The Center Square: Texas dental board shows the dark side of licensure


Early in the pandemic, when just about everyone was looking for a way to get services from home, the Texas Board of Dental Examiners banned teledentistry. Why would the board ban people from getting dental advice remotely at a time when people most needed to stay at home?

One answer lies in the composition of the board: eight of its 11 members are practicing dental health professionals, and protectionism is one helluva drug.

Teledentistry greatly cuts costs for consumers. Thanks to smartphones and laptops, patients can quickly consult with dentists about broken teeth or sores, get a second opinion about treatment options, or ask questions about dental hygiene – all from the comfort of their couch or car. Teledentistry is not only cheaper and more convenient than in-person visits, but also a tool for combatting dentophobia (fear of the dentist). It is far more relaxing to consult with a dentist from your living room than it is to travel to a sterile office, surrounded by tools and equipment.

Another benefit of teledentistry is emergency room triage. A large number of people show up each year at the ER complaining of tooth pain, but only a small fraction of those toothaches are true medical emergencies – making dental pain one of the most common causes of avoidable emergency room visits. Teledentistry allows people to quickly speak to a dentist and avoid unnecessary trips to the ER.

But for the same reason it’s a boon to patients, teledentistry is a threat to traditional practitioners. Perhaps that explains why in the early stages of the pandemic, the Texas Board of Dental Examiners banned teledentistry. In its “COVID guidance” posted on its website, the board interpreted its record keeping requirements as somehow mandating a physical exam in every dentist-patient interaction. According to the board, dentists must perform a tactile oral exam and record the results with every consult, regardless of whether the dentist deems it necessary or appropriate. Because teledentists can’t reach through the phone and physically examine a patient, the board’s interpretation effectively outlaws remote care.

That’s a disaster for Texans, who are experiencing a dental care crisis. According to estimates from the National Center of Health Statistics, 40% of Texans don’t see a dentist even once per year — mostly due to concerns about costs.

It’s also a disaster for dentists who rely on teledentistry to making a living. Dr. Celeste Mohr, a longtime Texas-licensed dentist, doesn’t maintain a brick-and-mortar office. As a caregiver for two special needs sons, she works out of her South Carolina home and fits in telehealth appointments when she can find time. For years she provided remote care via, an internet platform for teledentistry services. But when the board banned teledentistry last March, it robbed thousands of Texans of teledentistry and deprived Dr. Mohr of her livelihood.

Unfortunately, this anti-competitive behavior is common when it comes to licensure boards – and especially dental boards. Studies demonstrate that while purporting to act in the public interest, licensure boards often wield their regulatory power to shut out competition, with little to no benefit to the public.

Dental boards are notoriously anti-competitive. The Federal Trade Commission once charged the South Carolina Board of Dentistry with illegally preventing dental hygienists from providing basic preventive care to underprivileged children for purely anti-competitive reasons. It also investigated a North Carolina dental board for attempting to shut out competition for teeth whitening services. And in California, Golden State Warriors star Draymond Green recently spoke out against legislative attempts, supported by the state dental board, to make it harder to get teledentistry services. He argued that the measure would give more profits to brick and mortar dentists while shutting out underserved communities from vital, lower-cost care.

In Texas, Dr. Mohr and TheTeleDentists are fighting back. They’ve filed a lawsuit arguing that the Board’s actions are unauthorized, unfair, and unconstitutional. If they win their case, TheTeleDentists and Dr. Mohr will not only take one step toward breaking the cartel, they’ll be able to continue filling the gaps in access to dental care.

This op-ed was originally published by The Center Square on March 31, 2021.