Suggests greater role for mid-level dental providers in the United States
April 10, 2012
by W.K. Kellogg Foundation
An extensive review of the literature documenting care provided by dental therapists and clinical outcomes worldwide indicates that they offer safe, effective dental care to children. Released today by the W.K. Kellogg Foundation, the study reviews more than 1,100 reports regarding dental therapists and their work in various countries.
The report documents evidence that dental therapists can effectively expand access to dental care, especially for children, and that the care they provide is technically competent, safe and effective. In addition, the review also showed that the public values the role of dental therapists and there is strong patient and parental support for their work.
In the United States, dental therapists practice in Alaska and Minnesota, but there is movement in other states to use these providers to expand access to needed dental care. Numerous federal reports, the Institute of Medicine, states, tribes and foundations, such as the Kellogg Foundation and the Pew Charitable Trusts, have recommended exploring midlevel providers, such as dental therapists, as a way to solve the current dental access crisis.
The report reviews the history and practice of dental therapists in 54 countries ranging from the United States to the United Kingdom to Malaysia. Five of the top six countries on the Human Development Index — the United States, Canada, New Zealand, Australia and the Netherlands — employ dental therapists in their oral health workforce.
The report found no evidence to indicate that the public perspective of dental therapists in any country was other than positive, according to David Nash, DMD, MS, EdD, the William R. Willard Professor of Dental Education, Professor of Pediatric Dentistry at the College of Dentistry at the University of Kentucky, and the principal author. Nash is a member of the American Dental Association and of the American Academy of Pediatric Dentistry.
“There is no question that dental therapists provide care for children that is high quality and safe. None of the 1,100 documents reviewed found any evidence of compromises to children’s safety or quality of care,” said Nash. “Given these findings, the profession of dentistry should support adding dental therapists to the oral health care team.”
The report, A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States, comes at a time when the United States is struggling to expand access to dental care, especially for children. Tooth decay is the number one chronic illness for children, more prevalent than asthma. And close to 50 million people in the United States live in areas where they cannot gain easy access to a dentist.
In 2014, as part of the Affordable Care Act, an additional 5.3 million children will be entitled to dental coverage under Medicaid, according to the Pew Charitable Trusts. Yet few dentists treat Medicaid patients now and there have been wide reports of children on Medicaid waiting months to get care.
“Barriers to dental care have created significant oral health inequities for children in this country,” said Sterling K. Speirn, president and CEO of the W.K. Kellogg Foundation. “And this greatly impacts their overall health and well-being. No child should have to suffer the pain of a toothache or an abscess. We need to strongly consider expanding the number of dental professionals who can offer routine, preventive care to children in their own communities.”
Historically, the focus of dental therapists has been on the prevention and treatment of dental disease in children. In many countries, such as New Zealand and Australia, dental therapists provide their services through the school system. Dental therapists typically provide routine care that includes cleanings, filling cavities, preventive care and extractions of children’s teeth. While the scope of practice has typically been restricted to children, a few countries are beginning to permit dental therapists to treat adults as well.
According to the report, countries using dental therapists have been effective in improving access and the care provided to children. In New Zealand, 96 percent of school age children, and 49 percent of preschool children are enrolled in the school dental service and cared for by dental therapists. In Malaysia, 96 percent of elementary school children and 67 percent of secondary school children are enrolled in the school dental service staffed by dental therapists. And in Hong Kong, 95 percent of children have access to dental care in school clinics.
The survey also indicated that dental therapist-led school dental services are cost-effective. School dental programs in New Zealand and Australia cost less than private fee-for-service systems. The average cost of school-based dental care in New Zealand in 2010-11 was $99 per child, which included all preventive care and treatment of cavities. In the private sector, the cost would be similar for just one examination visit, and a simple restoration would cost an additional $99.
About the W.K. Kellogg FoundationThe W.K. Kellogg Foundation (WKKF), founded in 1930 as an independent, private foundation, is among the largest philanthropic foundations in the United States. Guided by the belief that all children should have an equal opportunity to thrive, WKKF works with communities to create conditions for vulnerable children so they can realize their full potential in school, work and life.
The Kellogg Foundation is based in Battle Creek, Mich., and works throughout the United States and internationally, as well as with sovereign tribes. Special emphasis is paid to priority places where there are high concentrations of poverty and where children face significant barriers to success. WKKF priority places in the U.S. are in Michigan, Mississippi, New Mexico and New Orleans; and internationally, are in Mexico and Haiti. For more information, visit www.wkkf.org.
As a dentist in the US, I find the research into the use of Dental Therapists enlightening. What I see as the key phrase for gaining success is “children are enrolled in the school dental service staffed by dental therapists”.
What I see in the US is zero effort to develop a similar system to get similar results. Instead, there is no effort to develop a school dental service and the Dental Therapist is being promoted to the public and the legislators as if their graduation from a training program will end up with the same results.
Sorry, but just graduating new providers is not enough… The countries showing success have a system that is well funded to train and then employ the Dental Therapists and provide administration, equipment, supplies, etc as well as the authority to deploy the DTs to the areas of need. The push for DTs in the US lacks every component of the successful programs except for training DTs.
The Kellogg report does not demonstrate successes using the Dental Therapist model currently promoted in the US. Promoting DTs to the public and legislators in the US ought to be using the same model as used in other countries …otherwise the claims of similar results are fabrications of the imagination. In fact, simply “expanding the workforce” to include DTs has been shown to NOT work very successfully. Without connecting the new providers to a well thought out and properly funded system, there is just a random chance of seeing Access to Care issues being affected. Look up “The Inverse Care Rule” and look up the Canadian Dental Therapist program for references.
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