Tens of thousands of Arizona residents pour across the Mexican border every year to get dental care they can’t afford closer to home.  Fewer people will have to do that now that Gov. Doug Ducey has signed a bill with a solution that had the overwhelming support of both Republicans and Democrats in the Arizona legislature.

After two years of debate, Arizona lawmakers approved the bill Ducey signed yesterday to expand the dental workforce to include dental therapists, clinicians similar to nurse practitioners and physician assistants.

Lack of access to affordable dental care has reached crisis proportions across the country and is especially acute in Arizona. Of the state’s 7 million residents, almost two-thirds live in federally designated dental health professional shortage areas, commonly known as dental deserts. These are places where few if any dentists practice. Arizona has the highest percentage of its population living in dental deserts of any state in the country.  

Compounding the problem is that in Arizona and other states, many residents don’t have dental insurance. Far more Americans lack dental benefits than medical insurance and paying out of pocket for increasingly expensive dental care, even for check-ups and cleanings, can bust a family budget. Low-income families are especially disadvantaged.  And even though children enrolled in Medicaid programs have dental coverage, finding a dentist willing to treat them can be difficult; many dentists do not accept Medicaid.


Wendell Potter, Tarbell’s founder | Credit: Emily Assiran | Philadelphia Magazine

The bill signed by the governor, which authorizes the training and licensure of dental therapists, passed with broad bipartisan support in both chambers of the legislature—47-13 in the House and 30-0 in the Senate. But the wide margin in favor of the bill belied what at times was a contentious debate over dental therapists, largely because of opposition from the Arizona Dental Association. Ultimately the dental association dropped its opposition to the bill after striking a compromise with the bill’s proponents.

Across the country, expanding the workforce to include dental therapists is one of a very few health care proposals that attracts support from lawmakers in both parties. A big reason is that community and patient advocacy groups have joined hands with conservative organizations and think tanks that view the employment of dental therapists as a free-market solution to a health care crisis—one that creates jobs and doesn’t require new taxes.

In Arizona, conservative organizations like the Goldwater Institute provided lawmakers with information supporting the use of dental therapists, noting that multiple studies have shown they provide safe and effective care and can help lower the costs of dental care.

Like nurse practitioners and physician assistants, dental therapists treat patients within a limited scope of practice, ranging from patient education and prevention to simple extractions and fillings. They have been a part of the dental team for decades in more than 50 other countries and are now treating patients in a growing number of states.

After studying problems and potential solutions associated with lack of access to dental care, the Goldwater Institute became a vocal advocate for dental therapists. In a report last year, the Institute criticized “restrictive government policies” that it said created artificial barriers to affordable dental care in the state. The Institute noted that a growing number of Arizonans who have trouble finding affordable dental care close to home cross the Mexican border to a town nicknamed Molar City because of the many dental practices there that cater to Americans unable to afford care in their home communities.

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In its 2017 report, the Goldwater Institute cited numerous studies that have found that dental therapists provide safe and effective care. “The support and evidence for mid-level dental providers can no longer be ignored,” wrote Naomi Lopez Bauman, the Institute’s director of health care policy. “It is time for Arizona to join more than a dozen states that already allow or are now considering dental therapists to increase access to dental care for their residents.”

The Goldwater Institute was one of more than 15 organizations that joined a coalition supporting the licensure of dental therapists. Other coalition members include Americans for Prosperity, the Free Enterprise Club, the Arizona Farm Bureau, the Rural Health Association, the Navajo Nation and the Inter Tribal Council of Arizona (ITCA).

The shortage of available dental providers hits especially hard in rural areas and tribal communities.

“Families living in rural and low-income areas are at the highest risk for poor oral health, have the fewest provider options, face longer wait times for appointments and travel farther to find a dentist,” Republican Sen. Nancy Barto, chair the Senate Health and Human Services Committee and lead sponsor of the Senate bill, wrote in a recent op-ed in the Arizona Capitol Times. By adding dental therapists to the existing team of dental care providers, “we can bring qualified dental professionals to rural and other communities in need.”

Tooth decay and dental disease is especially prevalent among Native Americans. According to the ITCA, 76 percent of Native American children have tooth decay by age 5, much higher than the national average.

“Tooth decay and other dental issues are becoming more and more prevalent among Navajo children at a very young age, and we are in great need of solutions such as licensing dental therapists throughout the state and through the Indian Health Service,” said Navajo Nation Council Delegate Amber Kanazbah Crotty. The Council earlier had approved a resolution calling on the legislature and governor to support the bill.

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To Be Fair, Inc. and Tarbell.org founder Wendell Potter is an American consumer advocate, New York Times bestselling author, consultant, and former health insurance industry executive. A critic of HMOs and of the tactics used by insurers, Potter is also an advocate for major reforms of the industry, including universal health care.