Oral health in the United States has improved substantially in recent decades, but the inequitable burden of preventable oral health disease persists. People from rural and low-income communities, racial minorities, individuals with disabilities, and the elderly suffer disproportionately from tooth decay and gum disease and are less likely to visit a dentist than other Americans. In 2017, nearly 63 million people in the United States lived in Dental Health Professional Shortage Areas (DHPSAs)—designated geographic areas with a shortage of dental care providers. In Minnesota, over half of counties are considered DHPSAs. Adequate access to oral health care is a persistent issue for many Americans.
To address the unequal distribution of oral health care, states have begun to increase oral health care access through innovations in the oral health workforce. Collaborative practice is one strategy to provide care to people who are not currently receiving dental care. It may be used to expand the roles of current providers in the oral health workforce (including dental hygienists and dental assistants) or to support new provider types (such as dental therapists). In Minnesota, dental hygienists who enter into a collaborative practice agreement with a licensed dentist may work in community settings without a dentist present. Since a 2017 change in the law, dental assistants may be included in a collaborative practice agreement between a dentist and dental hygienist. In a growing number of states, including Minnesota, dental therapists may provide restorative and preventive services as set forth in a collaborative management agreement with a licensed dentist.
This Issue Brief focuses on collaborative practice models as a strategy to increase access to oral health care for underserved communities in Minnesota. Part I of this Issue Brief outlines new workforce data from the Minnesota Department of Health to help put the oral health workforce landscape in perspective. Part II then describes how collaborative practice models utilizing dental hygienists, dental assistants, and dental therapists can improve access to care for those who need it most. Part II also highlights key legal features of each of these models and addresses barriers which have prevented these approaches from being utilized more widely. Part III discusses Medicaid reimbursement policy and why raising reimbursement rates is critical to improving oral health care access. This Issue Brief focuses on Minnesota but the policies discussed have national relevance. Strategies to expand and maximize the oral health workforce through collaborative practice models are a critical component of a multifaceted approach to improve oral health access among underserved communities.