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KANSAS CITY, Kansas (Reuters) - In a debate every parent of a six-year-old can relate to, the Kansas legislature is deciding who can pull baby teeth.
The problem is that rural areas in the United States have a shortage of dentists, and one proposed solution is to license "dental practitioners" who could do things such as fill cavities and pull baby teeth.
But the lobbying group representing dentists in Kansas wants no part of non-dentists messing with people's mouths, saying that only a person with a four-year graduate degree and additional training should be allowed to extract teeth.
"When a dentist cuts into a tooth, that's surgery, even though the public may not think of it that way," said Kansas Dental Association Executive Director Kevin Robertson. Tooth extractions, even of loose primary teeth in children, can get complicated, he said.
About half the 105 counties in Kansas have two or fewer dentists and there are 15 counties with no dentist at all, according to a state report.
Rural counties across the United States struggle to attract dentists as dental school graduates tend to favor the higher pay and amenities of larger communities.
The United States has been slow to adopt dental practitioners, with only Minnesota and Alaska allowing them, although 15 states are considering the idea. A recent study by the W. K. Kellogg Foundation, a Michigan-based child healthcare advocacy group, found that dental practitioners permitted in 54 countries provide safe and effective dental care to children.
In Kansas, the debate has landed in the state legislature.
One group that advocates child healthcare is pushing legislation to allow practitioners to fill teeth and remove baby teeth, along with teeth cleaning that dental hygienists already provide. The bill would require practitioners to spend their first 500 hours of practice under supervision of a dentist. Once on their own, they would still have to refer non-routine care to dentists.
"We are seeing a lot of people going without care or having to wait a tremendous amount of time to get basic dental care," said Suzanne Wikle, director of policy and research for the Kansas Action for Children. "Others have to travel great distances to get that care."
But Robertson said practitioners could further reduce the number of dentists in rural areas. Dentists would be less likely to move to an area where they see that dental practitioners are already in business, he said.
The dental association is pushing legislation in Kansas that would expand the services of hygienists to include temporary fillings and adjusting dentures. On the subject of baby teeth, the dentist lobby would allow extractions only if the teeth are very loose. The bill has passed the state House and is awaiting approval in the Senate.
The dental association proposal falls far short of meeting the needs of patients but is "a very small step in the right direction," said Wikle. Her group has vowed to return next year to again seek a broader bill that permits dental practitioners.
Editing by Greg McCune and Eric Walsh