Doctors and dentists
By IHPL - May 1, 2019

This is a special article from the Center for Oral Health, an organization committed to promoting oral health services, education, research and policy since 1985. The Center for Oral Health partners with the Institute for Health Policy and Leadership to improve the oral health of this region and beyond.

The (Un)charted Waters of Dental Therapy: Is California Ready to Embark?

Across the US, rates of tooth decay, periodontal disease, oral cancers, and edentulism are far higher and dental care utilization rates considerably lower for racial/ethnic minorities than for Whites.[1] The California Department of Public Health 2017 report on the Status of Oral Health in California noted that California is not on track to achieve many of the Healthy People 2020 national goals and objectives for oral health.[2] National reports also consistently rank California in the lower quartile among states for children’s oral health status and receipt of preventive dental services.[3],[4],[5]

A factor that contributes to significant inequities in oral health outcomes is an insufficient oral health workforce to provide care for the underserved, which is disproportionately comprised of racial/ethnic minorities.[8] There is evidence that a poorly distributed workforce results in shortages of dentists, particularly in tribal, rural and inner-city regions.[6],[8] Additionally, only 15.7 percent of dentists in California accept Medicaid (Denti-Cal) which exacerbates the challenges low-income Californians face when seeking dental care.[7]

One solution to this shortage of dentists is a new category of dental care providers: dental therapists. Other states and tribal governments are increasingly authorizing the licensing of dental therapists as a strategy to improve access to care for the underserved.[12] Authorizing dental therapists also has the potential to diversify the oral health care workforce and provide an economically sustainable source of employment for minority populations interested in the health professions.[8]

Dental therapists play a similar role to what physician assistants play on a medical team. They are midlevel providers who can deliver high-quality, cost-effective, routine restorative dental care under the supervision of a dentist.[9] They provide services such as filling cavities, temporary crowns, and tooth extractions.[12] They complement health care teams, often playing a leading role in preventive care and health promotion, allowing dentists to focus on more complex procedures.[11] The primary difference that distinguishes dental therapists from dental hygienists is their ability to prepare and fill cavities using a hand drill and perform nonsurgical extractions.[8]

The dental therapist is not a new entity in the dental workforce in all states in the US. In 2003, the Alaska Native Tribal Health Consortium developed a Dental Health Aide Therapist (DHAT) model, which functions like a dental therapist.[10] In 2009, Minnesota became the first state government in the U.S. to authorize dental therapists.[11] Since then, eight other states have authorized the licensing of dental therapists - Michigan, Arizona, Maine, Minnesota, Vermont, and tribal communities in Alaska, Oregon, and Washington. At least a dozen more are considering legislation to allow their licensure.[12]

Since dental therapy has grown and expanded nationwide, there has been an increasing need for greater consistency of the standards for this emerging profession. In 2015, the Commission on Dental Accreditation (CODA) approved a national accreditation program with uniform standards for Dental Therapy education programs. Recently, the Pew Charitable Trusts highlighted model legislation to help states craft evidence-based laws for the dental therapy models.[13] This new model legislation for authorizing the work of dental therapists could lead to more uniformity among state and tribal laws governing how much education dental therapists should receive and how they should be allowed to practice.[14]

In many US states, authorizing dental therapists has played a critical role in delivering dental care to the underserved and has helped boost access to quality dental care, especially in areas with shortages of dentists.[15]

For the state of California, the dental therapist model remains uncharted, presenting a new and promising opportunity.

Author Bios:

Dr. Barzaga
Conrado Bárzaga, MD – President and CEO, Center for Oral Health

Dr. Conrado Bárzaga is an internationally recognized public health leader with over 20 years of progressively important positions with organizations addressing public health issues. He is a Coro Fellow and a Global Leadership Fellow at the Global Child Dental Fund, King’s College London. He earned his Doctor of Medicine (MD) degree from the University of Havana in 1994.

 

Lizbeth Bayardo
Lizbeth Bayardo, MPH – Director of Programs, Center for Oral Health

Lizbeth Bayardo is the Director of Programs for the Center for Oral Health where she oversees Center for Oral Health’s Early Smiles programs, and the Oral Health Action Coalition-Inland Empire (OHAC-IE). Ms. Bayardo is currently pursuing a Doctor of Public Health degree from Claremont Graduate University and earned a Master of Public Health degree from Loma Linda University, and a Bachelor of Science degree from the University of California, Los Angeles.

References:

[1] Centers for Disease Control and Prevention, “Disparities in Oral Health,” http://www.cdc.gov/OralHealth/oral_health_disparities/index.htm 

[2] California Department of Public Health. Status of Oral Health in California: Oral Disease Burden and Prevention 2017, editor. Sacramento, 2017.


[3] Center for Medicaid and Medicare Services. Dental and Oral Health Services in Medicaid and Children's Health Insurance Program: Center for Medicaid and Medicare Services February 2016.


[4] Mandal M. Changes in Children’s Oral Health Status and Receipt of Preventive Dental Visits, United States, 2003–2011/2012. Preventing chronic disease. 2013;10.

[5] The Pew Center on the States. The State of Children’s Dental Health: Making Coverage Matter. The Pew Charitable Trusts, 2011.


[6] M. Vujicic, Interpreting HRSA’s Latest Dentist Workforce Projections (Chicago, IL: American Dental Association Health Policy Institute, 2015) [PubMed]

[7] Dentist Participation in Medicaid or CHIP. American Dental Association, Health Policy Institute. 2016 data. https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0318_1.pdf

[8] Koppelman, J., & Singer-Cohen, R. (2017). A Workforce Strategy for Reducing Oral Health Disparities: Dental Therapists. American journal of public health107(S1), S13–S17. doi:10.2105/AJPH.2017.303747

[9] Pew Charitable Trusts, “Expanding the Dental Team. Studies of Two Private Practices,” http://www.pewtrusts.org/en/research-and-analysis/reports/2014/02/12/expanding-the-dental-team 

[10] Alaska Dental Therapy Educational Program. Alaska Native Tribal Health Consortium. Access on 04/26/2019 at:

https://anthc.org/alaska-dental-therapy-education-programs

[11] Dental Therapist (DT) and Advanced Dental Therapists (ADT). Minnesota Department of Health. Accessed on 04/26/2019 at: 

 https://www.health.state.mn.us/facilities/ruralhealth/emerging/dt/index.html

[12] Grant, J., & Mizzi Angelone, K. (2018, December 31). Michigan Becomes 8th State to Authorize Dental Therapists. Retrieved from https://www.pewtrusts.org/en/research-and-analysis/articles/2018/12/31/michigan-becomes-8th-state-to-authorize-dental-therapists

[13] Experts Develop Model Dental Therapy Legislation. Proposed bill language can help states craft evidence-based laws. The Pew Trusts. 2019. Retrieved from:

 https://www.pewtrusts.org/en/research-and-analysis/articles/2019/03/29/experts-develop-model-dental-therapy-legislation

[14]National Model Act for Licensing or Certification of Dental Therapists. Evidence-based policies for licensing or certification of Dental Therapists based on emerging national standards for the profession.  National Dental Therapy Standards Consortium. 2019. Retrieved from: https://www.dentaltherapy.org/resources/file/Dental-Therapist-National-Standards-Report-and-Model-Act_FINAL.pdf

[15] Nash, D & et al., “Dental Therapists: A Global Perspective,” International Dental Journal58 (2008): 61–70.