Dana Obey works with a dental patient.
This story is part of a series on the challenges and solutions related to oral health in Michigan, Indiana, and Ohio. It is made possible with funding support from the Delta Dental Foundation.
Michigan is introducing a new role to address the shortage of oral health practitioners, and for students like Jamie Toney, Vanessa Cushman, and Dana Obey, the effort is as personal as it is practical.
On Sept. 2, Obey became the first licensed dental therapist in Michigan. Dental therapy is a licensed profession, similar to nurse practitioners or physician assistants in medicine, focusing on essential services such as fillings, basic extractions, preventive care, and patient education.
The role has the potential to expand care in places with persistent provider shortages.
“The intent of dental therapy is to close care gaps in regions where dental professionals are scarce and provide the most needed care,” says Misty Davis, a dental hygienist and oral health integration manager with the Michigan Primary Care Association.
For the past five years, Davis has overseen the implementation of the model, which originated in Alaska in 2003 and has since expanded.
Michigan lawmakers approved dental therapy in 2018, allowing the establishment of administrative processes required to eventually award licenses. Davis says the state now has that path to licensure and Medicaid reimbursement, and Ferris State University is developing an education program.
Meanwhile, three people from Michigan have studied or are studying dental therapy at Skagit Valley College in Washington state so they can serve communities identified as dental health professional shortage areas: Toney, in metro Detroit; Cushman, in Cadillac; and Obey, in the Upper Peninsula. Obey has become licensed and started practicing.
“All three are committed to serving their own communities and improving access to care,” Davis says.
Sacrificing for studies
Toney is finishing the dental therapy program in Washington and starting her preceptorship, a 500-hour residency-like training, at the organization where she once worked as operations manager.
Jamie Toney
If not for a scholarship and the support of her family, Toney says, she wouldn’t have been able to complete the program. The scholarship is funded by the Michigan Primary Care Association, Delta Dental Foundation, and the Michigan Health Endowment Fund.
“It covered essentials, so I didn’t have to worry about how I was going to eat or pay for basic needs,” says Toney, who wrote an op-ed about the need for diversity and disparity in the dental field for the Detroit News.
Her family also made sacrifices to support her through the program, as she was away from them during her studies.
Now back in Michigan, Toney says the preceptorship will let her begin making a difference right away.
“Dental therapists collaborate as a team to bridge the health care gap,” she says. “I can perform routine restorative procedures like fillings, which allows the dentist to focus on more complex cases.”
Bringing skills back to community
Cushman’s interest in oral health started with positive childhood visits. After completing a dental assisting program in 2008, she joined My Community Dental Centers in Cadillac and has worked there for 16 years. Demand overwhelms capacity, she says.
“If you were to call for an appointment, you’re probably out six months to even be initially seen,” she says. “Even with two dentists and two hygienists, it’s just too much.”
She considered attending dental school, but the cost was overwhelming. The average cost of student debt for dental school graduates in 2024 was $312,700, according to the American Dental Education Association.
“I always thought if there were a middle provider like a PA in the physician world, that would be perfect,” Cushman says. “Then I heard about dental therapy in Alaska and Minnesota, and a light bulb went off.”
Vanessa Cushman
Cushman decided to enroll at Skagit Valley rather than wait for a Michigan program to launch.
“It was a huge sacrifice,” she says. “We go year-round with short breaks. I’m still funding about $50,000 myself, but three years instead of eight years is a lot better.”
She plans to return to Cadillac and My Community Dental Centers next year for the 500-hour preceptorship.
“We’ll take the typical fillings so dentists can focus on extractions, implants, and root canals,” Cushman says. “The goal is to improve oral health by getting patients seen more often and giving more one-on-one support.”
Shaped by experiences
Obey has worked as a dental assistant for 16 years.
“I just kept seeing the doctors needed more hands, more people, or to delegate duties,” she says. “There wasn’t really a position for that. When I learned about dental therapy, it sounded like what I wanted to do.”
Obey then joined the program in Washington.
“I had to completely relocate from Michigan because everything is hands-on,” she says. “It was a three-year commitment.”
Finances were the hardest part.
“I didn’t have a scholarship when I left. I really had no plan,” Obey says. “I didn’t understand how expensive the schooling was or how limited funding was out of state. Because of that, I received other scholarships to help with the cost.”
A member of the Sault Ste. Marie Tribe of Chippewa Indians, Obey says her upbringing shapes her focus on prevention.
“My parents believed you only go to the doctor or dentist when you have a problem,” she says. “The idea of prevention wasn’t something they learned. I never went to the dentist as a kid unless I had pain.”
Misty Davis
Transitioning from assistant to provider changes what she can deliver.
“I’m giving anesthetic and making sure patients are comfortable,” Obey says. “I can do minimally invasive procedures, fillings on teeth that need it. We use a lot of glass ionomer, some extractions, sealants, and prevention. Those are all things I wasn’t able to do before.”
She says trauma-informed, relationship-based care is central to her training.
“There’s a different approach,” Obey says. “We offer minimally invasive options like silver diamine fluoride and focus on behavior management, building rapport so patients are comfortable enough for treatment. We’re breaking the cycle of fear, which is common in many tribal communities and low-income families.”
Relocating meant leaving her children, ages 17, 14, and 7-year-old twins, with family in Michigan.
“Everybody sacrificed, but they all knew how driven I was,” Obey says. “Now they want to go to college. They see this is how it can be done.”
Obey hopes a Michigan-based program will reduce those sacrifices for others.
“It would open opportunities for families,” she says. “People wouldn’t have to leave home to pursue this role.”
Obey recently accepted a position in the Upper Peninsula, where she is about to begin her preceptorship.
“I’m really excited, because not only am I able to help tribal members, but I’m also able to help other families with limited access,” she says. “They participate with Medicaid and Medicare and have different opportunities for everybody to receive care.”
Easier route to community care
Davis says dental therapy offers a practical pathway for primary care dentistry: a shorter, more affordable education; a focused scope under dentist supervision; and the ability to deploy where patients wait the longest.
“Not everybody can afford dental school and graduate with substantial debt,” she says. “Dental therapy creates an accessible pathway for people who want to focus on community-based care.”
Students say the structure delivers immediate impact. Toney points out that her preceptorship will be at the community-based health center she helped operate. Cushman outlines how same-day preventive plus restorative work can reduce backlogs. Obey describes provider-level prevention, anesthesia, and minimally invasive care that frees dentists to handle more complex procedures.
All three emphasize education and trust.
“Even when I’m cleaning teeth or reviewing X-rays, I’m talking with patients about their diet and showing them what I see,” Toney says.
Cushman is just as passionate.
“Public health isn’t about the dollars; you have to have passion and care for people,” Obey says. “I tell patients I want to see you even if you don’t have a toothache. Let’s talk about your teeth and get you comfortable coming in.”
Obey says the rise of her profession reflects a larger shift.
“We’re making strides in recognizing the mouth is part of the body,” she says. “Dental therapy isn’t just a career ladder. It’s a profession designed to improve access and equity.”
Toney is excited about the momentum the three women will bring to their new roles in Michigan.
“The doctors I used to work with are excited to collaborate. It feels great to return to a place that welcomes my new role.”
Obey sees the benefits in community terms.
“It wasn’t easy, but it was absolutely worth it,” she says. “It’s going to make a huge impact on this community and many more as we have more graduates coming.”
Cushman is looking forward to the growth of the new profession.
“I can’t wait to see dental therapy spread through the country,” she says. “I have a great feeling about it.”
