Dentists fought the original proposal on the grounds that it compromised patient safety. The dentists argued that mid-level practitioners wouldn't have enough training to perform some of the surgical procedures spelled out in the legislation.
But in recent days dentists withdrew their opposition after lawmakers agreed to beef up the education requirements. The Legislature is expected to take its final votes on the bill this week.Minnesota's mid-level dental practitioner legislation is not a perfect solution to the workforce problem in the eyes of many dentists.
Most dentists would prefer a plan that pays them more to take care of patients on public assistance programs. Usually, dentists lose money on those patients. But the state's budget problems make better reimbursement virtually impossible. So dentists decided this session to push for a compromise they could live with.
"We have made a 180 degree turn over the course of the last year," said Michael Zakula, a dentist who practices in Hibbing and is a member of the Minnesota Dental Association.
Zakula and his colleagues now agree there are situations when a mid-level practitioner, also known as a dental therapist, might make sense.
"We feel we are at the point now that if it is done properly with the right education, the right scope of practice and most importantly the right supervision, we can support this and we feel it will be a good addition to the dental team," Zakula said.
Dentists were most concerned about provisions in the original bill that would have allowed dental practitioners to fill or pull permanent teeth without the on-site supervision of a licensed dentist.
While many extractions and fillings can be routine, there are times when complications occur, said Jamie Sledd, a dentist from Maple Grove. The original bill's two-year training requirement didn't seem sufficient, she said.
"There was just too much for that individual to learn. They couldn't learn enough to responsibly care for a patient without a dentist on site," Sledd said.
The compromise bill creates two categories of mid-level practitioners.
Graduates from the basic program will work primarily in dental clinics where they will be supervised by a dentist. They will be allowed to extract baby teeth and fill some cavities.
Those who go on to receive advanced training will be able to practice on their own in under-served schools or nursing homes without a dentist present - although they would still be required to consult with a dentist, particularly when doing more complicated tooth extractions and fillings.
The legislation is significant because it will attract more people to the dental profession, said Michael Scandrett, with the Minnesota Safety Net Coalition.
"What this will do is create this new type of practitioner that is probably going to go into that practice because they want to serve these areas or these populations, either because they're from a rural community and they want to go back there or because they want to serve the underserved - low income or uninsured people," Scandrett said.
Nearly half of the state's counties are officially designated as dentist shortage areas. Most of those counties are in the northern and western part of Minnesota. There are also shortages in low-income areas of the Twin Cities metro. Dental therapists would only be allowed to practice in these officially designated shortage areas. Sen. Ann Lynch, DFL-Rochester, sponsored the bill in the Senate. Students can go to either the University of Minnesota or the Minnesota State Colleges and Universities system for mid-level dental practitioner training, Lynch said. "I am told that both of our public institutions will be offering programs beginning in the fall of 2009. I think 2012 is when you'll potentially see the first practitioners roll out," Lynch said.
House author Rep. Kim Norton, DFL-Rochester, is working on another piece of legislation that would expand dental services even further. Norton's bill would encourage pediatricians to do oral exams and apply fluoride treatments.
"That is another way we get to those dental issues when children are young and they're in the pediatrician's office and then of course the pediatrician will make a dental referral. And we're trying to treat dental just like health care. It really is part of the big health care issue," Norton said.
That bill still faces several more legislative hurdles.