Viewpoint: The consequences of a two-tier dental system

Oregon lawmakers have proposed Senate Bill 1549, which would license dental therapists to provide care throughout the state, specifically in rural areas. While the goal is to expand care to underserved areas, the former chief dental officer of Yakima Valley (Wash.) Farm Workers Clinic is worried it would create a two-tired dental system.

In The Oregonian, Mark Koday, DDS, opposed the bill in an op-ed. He claims that by licensing dental therapists, one level of clinicians would provide care for low-income communities while another level would serve more privileged communities.

"Senate Bill 1549 proposes that Oregon license a new type of dental provider — a dental therapist — to expand access to critically needed oral healthcare for rural and low-income Oregonians. But it misses the mark," Dr. Koday writes. "Instead of expanding access to high-quality care to those who need it most, the bill essentially creates a two-tier system that disadvantages the poor, those living in remote areas and individuals facing other barriers to receiving care."

Dr. Koday hints at monitoring dental therapist programs that have been introduced throughout the country before Oregon implement its own. In the meantime, Dr. Koday recommends expanding the reach of community dental health coordinators.

"My concern with Oregon's proposed dental therapy bill extends beyond the two-tier healthcare model," said Dr. Koday. "Existing dental therapy programs are in the very initial stages of development and evaluation. Furthermore, they vary widely in terms of what procedures these providers are allowed to perform, how much supervision they have and how much training and education they're required to completed."

"Oregon's bill ignores these critical factors and instead would allow dental therapists from anywhere in the country or even outside the U.S. to practice in Oregon, regardless of the scope of practice or training requirements for their license," he said.

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