Spotlight on Workforce Innovations

S2P Spotlight on Workforce Innovations_Dental Therapy_a Workforce Strategy for Expanding A.

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Dental Therapy: a Workforce Strategy for Expanding Access to Care

The United States has a well-documented shortage of dental providers, especially in rural areas and for individuals enrolled in Medicaid. The past two years have additionally seen new restrictions on Medicaid eligibility (and therefore access) and HHS's withdrawal of its longstanding fluoridation recommendation, both of which will have long-term negative effects on population-level oral health. These access challenges for vulnerable populations call for renewed attention to viable solutions, and the solution dental therapy presents does not require compromising quality of care.

Approximately one-third of New Yorkers (6.5M0F[1]) are covered by Medicaid/CHIP, but only one-third1F[2] of the 15,000 dentists licensed in New York2F[3] accepted Medicaid/CHIP as of 2024. Workforce measures to materially expand access for individuals who have been left out of the care delivery system are continually met with resistance. If our goal is for all New Yorkers to have access to dental care, regardless of their insurance type, we must seriously explore solutions that have demonstrated success in other states.

Dental therapists can help address the challenge of access: in states that have authorized dental therapists, they work in federally qualified health centers, hospital-based clinics, school-based programs, and mobile units. Because dental therapists' scope of practice sits between a hygienist's and a dentist's, they enable practices to expand the volume of preventive and routine restorative care they can provide, while allowing dentists to focus their time on the more complex cases.

That capacity can help prevent acute dental issues from escalating into emergencies. Nationally, non-traumatic dental conditions (NTDCs) account for over 2 million emergency department visits annually.3F[4] The pattern is pronounced in New York: 70% of emergency department (ED) visits statewide are for non-emergent conditions, and 15% of those are dental in nature — meaning roughly 10.5% of all ED visits in New York are for potentially preventable, non-traumatic dental conditions.4F[5] These visits rarely resolve the underlying issue; standard ED treatment consists of pain medication, antibiotics, and a referral to a dentist the patient likely could not access in the first place.

Emerging evidence suggests dental therapists can interrupt this pattern. A study presented at the 2026 AcademyHealth Annual Research Meeting examined Minnesota counties from 2010–2019 and found that counties with any dental therapist presence saw a 10.5% reduction in NTDC-related ED visits per capita; accounting for the staggered timing of dental therapist adoption across counties, the reduction was 18.6%, both statistically significant.5F[6] The findings indicate that expanding access to preventive and restorative dental care through a dental therapy model can reduce reliance on hospital emergency departments for conditions that are, in principle, preventable. Despite such findings, dental therapy continues to face opposition.

Dentists' relatively low rate of Medicaid participation is often attributed, at least in part, to reimbursement rates that do not adequately cover dentists’ costs, making Medicaid patients less financially viable to treat, independent of any judgment about the patients themselves. Some critics have opposed dental therapy on safety and training grounds, arguing that certain procedures should remain exclusively within a dentist's scope. But it is difficult to justify the position of simultaneously declining to serve Medicaid patients and resisting efforts to bring in a supplementary workforce that would.

Underlying some of this opposition is a concern that dental therapists could draw volume and revenue away from dentists. Dental therapy emerged as a pathway to alleviate strained access in underserved areas and has since demonstrated its value in reaching underserved populations, namely those with public insurance coverage. As noted above, low Medicaid acceptance among NY dentists especially limits access for low-income communities. It does not follow that a dental therapist, whose role is to supplement the delivery of dental care for the underserved, including Medicaid members, would ever eclipse a dentist. Dentists will continue to practice in the settings and with the payer mix they currently serve, providing the full range of dental care; dental therapists will take on a portion of more routine cases, freeing dentists to focus more of their time on complex procedures outside of a dental therapist's scope of practice.

