Dental Therapists: Just the facts, please.

It’s time for a truthful chat about dentistry’s most misrepresented provider.

I’m a dentist and I strongly support adding dental therapists to the dental care team. If you aren’t familiar with them, dental therapists are oral health care providers who work in dentistry much like nurse practitioners work in medicine. They provide routine and preventive care, they can work off-site from a supervising dentist, and we need them on the dental care team.

Team of Dental Health Aide Therapists provide care to patient. (Photo: Alaska Native Tribal Health Consortium)

When I tell this to my dentist friends and colleagues, the conversation goes something like this:

I say: Dental therapists will help us get dental care to the millions of people in the U.S. who go without it every year.

Dentist friend says: UNINTELLIGIBLE YELLING…“irreversible surgical procedures!”…UNINTELLIGIBLE YELLING.

I know I’m not alone in provoking this kind of response — advocates for dental therapy nationwide have heard the same thing many times. It is time for dentists to stop yelling and look at the facts.

FACT: Our dental care system is broken.

Last year, approximately 180,000,000 people did not or could not visit a dentist. More than 54 million people live in dental shortage areas — meaning they don’t have good access to oral health care.

Without access to dental care, people suffer. Parents miss work and kids miss school. The health consequences can be serious. If you have poor oral health, you are more likely to develop diseases such as diabetes and cardiovascular disease. And untreated dental infections can lead to serious illness and even death.

Deaths from dental infections aren’t common, but we have had nearly 100 of them in the past decade — far more than we should in the world’s richest country.

FACT: The evidence in support of dental therapists is overwhelming.

Dental therapists have been practicing around the world for more than 100 years, and in the U.S. for more than a decade. The evidence is overwhelming: Dental therapists provide high quality care and they expand access to low-income people, people of color, and people in rural and tribal communities.

  • A recent study from the University of Washington is the very first to look at the impact of dental therapists on oral health outcomes. Do you know what it found? Children in communities with more frequent access to a dental therapist had lower rates of tooth extractions, less use of general anesthesia, and more preventive visits.
  • A review of more than 1,100 academic papers by dentist and oral health expert David A. Nash concluded: “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 compromise to children’s safety or quality of care. Given these findings, the profession of dentistry should support adding dental therapists to the oral health care team.”
  • In 2015, the American Dental Association’s (ADA) own Commission on Dental Accreditation approved accreditation standards for the education of dental therapists. Would the Commission give its approval for a new profession that is unsafe? I think not! If dental therapy is good enough for the ADA, it is good enough for me.
  • Reams of published evidence show that dental therapists provide safe care, but one of the most convincing indicators of their safety is the cost of their malpractice insurance: less than $100 a year.
“Many published studies demonstrate that appropriately trained midlevel providers can provide high-quality services, including irreversible procedures such as restorative care and dental extractions.”
- The American Dental Association Council on Scientific Affairs

FACT: Dental therapists work in nonprofit health clinics where they provide care to those who need it most.

The vast majority of dental therapists work for not-for-profit groups, not “mills”.

  • In Minnesota, dental therapists employed by nonprofit Appletree Dental provide high-quality oral health care to elderly nursing home patients, among many others. Dental therapists employed by the 100-year-old non-profit Children’s Dental Services work in over 100 remote sites, including schools, providing excellent care to children. In fact, the Minnesota Department of Health’s 2014 dental therapy evaluation found that 44% of dental therapists in Minnesota work in rural areas and more than 80% of their patients are enrolled in Medicaid or are otherwise underserved.
  • In Alaska, dental therapists have been practicing for more than a decade, working in community clinics and other settings to get dental care to more than 45,000 people who would otherwise go without it. They are seeing their first generations of cavity-free kids and the dental therapy program is in high demand.
  • In Washington State’s Swinomish tribal health clinic, the single dental therapist on staff has cut the overall wait time for appointments in half and greatly expanded the dental care available to tribal members.

FACT: Dental therapists are economically viable.

Dental therapists are less expensive to educate and employ but they are reimbursed at the same as a dentist for the approximately 50 procedures in their scope of practice. A report from Community Catalyst found that a dental therapist costs less than 30 cents to employ for every dollar of revenue he or she generates.

Private practice dentists are seeing benefits too. In Minnesota, eight separate private practice dentists have hired 24 dental therapists. The therapists take care of the routine work within their scope of practice while the dentists focus on the more complex patients and procedures, actually netting increased revenue and allowing more appointments to be scheduled.

FACT: Here in the U.S., dental therapy is thriving and states are pursuing this approach to solve their access problem.

Dental therapists are practicing and/or allowed to practice in six states in the U.S. and nearly a dozen more are considering authorizing them. This is what happened when nurse practitioners were a new profession, and more states and communities recognized their value their work and changed their practice laws.

Dental therapy policies by state. (Photo: W.K. Kellogg Foundation)

FACT: Dental therapy has strong public and grassroots support and only one opponent — organized dentistry.

Across the U.S., broad coalitions of supportive community organizations are working to allow dental therapists to practice in their states — New Mexico and Washington each have more than 40 members in their coalitions. Vermont, which passed legislation allowing dental therapists to practice in 2016, had nearly 50. A 2016 public opinion poll showed strong support for dental therapy. 81 percent of people in the U.S. favored a “ new type of dental provider similar to a nurse practitioner” being able to work in their state and support crossed party lines — a rarity these days!

Photo: DrBicuspid.com

There is also more support among everyday dentists that you might think. According to a poll conducted by the National Institute of Health funded Practice Based Research Group, 48 percent of dentists and hygienists support dental therapists being allowed to practice in their state.

At the end of the day, dental therapy’s ONLY opponent is organized dentistry. And, as you read the facts I have laid out about dental therapy, you can see that their arguments against it are weak and getting weaker.

Dental therapists are succeeding in community after community, and people are getting care they desperately need to live long and healthy lives.

As a dentist, I believe that we and other health professionals have a social contract, codified in the legislation that gives us our licenses and therefore a monopoly on dental care in return for providing care to the public — all the public, not just those people who can afford our fees. That social contract requires us to stand on the side of progress and support models like dental therapy — which will ultimately help us do our jobs better — rather than obstruct them.

In that spirit, I call on my fellow dentists to listen to the facts and end their obstruction to dental therapy. I call on legislators to do the same — listen to the facts and act to expand dental therapy when they have the opportunity. Millions of Americans who live and suffer without dental care need you to do so.