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RON SEELEY: N.D. doesn’t need dental mid-level providers

WILLISTON — I read with interest the Herald’s editorial about dental mid-level providers (“High praise for Minnesota’s dental therapists,” Page F1, May 11).

I also read the op-eds from the Pew Foundation and Dr. Brent Holman.

What I’d like to add are points I feel were brushed over or missed; and, yes, I’m a practicing dentist (in Williston) and have been for 34 years. I am also a past president of the North Dakota Dental Association, though I speak here on my own accord with neither the approval nor a request from the association.

As Holman mentioned, medical mid-levels do not normally perform surgical procedures. In fact, medical issues and problems are about 80 percent diagnostic and non-surgical with only 20 percent surgical. This leaves a lot of open area for diagnostic procedures, which the medical mid-levels do quite well.

Dental practices, in contrast, are about 80 percent surgical or irreversible procedures. That only leaves 20 percent for diagnostic and reversible procedures, most of which are performed quite effectively today by hygienists and registered assistants.

This is a much different model than the medical model that is so often used to compare. In fact, there really is no comparison.

In Minnesota, these mid-level providers — 18 months of training vs. eight years for a licensed dentist and five to six years for a medical practitioner, by the way — are expected to work on underserved, poor and Medicaid patients. Really? So, supporters are comfortable creating a two-tiered dental system? Those who can, get quality care from a licensed dentist and dental team; those who can’t, get the mid levels?

Aren’t all our residents, regardless of economic ability, entitled to the same quality of dental care? I think so.

And would Herald readers really allow someone with 18 months of training out of high school to extract a tooth on their child or grandchild? I wouldn’t.

Supporters say the mid-levels do “routine” dental procedures. I’m sorry, but I do not consider any procedure that is irreversible to be “routine”.

The North Dakota Dental Association has worked with the Legislature for many years to try to fairly compensate dentists for their work on the poor and Medicaid community. We also worked with the North Dakota University System to raise the number of dental students who actually are from North Dakota.

Fair compensation would go a long way toward solving the dental access problem. Current reimbursement is in many cases less than 50 percent, and many normal treatments (including crowns, partials and root canals, to name a few) actually are denied for adults in North Dakota.

Dental mid-levels have NOT proven to increase access to dental care; and, regardless of what others may try to tell us, I feel very strongly they would lower the quality of care provided to patients.

And from a political standpoint, when was the last time we in North Dakota decided to emulate Minnesota?

It should also be noted that under Holman’s direction, the dentists in North Dakota have twice in the past five years had “Missions of Mercy,” one at Standing Rock and one at Turtle Mountain Indian reservations.

Hundreds of dental-team members donated services in those communities to highlight that there still is work to be done and that the North Dakota dental community is committed to being front and center in solving any dental access issues in our state.

So, why are Pew and Kellogg pushing mid-levels, and why specifically in North Dakota? Now, there are two questions for a good journalist to get answers to from all sides.

I will not extrapolate all the possibilities here, but suffice it to say it is mainly a political agenda, in my opinion, as North Dakota has (as viewed from the outside) lots of expendable cash to help start a mid-level program.

And, make no mistake, a mid-level dental program will cost lots of taxpayer dollars — dollars that could be better used for treatment for the underserved citizens, rather than for an expensive program that has not proven to increase access to care.

I spent six years on the North Dakota Dental Association board with Holman. He is the most compassionate dentist I know toward the needs of dental patients and the most passionate dentist I know when it comes to making sure no patient falls through the cracks that hinder access to quality dental care.

The North Dakota Dental Association and the state are lucky to have Holman as both a dentist and now as executive director of the association.

I, for one, certainly trust Holman more than the political agenda of Pew and Kellogg when it comes to dental-care issues in our state.

Dr. Seeley, a Williston dentist, is past president of the North Dakota Dental Association.

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