According to the 2017 Massachusetts State Health Assessment: “There are notable racial/ethnic disparities in oral health care utilization for children, adults, and pregnant women. Insurance status is often a barrier to accessing oral health care, along with lack of adequate transportation to attend an appointment. Improving access to oral health services and preventive measures, such as community water fluoridation, is important to preventing and treating oral diseases.” 

The introduction of a new class of midlevel dental professionals is one strategy for increasing access to care in underserved areas. While multiple bills were filed in the 2017-2018 legislative session concerning midlevel providers, An Act to Improve Oral Health for All Massachusetts Residents was introduced in April 2018 as consensus legislation following an agreement by leaders of the House of Representatives and Senate, as well as key advocates and stakeholders.

In the 2017-2018 legislative session, the Massachusetts State Legislature’s Joint Committee on Public Health was referred multiple bills seeking to authorize a midlevel oral health provider. The MDS advocated for An Act Relative to Graduate Education for Certain Professionals, legislation to create a public health dental practitioner position as part of a multi-faceted, comprehensive plan for improving access to oral health care. Under the MDS-backed legislation, this new practitioner would be directly supervised by a dentist and limited to providing care in designated dental shortage areas or at federally designated health centers, following two years of post-baccalaureate education. This new class of providers also would be required to meet educational standards comparable to similar practitioners in primary care, such as nurse practitioners and physician assistants.

An Act Relative to Graduate Education for Certain Professionals offered a comprehensive approach to improved access and oral health care for underserved populations, including:

• Increased advocacy for and awareness of fluoridated water in Massachusetts communities
• Improved integration of dental hygiene into the state’s Department of Public Health
• Mandatory dental screenings of children prior to entering kindergarten
• Introduction of a new class of "midlevel" dental practitioners

Legislative Agreement

Through the introduction of legislation, the MDS had the opportunity to work with leadership of the state’s House of Representatives and Senate, as well as key advocates and stakeholders, to reach an agreement on legislation that would best serve Massachusetts and serve as a model for the rest of the country.

In April 2018 a legislative agreement was reached with leadership of the state’s House of Representatives and Senate, as well as key advocates and stakeholders, on new bill language that would create a new class of dental therapist professionals. Under the terms of the agreement, the MDS succeeded in securing commonsense requirements that protect patient safety by ensuring master’s level training of licensed therapists, supervision by licensed dentists, and additional resources aimed at increasing access to care for underserved populations. The new legislation was introduced as An Act to Improve Oral Health for All Massachusetts Residents.

The Legislature concluded its formal session on July 31, 2018, before the comprehensive oral health legislation moved through the entire legislative process. The legislation was re-introduced when a new session convened in January 2019.