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Kansas needs to rinse and spit
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There is a dental crisis in Kansas and it is getting worse. To help, the Kansas Dental Association is calling for
140 more of its members to accept Medicaid patients in their practices. This is great news as currently, across
the entire state, only 222 general dentists - one in five - sees more than 50 Medicaid patients per year. While
I’m encouraged by this gesture, I know firsthand that it will not solve the high level of unmet dental need we
have, especially here in rural Kansas. Regardless of how many of Kansas’s 1425 active dentists decide to
actively participate in Medicaid, many communities simply have too few, or no dentists to begin with.
The dental shortage and the lack of dentists who will see Medicaid patients can affect all of us in some way:
higher costs; longer wait times to get an appointment; longer drives for care; or the inability to see a dental
provider at all. Unfortunately, missing school or work days and long drives to another town for dental care are a
way of life in many parts of Kansas. Because the elderly often cannot travel to see a dentist, many receive no
dental care at all. This lack of access to routine preventive services causes dental problems to be ignored until
they are emergencies.
Across Kansas, 93 counties do not have enough dental providers and 13 counties have none at all. This
problem will only get worse as the average dentist in Kansas approaches retirement age. Since April 2008,
we have only increased the number of active dentists in Kansas by eight, as dentists retire faster than we can
recruit new ones. This need is not just a Medicaid problem. Medicaid only covers dental care for children and
there are many Kansas residents over the age of 21 who can’t get care. We have to think bigger!
Miner Family Dentistry has been in Hays for more than a decade, providing care to all patients and all income
groups. Last year, we had more than 11,000 patient visits and more than half were children covered by
Medicaid. Our patients come from all over western Kansas – sometimes driving up to five hours round-trip for
a routine visit. Even though our team includes two dentists, three registered dental hygienists and five dental
assistants, we still can’t meet the need of Hays and our neighboring communities. Even with the recent addition
of a federally funded dental clinic in Hays, there are still patients waiting to receive care.
We need a new approach. Our dental care workforce is stretched far too thin. We need more dental care
providers and we need them in the communities that are currently not being served.
State lawmakers are considering legislation to allow for the creation of a mid-level dental provider. Registered
dental practitioners (RDPs) would be able to provide routine dental care like cleanings and fillings under the
direction of their supervising dentist. A midlevel provider is not out on their own; they have the benefit of a
supervising dentist to consult with and work with as a team. Much like nurse practitioners, physician assistants
and nurse anesthetists are crucial to the medical team; an RDP would be a valuable member of the dental
Just one RDP could allow a practice like mine to add an additional 2,000 - 3,000 patient visits a year.
Many communities are simply not large enough to support a full-time dentist and staff. I, as a supervising
dentist, could manage an offsite RDP via telemedicine, and help bring care to these small towns. These
smaller communities are perfect for midlevel dental practitioners just as many are served only by nurse
practitioners for medical care. Not only would this create jobs in those small communities, but it would save
patients hours of driving and lost work and school hours and make preventive dental care accessible.
Recently, I had the opportunity to meet several midlevel dental providers in Alaska and I watched them work
on many patients. By the time they have completed their education, training program, apprenticeship and
certification exam, they have performed hundreds of fillings and preventive services. Unlike dentists who have
to learn a large number of procedures and complex processes, midlevel practitioners perform the same few
routine procedures over and over again -- the quality of those procedures is no different from what I’ve seen
from dentists.
Midlevel providers are not a new concept for dentistry. They have been used successfully for decades and in
more than 50 countries. Alaska and Minnesota now have mid-level dental providers and I think it will work well
for Kansas. Midlevel providers would allow patients access to the care they need, when they need it and where
they live. This is a win-win solution for dentists and patients alike. Kansas should embrace it, so that quality
dental care is available in all our communities, for all Kansans.
Melinda Miner DDS
1010 Downing Ave #10