Efforts to expand use of dental therapists making progress

Mary Otto

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.

Photo: Morgan Schwartz via Flickr

Connecticut has joined a growing list of states embracing dental providers as a way to expand access to care.

After a long debate, “a bill to allow the practice of dental therapy passed this year,” reported Ellen Andrews in an end-of-session summary of legislative action published by the nonprofit Connecticut Health Policy Project.

“Under the new law dental therapists must practice under the supervision of a dentist and only in public health settings,” she wrote.

Dental hygienists registered to practice in the state must receive 18 months of additional training to become dental therapists.

As in other states that have passed such legislation, backers of the model in Connecticut say that dental therapists will provide a cost-effective way to increase the availability of dental services among publicly-insured and uninsured patients, and in rural and minority communities where dentists are often scarce.

In coverage of a free dental clinic for the Hartford Courant earlier this year, Monica Jorge highlighted unmet oral health needs in the state.

“Within three hours of the doors opening Saturday morning, the Connecticut Mission of Mercy’s (CTMom) annual dental clinic had reached capacity,” she wrote. “More than 400 hopeful patients withstood the rain, some waiting in line overnight, for the chance at free cleanings, fillings, extractions and more at Windham Middle School in Willimantic.”

This year, New Mexico and Nevada have also passed legislation allowing mid-level dental providers. The states joined Minnesota, Vermont and Maine and Michigan, where laws allowing dental therapists are already in effect.

Dental therapists, who often are compared to nurse practitioners or physicians’ assistants in the medical world, receive technical training in a range of routine preventive and restorative procedures. They work as members of dentist-headed teams.

The model has been in long use in many countries around the world but has been strongly opposed by leading U.S. dental groups, including the American Dental Association. The groups contend that only dentists are qualified to perform irreversible procedures such as drilling and extracting teeth.

Fifteen years ago, Alaskan dental health aide therapists, the first dental therapists to work in the U.S., had to overcome legal challenges from national and state dental associations to provide care in their remote and long underserved tribal communities.

Since then, tribes in Washington and Oregon — and most recently in Idaho — have joined Alaska Natives in employing the model.

Last spring, Idaho state lawmakers passed legislation, co-sponsored by the Coeur d’Alene Tribe and strongly supported by other tribal groups, that authorized the state dental board to license dental therapists to practice in tribal communities.

And in June, seven Portland-area dental therapy students celebrated their graduation from the Anchorage-based Alaska Dental Therapy Education Program and prepared to return to tribal and urban Indian health programs in Washington, Oregon and Idaho.

“Each of the graduates has spent the past two years mastering the most routine and preventive dental procedures that make up the dental therapists’ scope, while each of their Tribes secured the ability to license then in a way that works for their clinics and the government,” the Northwest Portland Area Indian Health Board reported in a summer newsletter.

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