baccalaureate program to train midlevel dental providers

Fort Hays State University in western Kansas will create a baccalaureate program to train midlevel dental providers who can extract and fill some teeth, if the state licenses this new profession.

The 4-year program would be only the fourth in the United States to train nondentists to do irreversible dental procedures.

Fort Hays President Edward Hammond, PhD, made the announcement on Tuesday when testifying before a joint committee of the Kansas State House and Senate, which is considering legislation to license registered dental practitioners.

"Seventeen counties in Western Kansas have no dentists," Dr. Hammond told Medscape Medical News. "The remaining counties are designated as shortage areas. The university has a responsibility to meet the needs of the citizens of western Kansas."

There are no dental schools in Kansas. Fort Hays currently does not train hygienists or any other dental practitioners, but created a physician assistant program 20 years ago, Dr. Hammond said.

Among other procedures, the registered dental practitioners would be able to diagnose oral disease and formulate treatment plans, administer local anesthesia and nitrous oxide, extract primary teeth, extract loose periodontally diseased permanent teeth, prepare and restore permanent and temporary teeth, and place temporary and preformed steel crowns. They could also practice as hygienists.

The legislation places some restrictions on where the new practitioners could work, but does not require that a dentist be on-site.

Dr. Hammond said the university is working out the curriculum for the 4-year-program.

Introduced last year, Senate Bill 192 and its sister House Bill 2280 are expected to come to a vote next year, Dr. Hammond noted. "I believe it will pass," he said.

The Kansas Dental Association and the Kansas Association of Pediatric Dentists both oppose the legislation, John Fales, DDS, a leader in both organizations, told Medscape Medical News.

"Public safety is at issue," said Dr. Fales, president of the Kansas Association of Pediatric Dentists and pediatric committee chair of the Kansas Dental Association. "There is no other area in which someone with a minimal level of education is allowed to do surgical and irreversible procedures."

Instead, the Kansas Dental Association is backing Senate Bill 132, which would expand the range of institutions at which hygienists could practice without a dentist on-site, and allow them to place temporary, but not permanent, restorations, said Dr. Fales. "We can't drill and fill our way out of dental decay. The only way to stop decay is prevention."

At this time, only Alaska and Minnesota have programs allowing midlevel dental providers. Dental health aide therapists in Alaska can fill and extract teeth in indigenous communities under a federal program requiring 2 years of training after high school. They are trained at the University of Washington.

Both Metropolitan State University and the University of Minnesota are continuing to educate new oral healthcare practitioners. The new practitioners will be able to prepare teeth and place all types of direct restoration, as well as install stainless steel crowns, do pulpotomies, make prostheses, and extract primary teeth.

The schools have taken slightly different approaches. Although the Metropolitan students must start as licensed hygienists, the University of Minnesota students can enter with high school diplomas on a 40-month baccalaureate track, or with bachelor's degrees on a 28-month master's track.

At least 3 other states are considering similar legislation, David Jordan, dental access director at Community Catalyst, told Medscape Medical News: New Mexico (HB 495), Vermont (HB 398), and Washington (HB 1310).

Last week, the W.K. Kellogg Foundation released a survey showing that most Americans are in favor of training "licensed dental practitioners" to provide routine and preventive oral health services.

"There is a lot of momentum," Jordan said.

Mr. Jordan's employer, Community Catalyst, supports midlevel dental providers.