Conference explores use of dental therapists to expand access to care

In November’s Health Affairs, Conan Murat explored his experiences as a dental health aide therapist (DHAT), providing care to his fellow native Alaskans in remote villages on the Yukon-Kuskokwim Delta.

Recently, Murat was in Washington, D.C., to join a crowd of oral health advocates who say technically trained dental providers could help answer the need for care in many other poor and isolated communities across the United States.

“This whole movement thing seems like it’s really starting to get going,” noted Murat, looking out over the crowd at the Dental Therapist Conference Convening, hosted by Community Catalyst, a national nonprofit promoting grassroots efforts to change the health care system.

Organized dental groups have fought hard against the therapist model in recent years, saying no one but dentists should be allowed to drill cavities and extract teeth.

Advocates, backed by nonprofits including Community Catalyst, the W.K. Kellogg Foundation and the Pew Charitable Trusts continue to work to expand the model. Discussions about mid-level providers are now going on in more than 20 states, according to David Jordan, who directs the Community Catalyst dental access project.

A lawsuit filed by the American Dental Association and the Alaska Dental Society failed to stop Murat and other DHATs from going to work on Alaska’s tribal lands in 2005.

After completing two years of training and serving three-to-six month preceptorships, DHATS travel to bush and island villages to offer a range of services including exams, screenings, X-rays, fillings, sealants and extractions, consulting with supervising dentists via telephone and computer.

Now 29 certified DHATs are at work and 11 more are in training, serving far-flung communities with a total population of roughly 40,000.

“Nobody has died yet,” reported Murat with a smile.

He said he believed such auxiliaries “would work down here in the lower 48 without a problem.”

The state of Minnesota is also giving the dental therapist model a try, as Lorna Benson, of Minnesota Public Radio News, reported recently.

“Over the past two years, universities have trained, and the state has licensed, 28 dental therapists, practitioners who perform many basic dental procedures that previously only a dentist would do,” Benson noted in her story.

Benson caught up with therapist Christy Jo Fogarty, who was one of the first therapists to be licensed in the state, as well as the first to be certified as an advanced dental therapist, which as Benson explained, is an even higher level of training that allows her to work in remote locations.

“I work under general supervision, which means a dentist does not need to be on site with me,” she said. “And I can do anything within my scope of practice.”

“I can do any kind of fillings – that’s on children and adults; white fillings, silver fillings. I can do stainless steel crowns – that’s both on children and adults. I can do extractions of baby teeth.”

At the Community Catalyst conference, Sarah Wovcha, executive director of the nonprofit Children’s Dental Services (CDS) said the work of Fogarty and the other therapists is making a difference.

CDS operates roughly 600 clinics across the state, serving 35,000 patients over the past year, the vast majority of them poor children and pregnant women. In remote rural areas, care is provided with the help of portable equipment set up in schools, Head Start centers, churches and community buildings.

Wovcha said her organization had looked at other ways of expanding dental care to people who needed it, including the use of foreign-trained dentists but “nothing was really working.

“What we wanted was something that was community-based … and that would allow dentists to practice to the top of their license. It was really natural that we would come to dental therapy as a solution.”

In 2009, CDS helped craft the legislation that established the licensing process for dental therapists in the state. Among the therapists the organization has hired is a Hmong-speaker who is particularly skilled at providing care to members of that ethnic community, Wovcha said.

“The entire dental team is more productive with the addition of dental therapists,” said Wovcha. “The quality of care has been excellent. We have had no patient complaints. Overall our clinic capacity has expanded.”

A report issued earlier this year by Community Catalyst, the Economic Viability of Dental Therapists, was similarly hopeful.

But the American Dental Association and other dental groups continue to challenge the efforts. And the ADA has its own plan to use dentists to reach underserved populations.

What is going on in your state?


One thought on “Conference explores use of dental therapists to expand access to care

  1. Avatar photoDave Mittman, PA

    While Dental Therapists seem great, educate them AT A VERY HIGH LEVEL and let them do things with or without dentist’s supervision after a number of years of practice on their own licenses. PAs and NPs have shown they can provide primary care and do to millions each day as well as specialty care. What we have seen is that the majority of these clinicians were hired by physicians and besides increasing the physician’s income by hundreds of thousands of dollars the necessity for “supervision” has made it very hard for EXPERIENCED PAs and NPs to get to the areas of need. This was a flaw in the thinking of both professions but not one that could have been expected. While physicians did see them as colleagues, the physician organizations did not (see recent pronouncements) and lobby extensively against either group being able to do anything without physician collaboration. While soon physicians will all be employees and very few will be opening their own practices in primary care (which will surely change the above equation) dentists will not be. They are not getting absorbed by ACOs and large hospital groups. All we may do with the dental therapists is repeat the same mistakes we made with PAs and NPs.
    It bears being closely looked at.

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