This Dental Therapist Is Filling a Gap in U.S. Health Care
She’s a health care provider who travels, an educator who listens, and a comfort to children who’ve never seen a dentist. She’s also a pain reliever, a problem solver, and even, it can seem, a miracle worker.
The many roles Jodi Becker plays are all part of her job as an advanced dental therapist. Most weeks, she can be found packing her portable equipment and hitting the road to treat the many people in rural and suburban Minnesota who either can’t find a dentist to treat them or can’t travel to an office to receive care.
Dental therapists are filling a gaping hole in American dental care, and Pew is working to increase their numbers around the country. States such as Minnesota have authorized the midlevel providers—akin to physician assistants—to provide routine prevention and treatment services, such as filling cavities and placing temporary crowns. Dental therapists can work in a range of settings—public clinics, community health centers, private practices, nursing homes, and schools. In addition to Minnesota, dental therapists have been authorized in Vermont, Maine, and in Native tribal communities in Alaska, Washington, and Oregon. But more than 53 million people in the United States still live in areas with dentist shortages. Access to care is also limited for the more than 50 million children and adults who rely on Medicaid. And only about one-third of U.S. dentists accept public insurance.
That’s why dental therapists like Jodi Becker are key. “I can see firsthand the difference we’re making for a lot of kids in Minnesota just by being able to provide care,” she says. No two working days are the same, and her schedule is ever-changing, but Becker says it’s all worth it.
Hauling dental equipment in the early morning hours is just the beginning of Jodi Becker’s 10-hour, or longer, day. Becker, an advanced dental therapist, must assemble a proper dental office before her first appointment, this time in a high school in Richfield, Minnesota, a suburb south of the Twin Cities. The room where she is to work is much smaller than she expected. But Becker and her dental assistant adjust. They have to—it’s 8 a.m. and the first patient is due in half an hour.
Becker and dental assistant Noel Jester set up their self-contained dental unit, which includes hoses and their own water in case a room has no taps. Each place they go, they assemble a full-scale dental operation, complete with a compressor that runs their air and water hand pieces and hoses, a reclining dentist’s chair, face masks, syringes, lights, sterilizer, bags of tools, and an X-ray machine. Today, the X-ray machine has to go across the hall in another room. After 30 minutes, they’re open for business.
Each dental exam includes Becker explaining to both parent and patient what the problem is and how she intends to fix it. Becker says that a description of treatment can be tricky because children, especially those who have never before been to a dentist, are often scared. “You have to speak in language that they understand, not dental speak. You can’t tell a child that they have an abscess and need an extraction,” she says. “Instead, I say: ‘Your tooth is very sick. I’m going to put on some sleepy juice to make it fall asleep.’”
A young patient doesn’t speak English, so Becker finds other ways to communicate, mainly through body language and lots of smiles. She knows the child has a terrible toothache, and the exam reveals teeth that need to be pulled. “When a child has a toothache, she may miss school and find it hard to concentrate. If the tooth is not treated, it can cause serious side effects,” says Becker, who saw 11 children ages 5 to 18 during one day at the high school. “I have the ability to treat those kids and keep them healthy so they can focus on school and just be a kid.” Though some children are scared of the bright lights, masks, and drills, this girl was calm throughout the visit.
Opening wide reveals decay; a tooth will have to go. Many of the people Becker sees each year—including a large number from Minnesota’s Hispanic and Somali immigrant communities—can’t afford basic dental hygiene. Each appointment ends with a lesson on proper care and brushing—and a chance to pick out a toothbrush. “The best part of being an advanced dental therapist is the ability to treat kids who might not otherwise receive care,” Becker says.
An X-ray shows baby teeth have deteriorated and will need to be pulled; the gray surrounding the broken teeth indicates severe infection. Becker will have to remove the teeth in pieces from the patient, a 6-year-old girl who had never been to a dentist. Becker says that many parents feel guilty once they realize that tooth decay can be caused by common kid foods, including fruit juice, fruit snacks, and crackers. “You have to explain these kinds of things without blaming,” Becker says.
Peering closely, Becker focuses on the work of restoring smiles. She spent 25 years as a dental hygienist before receiving a master’s degree in dental therapy from Metropolitan State University in St. Paul—then spent another year and a half adding “advanced” to her title by working with a dentist in a clinic and going through a credentialing process. As an advanced dental therapist, Becker not only administers the care, but can also make a diagnosis, which enables her to travel to various sites. She is supervised by a dentist, and the two keep in touch through telehealth technology. While some people maintain that only dentists should perform the services Becker can, the parents who saw her in Richfield disagree. “I feel that they are trained very well,” says one parent. “They make my daughter comfortable and help her feel better,” says another. “My kids and I feel safe.”
Photography by Ackerman + Gruber for The Pew Charitable Trusts