I think it's great for states to experiment, and I'm looking forward to seeing how things change. On the surface it seems like a no-brainer: quality of care isn't the issue; no care is the issue -- so let's get more people out there with less expensive training.
But . . . (and here begins the musings of a pre-dental neophyte . . .)
While I think it will find *some* traction, I agree with DrJeff that they still face the same issues, same overhead, same market forces, and same paths to increasing profitability. Will they be able to afford their own practices? Doesn't seem like it. But maybe I'm wrong; maybe they'll find a middle ground that keeps them afloat and still convinces people to skip the DDS, but that seems like an awfully fine line.
Another path for dental therapists: they're just going to be a new kind of employee for the dentists. Yeah, let's have the gov't subsidize a new class of employees whose potential employers are not currently training for themselves. Sounds like a recipe for success.
So, it's going to be difficult for them to own practices (unless they have an exceptional value-add personality), and it's going to be difficult for them to be employed by dentists and make anymore than they would as a hygienist or assistant. Again, they may find some success in those areas, but they aren't silver bullets.
Another route is for dental therapists to be the providers that interface more with managed care because they have less debt-righteousness and less negotiating power. But if that becomes their lifeline they will inevitably gain reputations as dental mills (negating their value-add personality in the process).
I think the best prospect for dental therapists is like the situation they've grown out of in Alaska: rural settings. It will be less expensive for the gov't to convince them to go rural compared to a DDS. And if the training for DT's is state-funded and controlled, they can conscript the students into longer obligations in certain areas. That would still create potential headaches and waste depending on how much the state controlled things, though.
The gov't, for better or for worse, could force some changes that may satisfy some pockets of people (like the Comprehensive Dental Reform Act) -- but I don't see the political climate for that happening anytime soon. ObamaCare is going to be politically toxic for a while. China will surpass the US in GDP in the next several years, spending is up, revenues are down, we're stuck in the Middle East, we keep putting off more permanent budget agreements . . . if by some miracle people calm down enough from those things, Social Security and Medicare insolvency will be on the table as 2030 approaches. Politicians aren't going to risk their political capital on dentistry any more than they'll start brushing and flossing every night. But maybe I'm wrong again.
For the time being, I think corporate dental mills, for profit or not for profit, will be the only good market force from the perspective of underserved populations. Maybe the federal gov't will pass some small incentives for their business models. Not much of a solution, but it's the only thing I really see on the horizon besides a handful of dental therapists in rural settings. There's not going to be a "solution" to the dental crisis, whether you want to call it a shortage, blame a lack of affordable care, or blame people for not brushing and flossing. Care is always going to be finite compared to the demand, and some people will always be able to afford better care than someone else. Dental therapists can fill a gap in the cost/quality continuum, but that only goes so far. The only place dental therapists can really keep practices afloat, in my opinion, will be the places the DDS folks won't go for whatever reason. And the therapists won't want to work there for the same reasons the DDS won't.