“We feel the focus should be on getting more hygienists and assistants in, rather than creating an entire new position,” Sullivan said, adding that registered dental hygienist and assistant programs already exist in the state.

Shortage areas

More than 1.5 million Michigan residents live in Dental Health Professional Shortage Areas, areas that the federal Health Resources and Services Administration has designated as having a shortage of dentists.

An additional 278 dentists are needed in the state, according to the Health Resources and Services Administration, which is part of the U.S. Department of Health and Human Services. All counties in the Upper Peninsula, many counties in the mid and upper Lower Peninsula, and most counties along the Michigan-Ohio border are designated as these areas, according to a Michigan Department of Health and Human Services map made using HRSA data.

Fox, the chief dental officer at The Wellness Plan Medical Centers, where Toney will eventually work, supports dental therapy.

Many dentists don’t accept Medicaid, the government health care program for low-income residents, she said. But Fox is a community health dentist who does accept Medicaid. She said many of her patients “have nowhere else to go.”

Having a dental therapist ― Toney ― will “augment what we’re able to do as community health dentists,” since Toney will be involved in The Wellness Plan’s outreach programs, Fox said.

“We’re able to touch a wider number of people, and it kind of just expands what we’re able to do for that patient population,” she said.

What is dental therapy?

Dental therapists provide preventive services, said Kari Ann Kuntzelman, the executive director of the American Dental Therapy Association, a professional organization that supports dental therapists. She said dental therapists generally provide care in the communities they live in or grew up in. That’s especially true for tribal members who are dental therapists, she said.

“They’re very compassionate, caring, empathetic providers, and just wanting to do and provide dentistry in a different way than … how it’s been provided in the past, because what’s been happening hasn’t been working,” Kuntzelman said.

Today, 14 states allow dental therapy, and Florida is considering it. Dental therapists don’t require the same level of training as dentists and often only earn a fraction of what dentists are paid.

Kuntzelman said dental therapists provide the most common procedures, such as fillings and cleanings, letting dentists perform more complex procedures, including root canals and crowns.

“It allows for the dental therapist to spend a little bit more time with their patients than maybe the dentist would have been able to if they’re, you know, doing back-to-back crowns or something throughout that day,” she said.

Dental therapy originated in New Zealand in 1921, according to the American Dental Therapy Association. Kuntzelman said the field started in the U.S. in 2004-05. Alaska Native tribes in rural areas sent community members to New Zealand to receive training to become dental therapists. The Alaska Dental Therapy Educational Program enrolled its first cohort of students in 2007, and there are now five dental therapy education programs across the country.

Dental therapy emerges in Michigan

It took a while for dental therapists to start practicing in Michigan because the state lacked training programs and because of the COVID-19 pandemic, said Riaz, the oral health workforce consultant and a licensed dental hygienist.

Some Michiganians don’t have enough dental providers near them, and some can’t find providers who accept Medicaid or face other barriers to care, she said.

“It’s not that we don’t have enough dentists,” Riaz said of Michigan. “We actually do. It’s just that the dentists are not well distributed in our state.”

Michigan’s dental therapists must practice in one of the Dental Health Professional Shortage Areas or serve underserved populations, she said.

Dental therapists are remotely supervised by a dentist, and they can work in mobile settings and community-based settings, Riaz said.

State’s first dental therapy program

Ferris State University is creating the state’s first dental therapy program, which could begin accepting students by 2028. A federal grant received through the state health department is paying for a consultant to help develop the dental therapy curriculum, said Theresa Raglin, associate dean of operations, assessment and compliance at Ferris State’s College of Health Professions.

Dental therapy may be a new profession to Michigan, but it is “a proven profession,” she said, referencing New Zealand and Alaska.

“It’s been a successful model since 2009 in the state of Minnesota,” Raglin said, “and so our program … is built on those previous models and is going to reflect the standards and the academic and clinical training that’s been proven for dozens of years now.”

The Ferris State dental therapy curriculum needs to be approved at various levels of the university, she said, adding that she hopes it will be completed by the end of 2026. The program will then apply for specialized accreditation through the Commission on Dental Accreditation. She said 2028 would be the earliest the program could admit students.

