A scaled-back version of a bill to allow mid-level dental providers to practice in the state passed the Senate Monday night following concerns from dentists that the original proposal wouldn’t actually meet the needs of underserved communities and could contribute to the corporatization of dental practices.
As passed, Democratic state Sen. Julia Ratti’s SB366 would establish a new category of dental providers known as dental therapists who would be able to perform a number of routine dental procedures currently performed only by dentists, including extracting loose teeth, filling cavities and applying sealants. Proponents, including the Nevada Dental Hygienists Association, have framed the proposal as a way to meet oral health needs in the state — particularly in underserved low-income, rural and tribal communities — while opponents, including many in dentists, have voiced concerns over the safety of such a proposal and whether it would actually help.
The legislation, which required two-thirds majority support, passed the Senate 17-4, with Republican state Sens. Ira Hansen, Pete Goicoechea, Joe Hardy, Heidi Gansert and Keith Pickard joining most Democrats, except state Sen. James Ohrenschall, in support. If passed by the Assembly and signed by Gov. Steve Sisolak, Nevada will become the 11th state to allow dental therapists to practice.
Ratti, in an interview on Tuesday, said that the amendment was an effort to get support for the bill broadly.
“If you look at the votes on that bill, it was bipartisan both directions,” Ratti said. “I think that, since we're doing something a little bit newer here — at least for the state of Nevada — I think that's where the comfort level was.”
Under the amendment, dental therapists will only be allowed to practice in a limited number of public health settings, including rural health clinics, federally qualified health centers, tribal health clinics, school-based health clinics, mobile dental units and any other clinics that primarily serve Medicaid patients or other low-income, uninsured individuals. Proponents had initially opposed such a limitation on the grounds that it might discourage people from entering the dental therapy practice and make it harder to establish a dental therapy training program in Nevada.
“I still believe probably the best path to do that is to open up the field and get as many professionals as possible, but sometimes in the process of legislating you need to look for the solution that can gain the broadest support,” Ratti said. “So at this time, the solution that has the broadest support is limiting the practice of dental therapists to public health settings.”
Lancette VanGuilder, legislative chair for the Nevada Dental Hygienists Association, said that the association is still “thrilled” with the bill where it is now, even with the change.
“We wanted all Nevadans to have access to the full tier of health-care providers, but we are thrilled that we're hopefully going to get this new provider implemented and if we have to start in public health settings only and collect some data and research and pilot some kind of innovative type model, we are really, really happy with the progress,” VanGuilder said.
Sarah Adler, lobbyist for the Pyramid Lake Paiute Tribe, said that the amendment may reduce some of the momentum behind establishing a dental therapy training program in Nevada, but that it’s something advocates will continue to push for.
“None of this is going to happen quickly, but the infrastructure is in place for that first handful of dental therapists to arrive in Nevada and to start to bring hope, belief in a health care system and access to people who really need it,” Adler said.
The inclusion of limits on the practice of dental therapy addresses one of the concerns expressed by dentists last month, but leaves open other concerns, including whether dental therapists will have the appropriate training to perform some of the procedures. (Dental hygienists, for their part, point to the education and training requirements in the bill to address those concerns.)
A representative of the Nevada Dental Association could not be immediately reached for comment on Tuesday.
The amendment also makes a number of other changes, including requiring a supervising dentist conduct a monthly review of the dental therapists they are overseeing and clarifying that dental therapists may not provide any services that are outside the scope of their authorizing dentist.
The bill now heads to the Assembly for a hearing by the Commerce and Labor Committee.