While working as a dental hygienist, Yadira Martinez recalls seeing Oregon’s dentist shortage caused the backlog of patients at her clinic. Some had to wait months to see a dentist or hygienist.
Difficulty accessing and affording dental care is a statewide problem in Oregon, with people in rural areas and other underserved populations — like the farmworkers Martinez serves at Virginia Garcia Memorial Health Center clinics — having the least access.
Under a state pilot program, Martinez late last year became one of Oregon’s newest licensed dental therapists. She now fills lots of cavities and restores patients’ damaged or decayed teeth at a lower cost.
But she is one of only a few such therapists, and the future of such training programs is in doubt in Oregon, meaning needs for rural and minority communities will continue to go unmet.
“I think that Oregon could use hundreds and hundreds of dental therapists,” Amy Coplen, director of Pacific University’s School of Dental Hygiene Studies, told The Lund Report.
After launching two temporary pilot programs, Oregon lawmakers in 2021 made dental therapists a permanent licensed profession as a solution for a shortage in oral health services. But a legislative compromise to get the bill passed has stalled its effect.
Despite the widespread need, just 13 dental therapists have been licensed, according to Oregon Dentistry Board filings. There is no accredited dental therapist training program in the state, and the only one that’s in the works still needs $1 million in funding before it can move forward.
To get her certification, Martinez spent Saturdays attending classes at Pacific University and training under the supervision of a dentist. The pilot programs now operating have only another 20 months before going away after an attempted legislative fix did not go forward.
In a state where a shortage of dentists persists and access to care continues to be an issue for low-income and rural residents, Martinez said the need for affordable dental work is great.
“To lower the cost of that to make it affordable is amazing,” Martinez, who serves as the dental hygiene programs manager at Virginia Garcia, told The Lund Report. “Not only that, but it allowed the dentist to provide a higher scope of care because they were freed up.”
Compromises between proponents of the bill establishing dental therapists and the dental lobby have meant a narrow licensing pathway to become a dental therapist.
For now, getting a dental therapist license in Oregon outside of the pilot project means moving to Alaska or Washington, where the only accredited programs are located — or waiting until Oregon gets its own.
An oral health ‘game-changer’ for underserved communities
Coplen said that dental therapists could play an important role in addressing the oral health needs of communities that have no dentists. The Oregon Office of Rural Health found in a recent report that vast swaths of the state have little dental care.
The report divided the state into 128 primary care service areas, which are clusters of ZIP codes generally served by the same health care resources. It found that 23 primary care service areas, all in remote parts of the state, have no full-time dentist.
The report, based on 2021 data, found that in Oregon an average 3.6 people per 1,000 had to visit the emergency department for a dental issue (an indicator they were unable to address oral health issues earlier). Fifteen primary care service areas, also all located far away from urban centers, had double that rate. Warm Springs, located on the Warm Springs Indian Reservation, had a rate more than four times higher than the state average, according to the report.
Dental therapists, who are described as having a skill set below a dentist but above a dental hygienist, could offer a solution in these areas. They can perform procedures such as filling minor cavities and extracting some teeth. Martinz said Virginia Garcia’s McMinnville clinic is down to one dentist, and having a dental therapist in rural areas can be a “game-changer.”
“It does bring the cost of dental care down,” she said.
Currently, 13 states license dental therapists, regulating their training and where they can work. A July 2022 government report called dental therapists an “emerging profession” with fewer than 150 practicing nationally. The report described how restrictions vary and only five states (Alaska, Minnesota, Maine, Oregon and Washington) have dental therapists practicing. Only five states, including Oregon, allow dental therapists to practice on tribal land.
The legislation that created the dental therapist license builds on the pilot program at Pacific University that Martinez participated in and another pilot that the Northwest Portland Area Indian Health Board sponsored. That program trains dental therapists to work specifically with tribal communities and is set to expire in May of this year.
Supporters of the bill pointed to that pilot and how outside evaluations found that dental therapists working in tribal communities were doing high-quality work.
Brenda Meade, chair of the southern Oregon-based Coquille Indian Tribe, told a legislative committee considering the bill that the pilot program meant tribal members could come back to their community to provide “mid-level dental service that fills the gap of care” in their communities. She said she supported the bill as a way to expand care for her tribe and all Oregonians.
“There are areas of our state that do not have dentists, do not have the appropriate dental care that they need,” State Rep. Tawna Sanchez, a Portland Democrat who cosponsored the bill, told a legislative committee in 2021. “We know that it’s an issue. We know that (dental therapists) have been working in Alaska and Minnesota for years, and it’s done well. We know that we’ve had a pilot program that’s done really well here.”