More concretely, evidence from other states reiterates that the authorization of dental therapy in New York would not threaten the practice of dentistry. Minnesota, where dental therapists have actively practiced since 2011, and which has three education programs for them, has 169 licensed dental therapists. For comparison, it has 4,000 dentists, 5,900 hygienists, and 7,700 dental assistants.6F[7] 

Research from Minnesota has observed an increase in dental visits among Medicaid enrollees and other low-income residents,7F[8] and, contrary to industry concerns, an increase in dentists’ productivity (as measured by RVUs).8F[9] Indeed, a separate ten-year study of one nonprofit community dental provider in Minnesota similarly found that dentists' average production value per treatment day rose significantly after dental therapists joined the clinical team, alongside an increase in patient visits –  evidence that dental therapists complemented dentists' work rather than displaced it.9F[10]

Other research indicates the potential “spillover” effect of authorizing dental policy on competition in the dental market, such that more dentists were motivated to accept Medicaid.10F[11] This would redouble the positive impact of the policy, expanding supply both by licensing new providers and increasing the reach of existing dental practitioners.

New York has historically moved cautiously on expanding scope of practice and authorizing new health professions, but the state now has an opportunity through dental therapy to promote access to care at a critical time for population health. Authorizing this practice is a modest, evidence-backed effort at a moment when access to dental care for the most vulnerable New Yorkers continues to narrow.

Endnotes

[1] New York State Department of Health. NYS Medicaid Enrollment Databook by Month: May 2026.

[2] American Dental Association: Health Policy Institute. Dental Care in Medicaid Programs. December 2025.

[3] New York State Education Department: Office of the Professions. License Statistics for Dentistry: Geographic Distribution of Registered Licensees As of January 1, 2026.

[4] Thakkar-Samtani, Madhuli; Bodek, Benjamin; Heaton, Lisa J; Sonnek, Adrianna C; and Tranby, Eric P. Repeated Use of Emergency Departments for Non-Traumatic Dental Conditions: Factors Associated with Being a “Superutilizer”.  Boston, MA: CareQuest Institute for Oral Health, June 2022. DOI: 10.35565/CQI.2022.2005

[5] In June 2023, the NYS Public Health and Health Planning Council's Health Planning Committee discussed ED utilization and extended offloading times for EMS, identifying that 70% of New Yorkers visiting EDs have non-emergent conditions treatable in a less acute setting, 15% of which were non-traumatic dental complaints. Source: Using Health Data and Information to Better Measure the Affordability of Healthcare. Step Two Policy Project. January 25, 2024.

[6] Sukalski, Alex; Sukalski, Jennifer; and Shane, Dan. "Evaluating the Effect of the Dental Therapist Workforce on Non-Traumatic Dental Conditions in Minnesota." Poster B-328, AcademyHealth Annual Research Meeting, Seattle, WA, May 31, 2026.

[7] Active Licensee Totals: Minnesota. July 1, 2026. 

[8] Elani, Hawazin. W.; Mertz, Elizabeth; and Kawachi, Ichiro. (2022, March). Comparison of dental care visits before and after adoption of a policy to expand the dental workforce in Minnesota. JAMA Health Forum (Vol. 3, No. 3, pp. e220158-e220158). American Medical Association.

[9] Langelier, Margaret, Surdu, Simona, Moore, Jean. The Contributions of Dental Therapists and Advanced Dental Therapists in the Dental Centers of Apple Tree Dental in Minnesota. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany; August 2020.

[10] Langelier, Margaret, Surdu, Simona, Moore, Jean. The Contributions of Dental Therapists and Advanced Dental Therapists in the Dental Centers of Apple Tree Dental in Minnesota. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany; August 2020.

[11] Elani, Hawazin. W.; Mertz, Elizabeth; and Kawachi, Ichiro. (2022, March). Comparison of dental care visits before and after adoption of a policy to expand the dental workforce in Minnesota. JAMA Health Forum (Vol. 3, No. 3, pp. e220158-e220158). American Medical Association.