Passing Dental Therapy Legislation in Oklahoma: Offering Essential Services in Underserved Areas (Guest Article)

The need for dental therapy to be a statutorily supported health profession in Oklahoma has been well documented and articulated. It has also been long established that strong public health systems include accessible oral health care services. So much so, the federal Bureau of Primary Health Care, a division of the Health Resources Services Administration (HRSA), includes oral health services in the federally qualified community health center program.

As the 60th Oklahoma Legislative Session begins in 2025, legislators will have the opportunity to consider dental therapy legislation that would expand needed essential dental services for rural, tribal, and underserved communities throughout the state. Public health advocates and community members are encouraging all key stakeholders to consider this health policy issue through an ethical and equitable lens.

In our Healthcare Policy, Law, and Ethics course at the University of Oklahoma, our students recently considered health policy topics that had a wide range of perspectives and viewpoints. We teach them to consider differing views respectfully as part of the policymaking process. Interestingly and importantly, when the concept of dental therapy is discussed, it is one of the few topics that receives unanimous classroom support. Our OU College of Dentistry does not graduate enough dentists who aspire to establish full time community practices in rural, tribal, and underserved Oklahoma. There is a shortage of accessible providers for children in those communities, many of whom rely upon SoonerCare or SoonerSelect for coverage.

Cost and access are repeatedly cited as main barriers to dental care. Therefore, without adequate physical and financial access to dental care, emergency rooms are the place of first (or last) resort for elderly and other patients experiencing severe tooth pain, where typically only palliative options are available and at an exorbitant cost. Despite past efforts for other reforms, our state oral health scorecard still shows us with a D, with plenty of F’s. As Dr. W. Edwards Deming said: Every system is perfectly designed to get the results it gets.

Meanwhile, some states have chosen to redesign their systems by expanding their dental health workforce by passing dental therapy legislation. This includes Minnesota, where the University of Minnesota has successfully launched a dental therapy program where they recruit students from underserved locations to pursue this practice under the direct supervision and support of dentists.

As the state’s premier academic health system training our health workforce of tomorrow, OU Health Sciences Center is perfectly positioned to champion and lead the way to improve oral health outcomes in rural, tribal, and underserved Oklahoma by creating the state’s first dental therapy training program by working in concert with our OU College of Dentistry and OU Hudson College of Public Health. After learning of the advantages provided by dental therapy, our students wonder why such a program doesn’t already exist in Oklahoma (and some of them say if it did they would be interested in pursuing that degree).

Similar to Newton’s 3rd Law of Motion in physics that says for every action there is an equal and opposite reaction, our students are taught if someone is FOR a policy change, there will be someone AGAINST that policy to prevent it from passing. But unlike physics, those forces are not always equal. Why? The answers get bantered around the classroom: Power. Lobbyists. Money. Fear of change. Protecting the status quo.

Who could be against expanding dental services for poor, underserved places, they wonder? Physicians have physician assistants, they point out. So the idea of advanced practice providers supporting doctors, and allowing them to practice at the highest end of their license, is not new and seems right. Why can’t dentists have dental therapists, they ask? As they learn more about the influence of political advocacy of stakeholder organizations, they wonder if our state dental association and dental hygiene association could help pass it too?

Patient autonomy is a virtue of the American Dental Association (ADA), yet they do not allow for a full scope of options for professional dental treatment in most states. The dentists that pay these association dues and political action committee (PAC) contributions state they are all for beneficence and justice, while some dental associations covertly and blatantly block efforts to pass policy and care reforms that would increase dental access for poor and underserved populations in need.

But not all dentists and dental hygienists are against dental therapy. Why do some in the field support dental therapy and others do not? Perhaps, the answer we settle on in class is ethics.

Some opponents to dental therapy believe denying dental access to populations that dentists won’t live in actually is ethical and right, in an effort to help protect the quality of the profession in markets dentists do serve in. While others believe that position is not honorable or moral, or representative of their Hippocratic oath to do no harm.

The use of mobile dental vans to improve the reach of dental services only provides temporary solutions to address access issues. Further, they do not create new local jobs, income, or pay taxes into underserved economies These mobile units have been around for decades, and have not led to “A-level” outcomes or performance at the population level. We can do better.

Ultimately, why will some legislators support dental therapy legislation next session and some will vote against it? Soon our class will find out.

To support the stated ADA ethical goal of nonmaleficence, OU has top notch faculty in medicine, dentistry, public health, allied health, and nursing trained in quality improvement and accreditation. They can help the Oklahoma Board of Dentistry create a robust oversight process to oversee and guide the practices of dental therapists. We can train the dental therapists in Oklahoma. We can continue to support graduates upon their completion of an accredited program in Oklahoma.

Oklahoma has some of the worst oral health outcomes in the nation, but it doesn’t have to be that way. We can choose to change. A great next step is joining Minnesota, Alaska, Oregon, Washington, Wisconsin, New Mexico, and Arizona by passing dental therapy legislation in Oklahoma in 2025 to support our rural, tribal and underserved communities. It happened there, why not here? Our students believe it can and is the right thing to do, and I do too.

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About the Author: Dr. Mark Woodring is an assistant professor of health policy and administration at the OU Hudson College of Public Health and the OU Dodge Family College of Arts & Sciences, and is actively developing new community partnerships with the Tribal, Rural, and Underserved Oklahoma Pathways Project at OU Health Sciences. As a Fellow in the American College of Healthcare Executives, he has spent the past 25 years in healthcare working to help make a difference in rural and underserved populations in various board, executive, and leadership capacities. He is currently Vice Chair for the Rural Health Association of Oklahoma Board of Directors and serves on the Oklahoma Medicaid Delivery System Quality Advisory Committee, and his action-oriented community participatory research with leaders and communities helps shine light on overcoming health disparities together.