Video: Legislature Sides With Dentists, Defeats Bill Allowing Expanded Practice


A shortage of dentists affects 40 percent of North Dakota’s counties and is expected to worsen as dentists retire. A proposed bill would allow dental hygienists to perform certain procedures under supervision. Forum file photo

“I urge you to trust your dentists and vote no.”

That’s what Rep. Jim Kasper (R-Fargo) said at the conclusion of the floor debate in the House today over HB1256. That bill, introduced by Rep. Bill Devlin (R-Finley), would have allowed for expanded practice in the area of dentistry.

Expanded practice has become a pretty common thing in the medical community.  Often when you visit the doctor’s office today you probably aren’t seeing an doctor but rather someone holding the title like “nurse practitioner” or “physician’s assistant.” These are people who can provide some, but not all, of the care you’d receive from a full-on doctor.

The idea behind expanded practice is that by allowing more tiers in the qualifications required to provide care we can expand the amount of care available.

In North Dakota one type of health care people, particularly those living in rural areas or in tribal communities, is dental care.

Devlin’s bill would have allowed dental therapists to practice in North Dakota. These people would be able to do some, but not all, of the things dentists do. The idea being that these folks could help expand the amount of dental care available in our state.

The problem? The dentists hate this idea and have fought it tooth and nail (see what I did there?) both in this legislative session and the last.

So when Rep. Kasper said “trust your dentists,” what he was saying was trust a group of people whose priority is protecting their industry from competition.

Here’s the video of the floor debate:

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In defending his bill, Rep. Devlin said he was inspired to introduce it when he visited Alaska, a state which has implemented a similar program (Vermont, Maryland, and Minnesota have as well). That state has far less population density than North Dakota does. Devlin said he observed a program in that state which does well in delivering dental care over a geographic area far larger than North Dakota’s.

He also pointed out that, for tribal communities specifically, there is a federal program to allow access to expanded practice dental care, but only if our state has a program in place. We don’t, and currently our tribal communities are suffering for it.

But the rebuttals were all about protecting the entrenched interests of North Dakota’s dental industry. Rep. Kathy Skroch (R-Lidgerwood) says the pitch for this bill was a “high pressure sales” job from “out of state interests.”

Rep. Tom Beadle (R-Fargo), pointing out that Devlin’s bill had been amended (in a bid to appease dentists) to allow dental assists to work only in the same facility as dentists, said it wasn’t going to address care shortages in the rural parts of the state. “This isn’t going to solve any of our problems,” he said.

Which is a self-fulfilling prophecy when dentists don’t want dental therapists working outside of the same facilities as dentists. Beadle also suggested that North Dakota’s rural markets aren’t large enough to support dental therapists, but why not make the market decide that? Maybe some entrepreneur out there can figure out how to make it work, but it has to start with allowing dental therapists in the first place.

A bill similar to this was defeated in the state Senate last session, but even after Devlin’s bill was defeated today I wouldn’t count on this issue going away.

Dental access is a real problem in our state, and perhaps eventually our state’s dentists can be coaxed out from behind the walls of their parochial interests and engage in a real discussion on how to address it.