OPINION | Washington Lawmakers Must Expand Dental Therapy for Underserved Communities

by Cheryl Berenson, R.N., M.S., M.P.H.

Since finishing my training as a family nurse practitioner in the early 1980s, I have cared for people, both young and old, who are struggling to access the health care they so desperately need, including dental care. While these access issues are at a crisis level right now, our state Legislature has the opportunity to make a real difference this legislative session.

As a public health nurse working with many adults and children suffering from homelessness, my patients are at high risk for inadequate dental care access and inevitably suffer from poor overall health as a result. The existing health disparities and inequities in our health care system have an immense impact on them. This lack of appropriate care is further impacted by systemic factors identified as social determinants of health, such as social, economic, educational, housing, transportation, neighborhood safety, and environmental factors.

Early on in my work, I was taken aback by the large number of people who had complex dental problems. Providing appropriate screening and referrals for vulnerable populations is challenging because it's difficult to find accessible, appropriate, and affordable care sites. Their very limited options to access oral care, then and now, include crowded emergency rooms, volunteer mobile outreach dental clinics, and scarce public and community health clinical sites. Dental-related issues are among the most common reasons uninsured people seek care from Washington's emergency departments. This reality is disheartening.

The condition of teeth in our own community members today is the worst I've seen working in public health — even worse than what I've seen in newly arrived refugees who've suffered for years in war-torn countries and refugee camps without any dental care. Before the pandemic, I worked at a clinic at the St. Vincent de Paul Georgetown Food Bank and saw many community members, including kids, who had dental emergencies and didn't even have a toothbrush or toothpaste to use. I also worked with Medical Team International's dental van at the Recovery Caf in SoDo. It was very clear that dental access in this population was severely limited, even for basic supplies, let alone emergency or surgical care.

The immense moral and medical crisis of disparities in oral care hurts those in every corner of our state and boils down to a lack of access and affordability. Expanding our capacity to serve our vulnerable community members is necessary and urgent.

Allowing dental therapists to join our dental care teams is a safe and logical part of the solution. Dental therapists are an extension of the dental workforce who provide basic and preventative services such as check-ups, cleanings, fillings, and uncomplicated extractions. They are comparable to physician assistants in medicine. Dental therapists also have the flexibility to meet the homeless where they are, eliminating any barriers this population can face when attempting to navigate the health care system.

Dental therapists have been practicing in tribal communities across Washington State since 2017, where they have safely and successfully improved access and care for their patients.

Washington State has an opportunity this legislative session to reduce the life-altering dental health disparities so many of our community members are experiencing. A dental therapy bill that would allow dental therapists to practice statewide in clinical settings that serve our rural and underserved populations has passed out of the state House and is now being considered in the Senate. New and expanded community health dental clinics should also be funded to meet the outsized need.

Dental care is health care, and access to the entire scope of health care is necessary for healthy communities. We need our lawmakers to approve the expansion of dental therapy, for the health and well-being of everyone.

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Cheryl Berenson is a public health nurse and member of the King County Medical Reserve Corps at Public Health — Seattle & King County and serves as the WA State Policy Advocate for the National Council of Jewish Women (NCJW) and on the WSPHA Policy Committee.

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