Dr. Miranda Davis, a dentist in Washington state and director of the Native Dental Therapy Initiative of the Northwest Portland Area Indian Health Board, helped manage the pilot. She said it produced dental therapists that provided needed care to their communities, including check-up, sealants and treating infections.
The Pacific University pilot training program was set up in May 2020 to test the feasibility of establishing dental therapists as permanent providers. It expires in January 2025.
The two pilot programs provided training for Oregon’s current 13 licensed dental therapists, according to Coplen. She said another eight are on track to become licensed.
Davis attributed the small number of licensed dental therapists speaks to what she called Oregon’s tight licensing requirements.
“I think it speaks to the need for more dental health programs,” she added.
‘The compromise that we had to make’
Oregon’s dental therapy law requires anyone seeking a license to complete a dental therapy program accredited by the Commission on Dental Accreditation of the American Dental Association.
Currently, the only two accredited dental therapy programs are offered by Ilisagvik College in Anchorage, Alaska, and Skagit Valley College in Mount Vernon, Washington. Skagit Valley College recently obtained accreditation and enrolled the first class for its three-year program last fall.
In Minnesota, by contrast, prospective dental therapists have the option of getting their license through one of two university programs that are state dental board-approved.
The Oregon Dental Association initially opposed Oregon’s 2021 bill creating dental therapists. The association pushed for the bill to include a provision putting dental therapists under closer supervision of dentists. The legislation also requires 51% of dental therapists’ practice to be dedicated to underserved populations.
Barry Taylor, executive director of the Oregon Dental Association, told The Lund Report in an email that his group ended up being neutral on the bill because its concerns were addressed.
“The most important thing to remember is that Oregonians can have confidence that dental therapists will complete an accredited education and training program, which helps to ensure uniform standards are met and that equitable care can be provided,” he said.
Stephen Prisby, executive director of the Oregon Board of Dentistry, told The Lund Report that the applicant pool of dental therapists will be limited for now, but there could be more once more schools are accredited.
Coplen said she and other interested faculty are in the early stages of creating a permanent, accredited dental therapist program at Pacific University.
Initial planning envisions a dental therapist master’s degree building on the curriculum for the university’s existing two-year dental hygienist bachelor of science degree (which requires prerequisites), Coplen said. The new degree would add on another year focused on dental therapist work, she said.
Coplen said an evaluator was “very impressed” with the abilities of the dental therapists training under the pilot at her school. During a site visit to Pacific University’s dental therapist training program last year, Oregon Health Authority staff found that students were meeting standards.
But Coplen said it’ll take an initial $1 million to get the new program up and running. She said that if all goes as planned with university approval and accreditation, Pacific University would admit its first class in the fall of 2025 who would graduate by 2028.
After Oregon’s pilot programs expire, the only paths to becoming a licensed dental therapist in the state will require moving or waiting until Pacific University opens its accredited program. Oregon’s narrow path to becoming a dental therapist is part of “the compromise that we had to make” in order to pass legislation creating the license, said Coplen.
State Rep. Janelle Bynum, a Happy Valley Democrat who co-sponsored the bill establishing the dental therapist license, told The Lund Report that her goal with the legislation was to help people access dental services in a safe way. She said that sometimes licensing requirements are structured for gatekeeping rather than delivery of services, and she’d be interested in taking a second look at how the bill has played out.
“Sometimes we can be a little tight with proscribing sideboards,” she said.
You can reach Jake at [email protected] or via Twitter @jakethomas2009.
It really doesn't matter how…
It really doesn't matter how inexpensive the provider is that you give the drill to for restoratives will never fix a cavity caused by a dental infection. Until the infection is under control you will never drill our way out the infection. We now have medicines and systems if applied will not only stop the existing cavity but prevent them in the first place, and stop more cavities. Not talking to patients about the cavity being from an out of control infection and that there are now medicines to stop the infection in my opinion boarders on malpractice by the provider doing the work whether dentist or mid level provider and for the government not requiring the medicines use before any work other than emergencies such as abscessed teeth, trauma etc. should not be allowed. Or at least require documentation that the infected person was given and choice that they chose not to. Definitive restorative should not be done until this dicussion has been had be the provider with the infected person or caregiver.
MIke Shirtcliff DMD
I agree that dental care is too expensive for many people and that there don't seem to be enough dentists.
Creating another class of dental care "dental therapists" looks like it will go down the road of "physicians assistants" and "nurse practioners" -- initially billed as "physician extenders" to increase availability and reduce cost of care. However, those professions have demanded and mostly received complete independence from clinical oversight, and have essentially the same privileges as physicians -- and now, also very close to the same cost to the patient. You don't get a discount if you see the NP or PA as your PCP.