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Tip Sheets

Momentum grows to establish dental therapists; what about your state?

Mary Otto
Mary Otto

By Mary Otto

Mid-level dental providers are at work in countries from the United Kingdom to Malaysia. Here in the United States, advocates are pushing hard to get states to enact laws that would open the way for dental therapists to get care to people who might otherwise go without it.

Organized dental groups, including the American Dental Association have fought the model, contending that only dentists have the training to perform what are termed irreversible procedures such as drilling and extracting teeth.

Even so, dental therapists, who provide care under the general supervision of dentists, are now treating patients in tribal areas of Alaska as well as in poor communities in the state of Minnesota. Maine has also passed legislation and is moving forward with therapists.

Meanwhile, other states are considering the model.

Is yours one of them?

There is a lot going on in this area to write about, so this seems like a good time to offer a tip sheet that features some of the latest coverage and resources that might help you explore this topic.

For one thing, earlier this month the Commission on Dental Accreditation (CODA), the agency that accredits dental and dental-related education programs, adopted training standards for dental therapy education programs nationwide.

The measure, which came in the wake of urging by the Federal Trade Commission, opens the way for accredited dental institutions to train the auxiliaries.

The commission will not move forward with accrediting existing dental therapy programs until programs have been in operation for a sufficient time and can show evidence of community support and sustainability, the American Dental Association’s ADA News reported.

At the same time, the step was applauded by advocates for the model, including David Jordan, dental access project director for the nonprofit Community Catalyst, a group that has been working to build support for therapists in states across the country.

“Having dental therapists helping dentists improve access to care can’t come soon enough for the millions of people suffering because they cannot find affordable care in their community. And now, not only is implementation of standards inevitable, the practice of dental therapists is imminent,” wrote Jordan, in a blog post that links to background information on therapists from Community Catalyst.

In another post, Jordan writes, “As we start 2015, over half a dozen states are pursuing legislation to expand access to dental care by adding dental therapists to the dental team.” (See a map.)

Meanwhile, in Colorado, Medicaid expansion is highlighting a scarcity of dental providers, Phil Galewitz recently wrote for Kaiser Heath News.

While state Medicaid officials say they have enough dentists in most places to meet the needs, state efforts to pay dentists a bonus to take more patients have stalled, Galewitz reported.

“With little political support to increase reimbursements to dentists, advocates have looked at other ways to boost care,” he wrote. One of the alternatives that has been mentioned is mid-level providers, Galewitz noted. He added that dental therapist legislation is pending in several states, including South Carolina.

In New Mexico, a state legislator recently filed a bill for consideration that would establish a licensing and practicing framework for the midlevel oral health providers there.

And in Washington state, James Casey recently gave readers of the Peninsula Daily News a thorough update of the issue there. A bill, newly introduced by Rep Steve Tharinger would enable “a new generation of oral health care professionals” to provide care to isolated communities, he wrote.

Advocates explain the model as “dentistry’s version of medicines nurse practitioners – to expand care and reduce cost,” Casey noted. The workers, which, in Washington would be known as dental practitioners and dental hygiene practitioners, would be the state’s version of dental therapists. They have won support from groups including the Children’s Alliance, wrote Casey. But at the same time, he added “the idea faces resistance from the Washington State Dental Association” which has opposed it for more than a decade now.

Casey’s newspaper covers the North Olympic Peninsula, which, he reminded readers “includes one of Washington’s eight federally designated dental-health provider shortage areas.”

“We have an oral health access crisis on the North Olympic Peninsula,” a local health officer told him. “Dental therapists can help.”

Dental therapists have been working in Alaskan tribal lands since 2005. In 2009, Minnesota became the first state government to pass legislation authorizing the model. As of last year, more than 30 of the auxiliaries were serving patients in clinics, hospitals and dental offices in that state. A newly released report to the Minnesota legislature offered preliminary findings on their work.

The report found that the therapists “appear to be practicing safely, and clinics report improved quality and high patient satisfaction with dental therapist services.”

The clinics using the therapists are seeing more new patients and most of them are from underserved communities according to the assessment.

“Dental therapists have made it possible for clinics to decrease travel time and wait times for some patients, increasing access,” the report found.

Last year, the Pew Charitable Trusts, which supports the use of dental therapists, issued a report entitled Expanding the Dental Team which looked at therapists working in nonprofit settings in Minnesota and Alaska as well as a group of dental hygienists who are using telehealth technology to bring care to California schools. The report concluded that the alternative models are showing promise in getting cost-effective dental care to communities that lack it.

In 2012, the WK Kellogg Foundation, which also supports the model conducted a review of more than 1,100 reports related to dental therapists and their work in various countries and concluded the care offered by the auxiliaries was safe and effective.