The Vermont House of Representatives passed a bill Friday that allows mid-level dental providers to practice in the state.
The House approved S.20 in a voice vote. The Senate passed an earlier version of the bill in 2015. The upper chamber will now have the option of accepting the House's changes or moving to conference committee.
The bill would establish a new profession in Vermont called dental therapist. The profession would require more education than a dental hygienist but less education than a dentist.
A dental therapist would have a bachelor's degree and be allowed to perform eight procedures more than a dental hygienist, including root canals. The person would need to work under a contract with a supervising dentist, who has a doctorate. However, the dentist would not need to practice in the same building as the dental therapist.
The Vermont Technical College in Randolph has outlined sample curriculum for a four-year program to train dental therapists should S.20 become law. The person would learn the same three years' worth of curriculum as a dental hygienist but spend an additional year in training.
Supporters of the bill to license dental therapists say S.20 creates jobs and makes it easier for Vermonters to get routine dental procedures. Opponents say the new profession would create a two-tiered system of dental care in which not all Vermonters can see a dentist.
Rep. Paul Dame, R-Essex Junction, spoke in favor of the bill in the House floor. He said that the bill creates jobs, and he cited information from the Joint Fiscal Office saying there would be no direct cost to the state.
"If you want to increase access, I can't imagine a more cost-effective way to do it than to let people take on a few more skill sets," Dame said. "As we get five or 10 years down the road, we can get a dental therapist who has more experience with those eight procedures than a brand new dentist."
Rep. Alison Clarkson, D-Woodstock, called S.20 an economic development opportunity for women, who she said represents the majority of dental hygienists. Under the bill, those hygienists would be able to study at Vermont Technical College to get licensed as dental therapists.
"Women make up the vast majority of dental hygienists," Clarkson said. "It is a terrific economic development opportunity and liberates our dentists to do the more complicated procedures for which they make more."
Voices for Vermont's Children, a nonprofit lobbying group, has been a long-time supporter of the bill. The group said in written testimony that "tens of thousands of Vermonters" don't access dental care in a given year, and this bill would improve their chances.
"Because oral health is integral to overall health, the lack of access to dental care in Vermont undermines the health and well being of children and adults alike," the organization testified. "We know that when parents don't access dental care, their kids are less likely to as well."
However, the powerful Vermont Dental Society has remained strongly opposed to S.20. In a postcard this month, the society warned that S.20 allows the state government to lower Vermonters' standard of dental care.
"The legislature is poised to pass an experimental plan lowering the standard of dental care without savings patients or the state any money," the society wrote in a mailing. "S.20 is bad for you and bad for Vermont's healthcare system."
Rep. Kurt Wright, R-Burlington, also opposes the bill. He reiterated the Vermont Dental Society's arguments on the House Floor, saying licensing dental therapists would create a two-tiered oral health care system.
"While there may be individual dentists who support this, it's clear that the dental society opposes this, and they lay out really significant reasons why," Wright said. "S.20 actually goes in the opposite direction of what we've hoped for."
Dr. Harry Chen, the commissioner of the Vermont Department of Health, testified in favor of the dental therapist bill. He said the literature that the Vermont Dental Society has sent to members of the public is "misleading."