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Dental Therapy Gains Steam in the U.S. as Model Curriculum Becomes Available

By Jane Koppelman, Research Director, Pew Charitable Trusts’ Dental Campaign

Dental TherapistDental therapy is an emerging profession in the United States helping to address critical gaps in care for the tens of millions of Americans who have difficulty finding a dentist to treat them. Dental therapists—performing a caregiving role similar to physician assistants—are supervised by dentists and work as part of a team to deliver routine preventive and restorative care, including preparing and filling cavities and performing simple extractions.

Dental therapists have practiced internationally for nearly a century and now work in more than 50 countries. There are 1,100 studies of dental therapists in over 26 countries, along with evaluations in Alaska and Minnesota demonstrating that they provide care at the same level of quality as dentists for those procedures they have in common.

The U.S. is a relative newcomer to this model, yet interest at the state and national levels is growing. In 2004, Alaska began using dental therapists to provide care to Native Alaskans, many of whom live in remote villages that dentists visit infrequently. Minnesota authorized their use in 2009, and Maine and Vermont followed suit in 2014 and 2016, respectively. About a dozen state legislatures are considering similar proposals to improve care for underserved populations, including Arizona, Kansas, Maryland, Massachusetts, Michigan, New Mexico, and Ohio.

Dental TherapistTribal activity is also growing. In 2016, Oregon approved pilot programs allowing two federally recognized tribes to employ dental therapists. That same year the federal Indian Health Service (IHS) invited comments on a proposed policy to allow dental therapists to practice in IHS facilities across the nation. And in early 2017 Washington became the first state to pass legislation to allow dental therapists to practice in Indian country.

Dental therapists are being used in a variety of ways in Minnesota to improve care access. Dentists are hiring dental therapists to serve more Medicaid patients, finding that the lower cost of employing them makes accepting Medicaid’s discounted payment rates more palatable. Minnesota Federally Qualified Health Centers are using the savings from employing dental therapists to serve more patients and provide more free or low-cost care to uninsured people, while other clinics are deploying dental therapists to schools, nursing homes, and rural hospitals to deliver care in more convenient locations.

While legislative change is necessary to allow dental therapists to practice in states, training institutions are essential to build this workforce. To that end, early this year a model dental therapy curriculum was unveiled for community colleges and universities interested in launching such training programs. This sample curriculum, developed with input from the American Association of Community Colleges, the W.K. Kellogg Foundation and The Pew Charitable Trusts, was designed to meet dental therapy guidelines issued in 2015 by the Commission on Dental Accreditation (CODA), the accrediting body for the nation’s dental education programs.

Dental TherapyFor a number of reasons, curriculum developers are particularly interested in boosting the role of community colleges in providing this training. CODA’s dental therapy guidelines call for at least three academic years of training, without prescribing a specific degree requirement, such as a bachelor of science. Dental hygienists and assistants are also given credit for the education they have already received. This opens the door for community colleges to play a central role in training dental therapists. Community colleges are committed to addressing the educational and workforce needs of their communities and to offering affordable training for some of the nation’s most economically challenged students. Their participation could go a long way toward expanding the diversity and cultural competency of the oral health professions. Community colleges have educated the majority of the nation’s dental hygienists and are a logical home for training dental therapists—especially given that about half of community colleges are located in or near rural areas where the shortage of dentists is most acute.

As more states strengthen and modernize their oral health delivery systems by authorizing dental therapy, schools have gained an important resource to develop high quality training programs to educate this emerging workforce. Progress on both fronts is certain to benefit millions of underserved Americans.

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