black third graders experiencing nearly double the incidence. It endorsed three policy proposals to address youth oral health: the Cavity Free at Three initiative, school-based sealant programs and community water fluoridation.

CDPHE's dental director, Katya Mauritson, reiterated that the department supports reducing inequitable access to oral healthcare, but has not yet endorsed the dental therapist model.

"Developing and growing the oral health workforce is an important strategy to improve access to care for underserved people," she said. "We have not taken a position on the creation of a dental therapist clinician in Colorado.”  

Colorado’s third graders experience untreated tooth decay at a rate of 15.2%. However, that is lower than Minnesota’s 20% of third graders. Seyffer believed that programming in schools would help improve that rate.

“In my perspective, we need to figure out how to get more providers in school-based settings,” she said. “Set up mobile dental units. We can go in and start treating and giving out referrals to clinics.”

One area in which Minnesota does exceed Colorado is in the percentage of residents served by community water fluoridation. Coloradans’ access to fluoridated water has decreased from 81.7% of the population in 1992 to 74% in 2014. By contrast, nearly 99% of Minnesotans live with public water fluoridation. 

The Centers for Disease Control and Prevention named community water fluoridation one of the 10 great public health achievements of the 20th century, citing how it maintains strong teeth and reduces cavities by 25% in children and adults.

“Colorado is moving in the wrong direction on that front,” Moreno admitted. “We’re going to have to see what we can do to increase the availability of that.”

(1) comment


Moreno said "Honestly, anything that we can do to increase the number of providers in our state I think will have beneficial outcomes for lower-income communities and rural communities."

But the history of 50-100 years shows minimal benefits for lower-income and rural communities IF the distribution of the new providers is based on the marketplace factors (higher pay, better benefits, nearness to conveniences, whatever the provider considers important to themselves and their family.) The common observation is that the least care will be situated to serve those needing it most, while most of the providers will be providing care to those that need it least. This is called The Inverse Care Law, first published in 1971. (It's all about the implementation specified in the legislation. If not designed to address the needs of the underserved, then it doesn't happen.)

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