dental therapist

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.

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  • Thedentalmaven

    If the New Zealand model of the Dental Therapist has been such a resounding success, why does New Zealand have a worse dental access problem than the US?

  • Wake up

    The same success has been achieved in Canada, In Europe and in Some US states where the dental monopoly over the oral hygiene industry has been broken. Give people the choice, the results will speak on their own.
    This is one instance where free enterprise can benefit health.

  • Concerned Dentist

    Follow the money trail for dentists and you will find that profiting from all oral care treatments is the priority for them. Public access, safety and other contortionist arguments in their monopolistic pursuits rank low in dentist set of priorities. Follow the money trail and you will find true motivation. Controlling other health care professionals is much more profitable than allowing them to practice independently and the ratio is exactly reversed if you look at it from the public’s perspective. The more control by one group, the less competition, the less quality, the less health, the higher the cost of healthcare. Follow the money trail.Period. Paragraph.

    The rate of dental caries and the adoption of healthy oral care habits has sky-rocketed since the creation of the professions of dental hygiene and dental therapy about 100 years ago. Its been a great improvement over the times where most 40 year olds no longer had teeth. Despite the improvements, we have been improving way too slowly since we are still operating in an environment where fixing teeth is more profitable than preventing the need to fix teeth for dentists. Give an economic incentive to professionals that are focused on preventing the need to fix teeth, solve the conflict of interests and watch the results confirm the easily understood intuitive appeal and speak for themselves.

    This is a no brainer, more freedom from a monopoly, no investment by government, no increase in health spending, more access to the public, more health, less disease….Where is the risk? It has been tested for the past 100 years, what’s the delay other than dentists early retirement age?

  • Concerned Dentist

    Correction to second paragraph. Rate of dental cavities has decreased.

  • Concerned Dentist

    Because they started off a lot lower on the scale of severity. Their improvement was much greater than in the US over similar time frames.
    Come on, as a fellow dentist, its time to focus on prevention, there is enough business for dental hygiene and for dentistry. Allowing dental hygienists to do their job for prevention rather than sell cosmetic dentistry for their boss is long overdue.

  • Druberto

    Paramedics save lives we do so as by working under a Doctors supervision. We are trained to do advanced procedures in the field to save lives. Para-dents AKA Dental Therapists will change lives and save us all money, just as paramedics have done since 1970. We need to embrace them ASAP.

    Damon

  • Thedentalmaven

    If I believed the midlevel provider was a viable answer I’d be on board. The promulgation of such a provider will have no effect on my practice whatsoever and I take umbrage with your unfounded assumption. I do know this: the most hardened criminal in this country doesn’t get appointed a paralegal – he gets a fully qualified attorney. Why is it that someone who may have been dealt a bad hand in life and is a poor, yet law abiding citizen – why does that person get a midlevel provider and not a fully trained dentist?

  • Engrid Dandasan

    It can be a great experience and rewarding in terms of money. Try to find Newmarket Dentist.

  • Kat Lee

    Are you talking about the same dental therapists in NZ who unnecessarily filled my teeth with amalgam? Admittedly that was 30 years ago. These days I use great products such as remineralizing toothpaste and Waterpik flosser, along with visiting my hygienist twice a year. I haven’t needed any other dental work in over 10 years.

  • Shaina

    I am quite new to this concept. But dentists santa cruz has Dental Therapist available for consultancy.

  • student

    Dental therapists are fully trained in the procedures that they are allowed to perform. They require less schooling than a dentist because they are not the ones who diagnose or make the final decision on what procedure is going to be done. A dental therapist will be more focused on the task at hand, while a dentist will now be able to use more diagnosing skills and less of the performing daily procedures. I understand that people may have had bad work done by a therapist in NZ or elsewhere, but I have also had bad work done by a dentist in Minnesota. It does not mean I will stop seeing a dentist, it just means that no one is perfect. Professionals make mistakes unfortunately, but we should not categorize them when one person does something that is incorrect. Please take that into consideration.

  • laruen

    Going to the dentist has always been a scary thing for me. I am always worried that they are going to mess up my teeth. I think I would do better with cosmetic dentistry than regular dentistry.

  • kevin

    The pain with which patient looks at us. It really is scary view as being a dental assistant. I sometimes break down!