As a hygienist at the only nonprofit dental clinic in a wide swath of southern Minnesota, Jodi Hager sees close-up what limited care means: children from poor families with decay in every tooth and adults weary from driving two hours to a place that will take their state insurance.
"I've gotten to know my patients over the years, and I see the need," she said. "It's hard after a while to look the other way. You want to do something for them, to do something to address this problem that you're dealing with every day."
That's why Hager, 40, is studying to become a dental therapist _ a midlevel provider who can do simple invasive procedures currently done only by dentists. Dental therapists are common in Canada, Great Britain and 50 other countries, but Minnesota is the first U.S. state to license them widely. Alaska has had a small but growing program since 2003 that limits therapists to tribal lands.
Supporters say Minnesota's program to train therapists, launched this year, should improve access to care by lowering the cost of providing it.
Sen. Ann Lynch, a Democrat from Rochester, pushed for legislation allowing dental therapists despite opposition from the American Dental Association and other groups. Lynch said the therapists were necessary to help meet dental needs in rural Minnesota, in the inner city and among people on state-subsidized insurance.
Like other states, Minnesota's rural areas can't attract enough dentists. And many dentists won't take enough patients on Medicaid or other government insurance because dentists say the programs don't reimburse them enough to cover costs.
It's a problem some fear will get worse as dental school classes shrink and dentists get older.
Shelly Gehshan, director of the nonprofit Pew Foundation's Children's Dental Campaign, said about a dozen state dental associations around the country are watching Minnesota's model. "Minnesota is a couple of years ahead of a wave of activity across the states," she said. "It's an idea that is sweeping the country."
In Connecticut, the state dental association approved a pilot project in November so it could learn more about the concept, the group's president, Dr. Bruce Tandy, said.
Hager is among 16 students in Minnesota's first class of dental therapists in programs at the University of Minnesota and at Metropolitan State University in St. Paul.
At the University of Minnesota dental school, therapy students train side-by-side with the dental students _ same equipment, instructors and techniques, said Dr. Patrick Lloyd, the dental school dean. Though the future dentists ultimately go on to study more complex techniques than the therapists, the principle "is that they should work together and get an appreciation for each other's competency and skill set," Lloyd said.
After the first group of therapists graduates in 2011, they will work under the supervision of dentists, but will be able to do simple invasive procedures that hygienists can't _ including drilling cavities, extracting baby teeth, removing stitches and capping nerves. Tasks such as diagnosing patients, planning treatment, performing root canals, surgical extractions, placing crowns and bridges, and implanting dental devices will be left to dentists.
The American Dental Association and other such groups opposed therapists for years, saying they fear the therapists would provide substandard care. Kathleen T. O'Loughlin, the ADA's executive director, has been somewhat reassured that the therapists will be supervised by dentists, although it hasn't endorse Minnesota's approach.
"We're very supportive of anything that improves access to dental health care to vulnerable populations," she said.
Dr. Michael Helgeson runs the nonprofit Apple Tree Dental, which operates three clinics, including Hager's in Madelia. Helgeson, a University of Minnesota-trained dentist, said he's excited about the prospect of being able to hire dental therapists who can help him treat patients more affordably.
Apple Tree Dental estimates it would save $50,000 a year for each therapist it hires while maintaining the same level of service. Helgeson said Apple Tree would probably be able to treat more needy patients as a result.
That means helping more people like Jessica Carlson, who was dropped by her family dentist of 20 years after she lost her job in 2008. Carlson, 37, endured increasing oral pain for six months before coming to Apple Tree's Coon Rapids clinic, where her state insurance was accepted.
Carlson's face lit up as she described the relief she found at the clinic.
"You are going through all that pain, and you get the root canal and the pain is gone," she said.