The state health department has also used federal grant funding to survey other higher education institutions throughout Michigan for interest in creating a dental therapy program. Riaz said the state has “gotten some interest” from other schools, and the department is providing them with education and resources about the field.

The Michigan Primary Care Association provided scholarships to three students for training in dental therapy in another state and returning to Michigan to practice. Obey and Toney were among them. They graduated from the dental therapy program at Skagit Valley College in Mount Vernon, Washington.

The third Michigan student is still in school.

Dental group’s opposition

But Sullivan of the Michigan Dental Association argued that the resources the state has dedicated to dental therapy would be “better spent” trying to recruit dental hygienists and assistants and “figuring out a way to get dentists to go into the rural areas.” Michigan has a “severe shortage” of dental hygienists and assistants, but has already established schools for training, he said.

The Michigan Department of Health and Human Services is backing dental therapists as a way of complementing dentists, dental assistants and hygienists while trying to improve access to care, said department spokeswoman Lynn Sutfin.

“To help address dental hygienist shortages, dental hygiene programs in Michigan are already increasing the number of students they admit into their programs, and some are considering year-round classes to help students get into the workforce sooner,” Sutfin said in an email. “In addition, at least two colleges are considering adding dental hygiene programs.”

Sullivan said he has talked with younger dentists and dental students, and they “just don’t like the lifestyle” of rural areas.

“They don’t like being out in the middle of nowhere or having to drive 45 minutes go to a grocery store,” Sullivan said.

When the 2018 legislation was approved, one of the things that “concerned” his association the most was that it allowed dental therapists to do “simple extractions,” he said.

“Now, all extractions are simple until they’re not,” Sullivan said. “That’s where you have the extra training of the dentist that comes in and is important for the patient care.”

First dental therapist

Before becoming a dental therapist, Obey worked as a dental assistant for about 16 years, much of it in the West Branch area. She said that when she learned about dental therapy, it “really aligned with exactly what I wanted to do,” because it incorporates some of the dental hygienist role and some of the dentist role.

“I’ve always wanted to be one or the other, but never really one or the other only,” said Obey, 41. “I was like, ‘Gosh, I wish there was a combination of the two,’ because I really just like the variety of dentistry, and the dental therapy role is exactly that.”

Dental therapists also do community-based activities, which she likes. As a dental assistant, she said she was always the first to volunteer to go to events in the community with a dentist or hygienist.

While attending the dental therapy program at Skagit Valley College, Obey had to do a preceptorship, which is similar to an internship. She was supervised by a dentist at the Sault Tribe Dental Department in Sault Ste. Marie, where she is a member of the Sault Tribe.

Today, she mostly sees tribal members or patients who are on Medicaid or Medicare, the government health care program for seniors.

“There’s such a need for that, you know, and private insurance patients can go to a private dentist,” Obey said.

Her clinic, Bay Mills, is a federally qualified health center and a tribal health facility.

Obey said she primarily performs fillings, simple extractions, minimally invasive dentistry, emergency exams and hygiene exams.

“I think because of the flexibility with our scope of practice, it makes us a pretty valuable asset to these places, because we can work on our own,” she said.

Metro Detroit’s first dental therapist

Toney, the soon-to-be dental therapist, was the office manager for The Wellness Plan Medical Centers before going to dental therapy school in Washington state. She started her career as a dental assistant before working in billing and administration.

Working for The Wellness Plan Medical Centers and previous employers taught her about access to care, Toney said. Many patients at The Wellness Plan needed to come in for restorative treatments ― such as fillings or crowns ― but its schedule was “pretty booked,” she said. There weren’t enough providers to handle the “load of patients,” she said.

“I decided to become a dental therapist because my experiences in dentistry revealed both the transformative power of oral health care and the persistent gaps that prevent many individuals from receiving it,” she said in an email. “Over time, I came to understand that oral health is not just clinical, but it is deeply tied to overall health, self-confidence, economic stability and quality of life.”

Fox, the dentist who is supervising Toney, said The Wellness Plan collaborates with schools, health departments and other organizations to address oral health disparities. As part of that work, Toney will be providing care to youth in juvenile detention centers.

Toney said she is “super excited” about entering the field.

“And I’m just so grateful to just everyone that played a role in me getting to this point here,” she said.

asnabes@detroitnews.com