Dental therapists to fill rural gap

In rural Minnesota there are too few dentists, a fact not wasted on Jodi Hager, who was a hygienist for four years at Apple Tree Dental in Madelia before signing up for a new dental therapy program at Metropolitan State University.

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"There is only one other dental clinic in southwest Minnesota accepting medical assistance patients," Hager says. "We have patients who drive from Pipestone. That's two and a half hours away. And Lake Benton."

Metro State is one of the first schools in the country to provide hygienists the additional training to fill cavities, pull some teeth and perform other services dentists normally provide (there is a similar program at the University of Minnesota). Dental therapists are often called "midlevel providers" because they fill the gap between hygienists or dental assistants and dentists. By design, they will work in underserved areas.

Dental therapy is one way the rural health care system is trying to respond to the fact that finding doctors and dentists is harder than ever.

Hager's class of seven will graduate on June 23. After that, she'll take a board exam and return to Madelia with new skills. As a hygienist, Hager says she screened kids in Head Start programs and found problems that needed to be fixed. "But then trying to find a dentist willing to fix them was challenging," she says. "This allows me to be able to do that for them."

Though some of her fellow students will work in underserved neighborhoods in the Twin Cities, Hager, who grew up in Pipestone, thinks she can do the most good in rural Minnesota, which is disproportionately poor. "I hear stories from patients who called 50 dentists and couldn't find anyone to see them... When you have people driving two and a half hours to get care, that's significant. To me that speaks volumes."

Apple Tree strives to keep its doors open to all patients, says Hager. The family of clinics supplements normal fees and insurance payments with grants and private donations so, if need be, it can provide uncompensated service.

"What we see a lot of right now, with the recession, are working poor," says Hager. "We have a lot of people who come in and they don't qualify for state aid, but they can't pay for insurance. That's one population we're trying to target. They're falling through the cracks and they're out there. We also have a large Hispanic population around Madelia. Many are migrant workers. That comes with its own set of challenges."

Once Hager accumulates 2,000 hours of clinical experience as a dental therapist, she can take an exam (which hasn't yet been devised) to become an advanced dental therapist. While all dental therapists must work under the supervision of a licensed dentist, advanced therapists don't have to have a dentist physically on site.

That will allow Hager to run a mobile dental clinic and perform services in the field, whether in a school, nursing home or church. "Apple Tree has been doing this for quite a few years," she says. "The clinic in Coon Rapids has worked this into an art." She says the mobile clinic looks like a furniture truck and is stuffed with equipment on wheels. When the clinic arrives at a location, the equipment is unloaded and set up. "It can go anywhere," she says.

Dental therapy has met some resistance from dentist associations. But Hager says the coworkers at her clinic have been very supportive. Even if they hadn't been, she says, "I haven't been worried about getting a job, there are so many areas that need help."

"With time, I think you are going to see people come around," Hager adds. "That's what happened with nurse practitioners. There was opposition to them, too. Dentists will see how we can be an asset to them."

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