Dental Therapists: A Step in the Right Direction or a Step Too Far?

The US Surgeon General’s 2000 Report “On Oral Health” was a wake-up call for America. Over one half of children are suffering from tooth decay, and twenty-two percent of adults have reported experiencing oral-facial pain in the last six months. However, the most staggering statistic is the inequity within oral health-care; for every one American without medical insurance, there are three without dental insurance.1

These bleak findings inspired a wave of innovative ways to provide quality oral health, especially to disadvantaged Americans. For example, dental therapists are a mid-level clinical profession between dentists and hygienists that would be licensed to provide cleanings, simple extractions, fillings and some pulpal treatments. They must complete three years of training after graduating high school, and each of their completed procedures must be reviewed by a dentist. However, they do not have to be under direct, on-site supervision by a dentist.2

Dental therapists are not a new idea. During World War I, New Zealand’s government discovered the poor oral health of recruits and in 1923 started the world’s first dental therapist program.3 Today, the program reaches 97% of all school children, and multiple studies have shown that it produces patient satisfaction, and quality of care at least comparable, if not better than, traditional dental practices.4,5,6,7 This is a major public health achievement.

The success of dental therapists in New Zealand fueled their spread around the world; however, they were frequently met with controversy. In 2003 the Indian Health Service sponsored several Alaskans to train in New Zealand to become dental therapists.8 When they returned in 2005, their scope of practice was limited to Alaskan indigenous populations. Studies of their work showed the increased access, patient satisfaction and overall oral health that was originally found in New Zealand9. The American Public Health Association (APHA) and the American Association of Public Health Dentists (AAPHD) endorsed dental therapists once these studies were published.10,11

The American Dental Association (ADA) has a different perspective. Their position is that a non-dentist should not perform irreversible dental procedures such as fillings, extractions and pulpal treatments. There is no such thing as a simple dental procedure, and there is a chance of life-threatening complications inherent in all irreversible dental treatments. Furthermore, dental therapists would create a more insidious kind of inequality in which the poor would be forced into second rate dental care provided by non-dentists.12 These arguments were the centerpiece of an unsuccessful 2006 lawsuit against Alaskan dental therapists alleging that they violated licensing requirements.

The ADA’s criticisms highlight crucial problems, but the track record of success abroad and the positive initial findings have earned dental therapists a fighting chance. Currently the Kellogg Foundation is supporting pilot programs to bring dental therapists to rural and underserved urban areas in Connecticut, California, Maine and New Hampshire13. This limited expansion will allow a more accurate picture of the risk and possibilities of dental therapy without exposing target populations to undue risk. It should be supported with cautious optimism by the dental community and the American public rather than being faced with the legal actions that mired previous efforts.

References

  1. U.S. Department of Health and Human Services. Oral health in America: a report of the surgeon general. Rockville, Maryland: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000. 308.
  2. Nash, David A., and Ron J. Nagel. “A Brief History and Current Status of a Dental Therapy Initiative in the United States.” Journal Of Dental Education 69, no. 8 (2004): 857-59.
  3. Brooking TWH. A history of dentistry in New Zealand. Dunedin, New Zealand: New Zealand Dental Association, 1980.
  4. New Zealand. Ministry Of Health. Oral Health. Our Oral Health: Key Findings of the 2009 New Zealand Oral Health Survey. By Robyn Haisman, Kylie Mason, and Erin Holmes. Wellington, N.Z.: Ministry of Health, 2010.
  5. Fulton, JT. Experiment in dental care: results of New Zealand’s use of school
  6. dental nurses. Geneva, Switzerland: World Health Organization, 1951.
  7. Dyer, Ta, and Pg Robinson. “Public Awareness and Social Acceptability of Dental Therapists.” International Journal of Dental Hygiene 7, no. 2 (2009): 108-14.
  8. Ryge G, Snyder M. Evaluating the quality of dental restorations. J Amer Dent Assoc 87 (1973): 369-377.
  9. Nash, David A., and Ron J. Nagel. “A Brief History and Current Status of a Dental Therapy Initiative in the United States.” Journal Of Dental Education 69, no. 8 (2004): 857-59.
  10. Allukian, M., M. E. Bird, and C. A. Evans. “Apha Presidents Support Dental Therapists.”American Journal of Public Health 95, no. 11 (2005): 1880-881.
  11. The American Assoc. of Public Health Dentistry’s Panel Report of the Educational Plan for Two-Year Dental Therapist Programs. Rep. Vol. 44. 2011.
  12. Marty Jablow DMD – Dental News and Technology.” ADA Comment On AAPHD Dental Therapist Curriculum Development. American Dental Association. Last modified June 29, 2011.
  13. Dental Therapy.” Dental Therapy Today. W. K. Kellogg Foundation. Accessed March 2, 2012.
  14. Image credit (Creative Commons): Harrison, Eddie. “Dental Therapist.” Flickr. Last modified September 6, 2010.

Petar Georgiev is a Georgetown University undergraduate student whose principal interests are global public health and dentistry. Follow The Triple Helix Online on Twitter and join us on Facebook.