Saint Paul Pioneer Press
TOM MAJESKI
An idea borrowed from Canada and now being debated by state lawmakers might someday help Minnesota seniors get better care for their dentures.
The plan calls for creating a new group of professionals, called denturists, who would be specially trained to exclusively build and repair dentures. Because they would not need the extensive training dentists receive, denturists should be able to do their work at prices far below those charged by dentists.
While supporters say the plan is a reasonable response to a serious problem, it has generated opposition from dentists, dental groups and some lawmakers, who want to table the measure for a year so their questions and concerns can be answered.
"I feel the health and safety of people will be hurt by substandard care and that teeth may be removed just to sell dentures,''Dr. Tim Peterson, a prosthodontist from Hennepin County Medical Center and president of the Minnesota section of the American College of Prosthodontists, told members of the Senate Health and Family Security Committee last week.
But Dr. Carl Ebert, who devotes much of his time treating nursing home patients for Apple Tree Dental, a nonprofit, Minneapolis-based company, strongly supports the denturist plan.
"Every day in the clinic, I see patients coming in with dentures that are 20 years old,'' Ebert said. "Some people stuff Kleenex in them because they fit their gums so poorly. I see things you wouldn't believe. Teeth (in dentures) worn down to the pink acrylic and they're chewing on that. I see patients with teeth falling out (of their dentures) and they can't talk or eat.''
Ebert blamed this lack of care to the fact that most Minnesota dentists provide very little or no care to people on public programs. What's more, denture services represent only about 1 percent of the average dentist's business, he pointed out.
"Not providing care and then opposing a plan to have someone else provide the care is just barbaric," Ebert said.
Experts predict the lack of dental care for Minnesota's poor and elderly will only worsen.
Minnesota currently has more patients per dentist than any other state in the nation, they say. Worse yet, the ratio is expected to worsen in coming years as an increasing number of older dentists head into retirement while the number of new dentists moving into fill their shoes steadily declines.
In this strong sellers' market, the first to get left out are the poor. An estimated 600,000 Minnesotans are on Medical Assistance and other publicly funded plans. Because these plans have low reimbursement rates, members face an increasingly difficult task of finding a dentist willing to treat them at rates that don't cover the cost of the care, experts say.
Canada and a handful of U.S. states have tried to plug the treatment gap with denturists. Proponents say they get more trainingon denture work than the average dentist and can afford to charge lower fees.
Richard Diercks, executive director of the Minnesota Dental Association, says denturism is a new idea for the state that needs further study before being enacted into law.
"We think it's an interesting concept and we're willing to take a look at it, but there are a number of questions and concerns that should be looked at,'' Diercks said.
For instance, the only training program in the United States is located in Washington state. There are five programs in Canada. "So how they would be trained is unknown and it could be very costly,'' Diercks said.
Diercks also pointed to a 1997 study in Ontario that showed the promised price reductions from denturists did not exist five years after the program began. "In fact,'' the study's author wrote, "certain services actually cost less if they are provided by a dentist using the (Ontario Dental Association) fee guide.''
Diercks believes that if denturists are permitted by the state, they should work under the supervision of a dentist, just like dental hygienists do today. "That's best for patients,'' he added.
Rep. Michael Paymar, D-St. Paul, said he introduced the House version of the denturist bill because he believes the concept will help consumers save money. Over time, he added, it also may help the state save on its Medical Assistance program, as well as reduce the cost of providing dental care to prison inmates.
"It's done in Canada; it's high time it came to Minnesota,'' Paymar said.
