By KELSIE JENNINGS
KU Statehouse Wire Service
TOPEKA — Since 2011, Kansas Action For Children, a nonprofit organization in Topeka, has presented legislation that would create a new class of dental workers.
KAC representatives say 92 of 105 Kansas counties don’t have enough dental providers. They say the dental workers would help fill the void. So during the 2015 legislative session, KAC proposed legislation to address the problem but for the third time in four years it didn’t gain enough support to advance.
The proposed legislation, more commonly known as the Kansas Dental Project, was introduced as twin bills — House Bill 2079 and Senate Bill 49 — in hopes of gaining more traction in the Statehouse. The project would’ve created a class of dental workers known as “registered dental practitioners,” a mid-level dental worker who is somewhere between a dentist and a dental hygienist.
With 18 months training, a dental hygienist could become an RDP and would be able to do some fillings, give local anesthesia, do some simple tooth extractions and a number of other things. RDPs would provide more preventative dental care so Kansans could avoid expensive, major dental problems.
“(Patients) would still need to see a dentist,” said Lauren Beatty, KAC communications director. “We’re not aiming to replace dentists in any way; we really see this as a member of a dental team and (RDPs) would always work for a dentist. They’re not independent practitioners; it’s in the legislation that they would have to work for a dentist.”
The Kansas Dental Project is supported by a coalition of about 50 groups, including the Kansas Dental Hygienists’ Association.
Minnesota, Alaska and Maine already use mid-level dental providers, according to Cathleen Taylor-Osborne, director of the Bureau of Oral Health for the Kansas Department of Health and Environment.
But despite support for the Kansas Dental Project, it has not been able to gain support in the Kansas Statehouse.
“It’s not something that’s widely accepted across the United States,” said Rep. Daniel Hawkins (R-Wichita), chairman of the House Health and Human Services Committee, which heard HB 2079 in February. “I know there’s a group of people out there that want that thing dearly, but there’s also a group of people out there that are fighting against it.”
Two such groups are the Kansas Dental Association and the Kansas Dental Board, which licenses and regulates dentists and dental hygienists in Kansas.
One of the main reasons the Kansas Dental Association (KDA) opposes legislation for RDPs is because the bills would allow RDPs to do extractions and fillings that would require drilling teeth, which is considered surgery. KDA representatives don’t think RDPs would have enough training to do this level of work, and have concerns about the health and safety of patients.
“By the time they would receive the amount of training that we think is appropriate, they might as well be a dentist,” said Kevin Robertson, KDA executive director.
KDA representatives also think the problem with dental access is not a lack of dentists, but that people can’t afford to go to a dentist. Robertson said programs such as KanCare, a program that manages Medicaid in Kansas to help low-income patients pay for medical services, needs to be made more appealing for dentists to accept KanCare health plans at their practices.
“The problem with access to underserved or socially, economically depressed classes of folk is really the issue with state Medicaid and the fact that Kansas does not have a robust dental program for adults, really, no program at all,” Robertson said. “There are systematic problems that are at play here, not just, ‘We don’t have enough people to go around.’”
In 2014, 1,951 dentists had active Kansas licenses, according to the Kansas Dental Board, and 1,518 of those have practices in Kansas. There were less in 2011 with 1,846 active dentist licenses and 1,448 practices with active licenses.
But Robertson agrees that there are some areas that have poor access. He said it’s hard to get dentists out to rural areas because dental practices have high overhead equipment costs. He said it takes about 4,000 to 5,000 patients who regularly go to the dentist to keep the business going, and that areas in Kansas such as Johnson County have a more concentrated population and higher average income so it’s able to better sustain dental practices.
KDA representatives said there are better alternatives to improving access to dental care than creating an RDP position. For example, dental hygienists can get additional training and receive an “Extended Care Permit.” Extended Care Permits have three levels, the third becoming law a few years ago. A dental hygienist with an Extended Care Permit III can scrape out tooth decay and fill cavities with temporary fillings. KAC says RDPs would be able to provide permanent fillings. The permit requires only 18 hours of training, while RDPs require 18 months. The permit would not allow hygienists to treat as many patients as an RDP could. Because of these differences, KAC thinks RDPs are more beneficial.
“The ECP III can do more services than just a general hygienist, but the RDP would go even further than that, so that’s why we think RDPs would allow more people to get access to care,” Beatty said.
Wichita State University and Fort Hays State University have agreed to create and provide the educational programs needed for RDPs if legislation is ever passed.
“We have the School of Oral which houses the only baccalaureate level dental hygiene and advanced education in general dentistry programs in the state and as such are uniquely positioned to offer the educational program for this new provider should you in your wisdom pass this legislation,” said John Bardo, president of Wichita State, in his written testimony for HB 2079.
KAC first proposed twin bills, one to the Senate and one to the House, in 2011. Both bills were heard by committees, but neither one of the committees took action, so the bills didn’t make it to the House or Senate floors.
Then in 2013, KAC decided to try again and introduced twin bills once more, but the bills never received committee hearings.
In 2015, KAC introduced twin bills for a third time to both the Senate and House, but were unsuccessful once more. Beatty said KAC is in the process of deciding what its plans are for the project and future legislation.
But for this year, Hawkins said all committee work is finished. Any bills that didn’t make it past a committee will have to wait until next year, and even then legislators might not take action on them.
“It really depends on what all the issues are at that time. Issues do change every year, priorities change, agendas change,” Hawkins said. “We’ll have to re-evaluate next year when we get there and we find out all the bills that we’re going to have. We’ll prioritize them and look if there’s support … I know that they’ve (KAC) worked hard but there’s not very much support for that bill in the House.”
Kelsie Jennings is a University of Kansas senior from Olathe majoring in journalism.
