Seattle Times Op-Ed: Dental Therapists Create a Two-Tiered System of Care

Jun 1, 2021
Drs. Marissa Bender and Harlyn Susarla recently authored the op-ed "Dental Therapists Create a Two-Tiered System of Care" for The Seattle Times.

Drs. Marissa Bender and Harlyn Susarla recently authored the following op-ed for The Seattle Times.

Dental Therapists Create a Two-Tiered System of Care

Tera Bianchi’s recent Op-Ed focused on the important issue of increasing access to dental care in Washington, but her message was undercut by comments insulting dentists and grossly mischaracterizing the Washington State Dental Association’s opposition to authorizing dental therapists to practice statewide.

In caring for patients from many socioeconomic and cultural backgrounds, we see firsthand how poor oral health impacts overall health and the access-to-care problem. Dentists share the goal of solving that problem, but as licensed clinicians with eight to 12 years of training, we have a different perspective on how to increase access while protecting patient safety. This difference of opinion does not mean dentists are ignorant of the issue, distrustful, or racist, as Bianchi asserted.


Countless dentists have volunteered tens of thousands of hours providing free care at the annual Seattle/King County clinic and other public-health events statewide. These experiences demonstrate existing deficiencies in Washington’s dental safety net and highlight two types of care underserved patients typically need.

Some need cleanings and routine preventive care, usually provided by dental hygienists. Others have medically complex problems, requiring the expertise of general dentists or specialists. Dental therapists are not a good fit for either need.

Dental therapists simply aren’t as well-trained as licensed dentists; most are not required to earn an undergraduate or graduate degree or pass a certified licensing examination. Instead, they only need to have a high school diploma (or GED) and complete a few years of limited training. We don’t believe this adequately prepares someone to deal with complications that can arise in even seemingly routine procedures. We both have experienced “simple procedures” turning unexpectedly complex and have relied on our extensive training to provide the appropriate level of care.

While the state dental association does not oppose authorization of dental therapists on tribal lands, this is not because we consider dental therapists an effective solution. Rather, we respect Washington tribes’ rights as sovereign nations to choose the care they deem appropriate.

However, we will continue raising concerns when the state’s dental therapy task force begins studying statewide authorization. The task force, which consists largely of dental therapy proponents, must answer important questions about why the model has failed to significantly improve access elsewhere.

  • Why have fewer than 10 dental therapists been added to the national workforce annually since 2009?
  • Why do studies show that most practicing therapists aren’t in rural areas?
  • How do therapists save patients money, when studies show their fees typically align closely with those of licensed dentists? 

Beyond these questions, the task force should review other proven solutions for improving access to care.

First, we must expand dental hygiene education to address the hygienist shortage that’s making it difficult for some patients to receive preventive care in both community health centers and private practices. That’s why the state dental association is helping support relocation and expansion of the Shoreline Community College hygiene program at the University of Washington School of Dentistry.

While dental therapist proponents have spent heavily on public campaigns promoting their ideas, the dental association has partnered with other organizations to invest in real solutions, like dental residencies that utilize fully trained and licensed dentists, each providing $500,000 to $700,000 of free or discounted care annually.

Finally, the state needs to consistently invest in its dental Medicaid program. Recent increases in Medicaid reimbursements for adult dental services are an important step, but Washington’s pediatric reimbursements remain some of the nation’s lowest. Years of insufficient funding cannot be corrected overnight, and we hope legislators will continue making crucial investments as they did this session.

Too many Washingtonians lack access to quality dental care. Authorizing dental therapists would create a two-tiered system of care, putting the neediest patients a step further from a dentist. Instead, let’s make strategic investments in evidence-based, cost-effective solutions to provide all Washington residents access to quality dental care.

Dr. Marissa Bender is a board member of the Washington State Dental Association and writing this Op-Ed on behalf of the association.

Dr. Harlyn Susarla is immediate past president of the Washington State Academy of Pediatric Dentistry. She is writing this on behalf of the academy.