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North Dakota lawmakers on Tuesday shot down a bill that would have allowed dental therapists to practice in the state.

A dental therapist is a mid-level provider comparable to nurse practitioners and physician assistants. House Bill 1426, introduced by Rep. Bill Devlin, R-Finley, would allow dentists to hire dental therapists in certain health care settings, including nonprofit dental practices and Indian Health Service clinics.

The bill failed by a margin of 31-62.

Eleven lawmakers sponsored the bill, as well as several organizations, including North Dakotans for Dental Access, a group of 24 organizations and tribes in the state. Proponents believe the bill would expand access to care for children, the elderly, Native Americans and low-income families, including those on Medicaid.

Devlin also sponsored dental therapy legislation in 2017, which failed by a vote of 32-59. In 2015, another similar bill failed to pass by a vote of 6-40.

Despite Devlin's bill this session getting a "do pass" recommendation from the House Human Services Committee, and several lawmakers on Tuesday testifying in support of the bill, it was unable to garner enough support. Opponents cite patient safety concerns and the ability to provide quality care.

Rep. Kathy Skroch, R-Lidgerwood, said on the House floor that there have been "several examples of serious deficiencies in the care provided" in dental therapy programs in other states.

"Dental therapists may help marginalized persons gain access to dental care, but at what cost? Increased access does not necessarily equal quality care," Skroch said.

Skroch also said she and other members of the House Human Services Committee heard from a dentist who questioned  "outside interests with a national agenda" behind the bill.

Devlin, however, said there are some practicing dentists in North Dakota who support it.

"In the (House Human Services Committee), we had dentists in both Fargo and Bismarck and elsewhere that have said they would hire dental therapists in their limited practices. Why in the world would we as a state Legislature prevent that from happening?" he said.

Emily Mallory, president of the state Dental Hygienists Association and spokeswoman for the North Dakotans for Dental Access, said she was disappointed the bill didn't pass.

"The level of training that these dental therapists do have, I think, needs to be witnessed by more of our legislators to get them to understand that they are highly trained and that this is not inadequate or harmful or dangerous care for patients," said Mallory, who is also a dental hygienist in Grand Forks.

Mallory said she's not aware of any issues with the care dental therapists provide in Minnesota, which, in 2009, became the first state government in the United States to authorize the licensing of dental therapists.

Mallory said she's accepted that dental therapy legislation may take time to pass, as legislation to allow nurse practitioners and physician assistance took time before it moved forward.

"The access to care is going to continue to be an issue," she said. "We will continue to push for this and support it and rewrite the bill if we have to."

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(Reach Blair Emerson at 701-250-8251 or Blair.Emerson@bismarcktribune.com)

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Education and Health Reporter