Policy Position

Dental Care Access

in Health Care


Updated as of January 2020.

The importance of oral health is often overlooked in the broader health care discussion. Proper oral health at a young age and into one’s elderly years is an essential factor in one’s overall health. However, accessing or affording a dental professional can be difficult, especially for those in more remote areas, or those with modest income. Dental therapy is a relatively new occupation in the United States that can help with access and affordability problems that burden so many North Carolinians.

Dental therapists are highly trained, mid-level dental professionals analogous to a nurse practitioner or physician’s assistant. Generally, the scope of practice for a dental therapist includes many of the same duties as a dental hygienist, plus the ability to perform common restorative procedures such as drilling and filling cavities, simple extractions, and stainless-steel crowns. These professionals complete an educational program, usually two to four years, and work under the supervision of a dentist.

While 10 states allow, to some capacity, the practice of dental therapists, only four states currently have dental therapists practicing on the ground. North Carolina is not one of them. The introduction of dental therapists into North Carolina would likely help many who have trouble accessing or affording proper dental care. Dental therapists specialize in preventive care, so patients will benefit from having oral problems addressed before they become painful and expensive. With the appropriate regulatory framework in place, dental therapists will receive supervision from a dentist, but they still will have the flexibility to practice outside the traditional dental office. This is key. One of the easiest ways to provide patients in rural areas with access to oral care is to allow these professionals to travel to schools, community centers, or nursing homes.

Adding dental therapists to North Carolina’s dental profession is a multi-step, multi-year process. First, lawmakers would need to approve licensure. Next, an academic institution would need to adopt a curriculum and enroll students. Once students have completed the requirements and receive a license, then patients could begin receiving care.

Key Facts

  • Health professional shortage areas (HPSAs) are geographic areas, populations, or facilities where the number of dental care providers does not meet the needs of the nearby population. North Carolina has 165 dental HPSA designations where over 2.5 million individuals live, and as of the end of 2018, 74 of North Carolina’s 100 counties were affected by dental professional shortages.
  • North Carolina could lead the southeastern United States in the dental field by allowing dental therapists to practice. As of April 2019, 10 states allow dental therapists to practice in some capacity. Arizona, Maine, Michigan, Minnesota, New Mexico, and Vermont have authorized dental therapists to practice statewide. In Alaska, Idaho, Oregon, and Washington, dental therapists are only allowed to practice in tribal communities.
  • After Alaska approved the practice of dental therapy, more children and adults received preventive care in areas where dental therapists practiced. These communities also had fewer children with front-tooth extractions and fewer adults with permanent-tooth extractions. In total, the introduction of dental therapy in Alaska had expanded access to over 40,000 individuals in 80 rural communities.
  • In 2011, Minnesota licensed the state’s first dental therapists and, as of 2019, had the most dental therapists practicing on the ground. Over 40 percent of these dental therapists practice in non-metropolitan areas. A report by the Department of Health and Minnesota Board of Dentistry observed 14 clinics where dental therapists treated over 6,000 patients, 84 percent of whom had public insurance.


  1. North Carolina should amend Chapter 90 of the North Carolina General Statutes to establish, recognize, and regulate the practice of dental therapy. Furthermore, the North Carolina Board of Dental Examiners should be granted the power to oversee licensure.


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