The first of nine dental therapist graduates of the University of Minnesota School of Dentistry’s dental therapy program are now filling cavities, pulling teeth and placing crowns at dental clinics in Minnesota.
Minnesota and Alaska are currently the only states where dental therapists are licensed to practice under the general direction of a dentist.
A shortage of dentists prompted Minnesota to license dental therapists to meet the growing demand for dental care, especially in rural areas. Dental therapists cover the gap between the dental hygienist and the dentist, much like a nurse practitioner does in a medical office.
However, Minnesota dental therapists are only allowed to work in dental practices where at least 50% of the dental patients are low-income.
The first Alaskan dental therapists began working there in 2005; the program was created via congressional board to improve access to dental care in rural Alaska. As no American dental school offered dental therapist credentials at that time, the very first dental therapists to practice in the U.S. trained for two years in New Zealand.
Since then, states who report a shortage of dentists have been pushing legislation for dental therapists. Vermont, Kansas, New Mexico, Ohio, and Washington are the latest states to introduce legislation to allow dental therapists to begin practicing in their state. California, New Hampshire, Maine, and Kansas are considering legislation to introduce the dental therapist model.
A report published in January in the peer-reviewed Journal of the American Dental Association details a nearly year-long systematic review of scientific papers about the use of mid-level dental providers to perform such irreversible surgical procedures as restorations and extractions.
The systematic review sought to answer this question: “In populations where non-dentists conduct diagnostic, treatment planning, and/or irreversible surgical dental procedures, is there a change in disease increment, untreated dental disease and/or cost-effectiveness of dental care?” (Source ADA)
According to J. Timothy Wright, DDS, MS, the report’s principal author, the analysis showed that surgical treatment by mid-level providers does not result in reduced rates of dental caries in the population. Oral health disparities exist regardless of the provider workforce model.
Caries rates do decline over time in populations treated by dental therapists, as measured by DMFT scores. And similar decreases have occurred in countries that do not employ dental therapists, further fueling the dental therapist controversy whether mid-level providers are truly needed. (Source ADA)
The Dental Crisis in America report by the U.S. Senate found that approximately 130 million Americans don’t have any dental insurance, more than 47 million people in the U.S. live in places where it is difficult to access dental care, and that there were over 830,000 visits to emergency rooms across the country for preventable dental conditions in 2009 – a 16% increase since 2006.
The dental therapist model is being touted as a possible solution for the under-served in the dental population.
A 2012 The Wealthy Dentist survey of dentists showed 53% believe that alternative dental providers are a bad idea and 59% of the dentists who responded to the survey challenge thought that there should be fewer alternative providers than there already are.
Dentists questioned whether mid-level oral health providers can sustain the same standard of care as a licensed dentist.
As one California dentist put it, “I went to college and dental school for eight years in order to receive the education necessary to safely perform irreversible procedures upon the human body. It is clear that this level of education cannot be achieved in two or three years. Isn’t it interesting that the proponents of the low-level provider scheme intend that it be used for OTHER people’s healthcare, and not for their own?”
What are your thoughts on this dental therapist trend? Do you think that it is a good idea?
For more on this story see: Coming Soon To Massachusetts’ Dental Offices—Maybe