Midlevel dental providers gain support from national organization

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

With dental care in short supply and oral disease rates high on tribal lands, Native American leader Brian Cladoosby recently announced that his Swinomish Indian Tribal Community in Washington state will begin employing midlevel dental providers to offer preventive and restorative services to the tribe.

The Dental Health Aide Therapist (DHAT) model that the tribe has endorsed has been used in many parts of the world, including Alaskan tribal areas, as a way of expanding services in poor, isolated and minority communities.

Such midlevel dental provider models are controversial though. They have been strongly opposed by some dental organizations, including the powerful American Dental Association. The groups contend that only dentists have the training to drill, fill and extract teeth and that relying on auxiliaries would not be effective in reducing disease.

Now, however, a dental organization representing about 7,000 minority dentists, hygienists and dental assistants, has spoken up for midlevel providers.

Leaders of the National Dental Association (NDA) announced support for “emerging workforce models,” such as DHATs, at its annual convention in Chicago last month.

“We view access to dental care as a matter of social justice,” NDA President Carrie Brown said in a statement during the conference. “Despite advances in health care and technology, glaring disparities exist among underserved, vulnerable and diverse populations. We must explore all strategies to eliminate these disparities and improve oral health, including expanding the dental work force.”

During the conference, the group released a position paper outlining its findings on the workforce question. With an estimated 100 million Americans lacking dental coverage and millions living in roughly 4,800 federally designated dental health provider shortage areas, NDA leaders said additional providers are urgently needed.

“The current delivery system is outdated and no longer works for a third of the nation,” Brown said. “That means many people are constantly in significant pain. People are less productive, and in the most extreme cases lose their lives, because of basic lack of dental care.”

In spite of some progress in expanding care to children in recent years, racial disparities persist in oral health, national data show. Residents of poor and isolated communities, the uninsured and elderly also continue to face significant barriers to obtaining care.

It was the summer of 2000 when then-Surgeon General David Satcher warned of a “silent epidemic” of oral disease afflicting millions of Americans. In an interview this year marking the 15th anniversary of the publication of his landmark Oral Health in America report, Satcher noted that minority people continue to bear a disproportionate burden of oral disease.

Satcher voiced his support for employing midlevel dental providers to expand oral health services in much the same way that nurse practitioners are now being used to expand access to medical care.

“Midlevel providers are important because they offer a service that is needed … services that are otherwise unavailable, he said.

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