By Mary Otto
From its beginnings in New Zealand, the dental therapist model has evolved over nearly a century and is now being used in several countries around the world as a cost-efficient way of way of expanding access to dental care, particularly to underserved populations.
Still, dental therapists are relatively new to the United States.
Alaska’s tribal communities began employing a variation on the model, called Dental Health Aide Therapists, or DHATs more than a decade ago.
The workers are now being employed in tribal clinics in Washington State and Oregon as well.
This first-person account, written by a dentist working with dental therapists in tribal clinics, offers additional insights into Alaska’s program.
In 2009, Minnesota became the first state government to approve the licensing of its variation on the dental therapist model.
Vermont and Maine have also adopted the model; unlike Minnesota, those states have not yet put dental therapists to work.
A timeline developed by the Pew Charitable Trusts offers a useful reference for the evolution of dental therapist efforts in the US.
Studies in Alaska and Minnesota indicate that dental therapists are helping to expand access to care.
Despite the growth, dental groups have continued to resist the midlevel providers, as Will Drabold explained in this Q and A on his coverage of the successful effort to bring dental therapists to tribal clinics in Washington State for the Seattle Times.
Efforts to promote the model often unfold over multiple legislative sessions, as in Massachusetts, where long-debated legislation that would allow dental therapists to work in the state took a recent step forward.
“Lawmakers believe they have landed a deal to create a new mid-level dental therapist profession that could expand access to oral health care by increasing the number of providers and requiring them to serve harder-to-reach populations,” State House News Service reporter Matt Murphy told listeners in a story that aired on Boston-based WBUR radio on April 25.
“The compromise struck between dentists, hygienists, health care advocates and lawmakers could resolve a long-simmering policy fight over how to expand access to oral health care without jeopardizing the quality of care or threatening the dentistry profession, which requires years of education and training.”
Under the compromise bill developed by the legislature’s Joint Committee on Public Health, dental therapists in the state would be allowed to provide some services without a dentist onsite but would be restricted to working under a dentist’s direct supervision when performing some procedures including extractions or placing crowns, Murphy reported.
The Massachusetts legislation has been strongly supported by state Senate President Harriette Chandler. In a blog by health writer Wendell Potter, Chandler explained why she has continued to press to bring dental therapists to her state.
“It cannot be stated often enough: too many people are deprived of dental care,” Chandler noted. “We have a coalition that agrees this legislation is a solution – and after nearly four years of debate, it’s time for this solution to become law.”
In the blog, written earlier this year, Potter predicted that momentum for dental therapist legislation would continue to build.
“More states than ever before are now actively exploring authorizing dental therapy,” noted Potter. In addition to Arizona and Massachusetts, Potter reported that Florida, Hawaii, Kansas, Maryland, Michigan, New Mexico, North Dakota, Ohio and Wisconsin were in the process of exploring the use of dental therapists.
The Pew Charitable Trusts, which supports the model, keeps its own tally (as of January) with additional states where dental therapists have been discussed.
