BISMARCK - A recent Herald editorial claimed the solution to North Dakota's oral health problems would be to copy Minnesota's approach, employing a new mid-level provider with an expanded set of capabilities ("Evidence in favor of dental mid-levels grows," Page A4, Oct. 2).

Earlier this year, the North Dakota Legislature clearly stated it is premature to invent a new type of dental provider in our state by voting 6-40 to reject a bill that would have allowed this lowered standard of training for dental procedures. In the 2013-15 interim, the Health Services Committee studied the issue and failed to recommend a bill.

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It's been six years since Minnesota passed legislation in 2009 allowing dental therapists. Despite their presence in the state, underserved Minnesotans still experience the same barriers to obtaining good dental health. Nothing has changed.

Dental therapists have failed to expand dental services to underserved and rural communities in Minnesota in any meaningful way. The 2014 Minnesota Department of Health/Board of Dentistry report on dental therapists revealed only seven rural clinics in Minnesota employ a dental therapist. The majority work in metropolitan areas.

Additionally, many people who lack access to dental care also suffer from serious underlying oral and medical conditions that complicate the process of treating them. These are the last patients we would want to relegate to anyone but a fully trained dentist.

Six years later, Minnesota ranks at or near the bottom states in the number of children who receive dental care under Medicaid. It has one of the highest disparities in dental access between children covered by Medicaid and those with private insurance. Clearly, this is not a model to replicate if we want to actually connect more underserved North Dakotans to dental care.

The editorial also mischaracterizes recent action by the Commission on Dental Accreditation to start approving dental therapy programs. The commission voted to implement these standards not as an endorsement, but to clarify inconsistent and confusing guidance dental schools received from lobbyists being paid to pass dental therapy legislation and respond to demands by the federal government. It has not yet accredited any dental-therapy programs - a process that is just one of several costly steps for institutions to adequately prepare these practitioners for the workforce.

Rather than pursue a one-size-fits all solution, a smarter, more immediate approach would focus on finding ways to get more people the care they need now - with minimal burden to taxpayers. We need an approach that solves problems, not creates new ones.

We are making significant progress. According to a recent report from the American Dental Association Health Policy Institute, North Dakota has reduced the gap in dental care between Medicaid-enrolled children and those with private benefits by nearly 50 percent, through community-based efforts such as our Seal! ND program, expansion of nonprofit dental clinics, improvement to dental Medicaid and more.

By continuing and expanding such programs, we will be able to remove the barriers that keep North Dakotans from receiving needed dental care.

The North Dakota Dental Association's Action for Dental Health initiative combines strategies that address the diverse barriers that keep North Dakotans from care, including:

▇ Supporting nonprofit safety net clinics through public/private partnerships and highly successful loan repayment programs;

▇ Expanding North Dakota's school sealant program with grant funding to serve more low income children;

▇ Adding Medicaid-supported case management to direct high-risk patients into dental homes to save treatment costs;

▇ Using dental hygienists and dental assistants to their maximum level of education through expanded functions and outreach collaborative practice;

▇ Developing a volunteer/contracted network of credentialed dentists, dental hygienists and dental assistants to serve in Indian Health Service and nonprofit clinics.

Dentists are doing their part to make sure every North Dakotan can have a healthy mouth. Let's double down on the solutions that are already working. More on this plan is available at

Dr. Holman is executive director of the North Dakota Dental Association.