Dental Therapists Could Be End to Oral Workforce Decay

By Lisa A. Weder

In a push for states to expand their dental workforce, Families USA has launched its Access to Dental Care Initiative, which focuses on improving awareness of dental care access for low-income families and expanding the use of mid-level providers, such as dental therapists, in more states. The initiative attempts to heed the call of underserved populations in which 14 million low-income children went without dental care in 2011, according to Pew Charitable Trusts (Pew). Pew attributes the workforce problem to an unbalanced distribution of dentists across the country and the small network of dentists who participate in Medicaid. Families USA says this impacts more than 49 million Americans.

The initiative centers on expanding dental teams to include dental therapists in order to reach more patients. Reaching more dental patients allows dentists more time to focus on treating patients with complex care needs.

Families USA sees dental therapists as a means to cost-effective and patient-centered care allowing dental practices to increase productivity and revenue because dental therapists earn lower salaries, take a shorter amount of time to train (receiving two to three years of hands-on training), and are able to provide routine preventive and restorative procedures including dental exams, cleanings, x-rays, fluoride treatments, sealants, fillings, and basic extractions under the general supervision of a dentist. They also provide much needed prevention and education services within communities where dentists are scarce.

Dental therapists already provide care in more than 50 other countries, as well as in previously underserved communities in Alaska and Minnesota. Maine passed legislation in 2014 allowing dental therapists to provide care within dental practices, and 15 other states are considering the move as well.

Three nonprofit dental programs reaped benefits of using dental therapists:

  • People’s Center Health Services, a federally qualified health center (FQHC) in Minnesota, targets Minneapolis’ diverse, low-income population. In April 2012, the FQHC became the first to hire a dental therapist to increase the number of patients who could be served. She saw 1,756 low-income, uninsured patients in the first year.
  • Norton Sound Health Corporation, a tribally owned and operated nonprofit health care organization, deploys dental health aide therapists to distant rural locations. According to Mark Kelso, D.D.S., the group’s dental director, dental therapists who provide routine care have given its dentists more time to attend to unmet needs for higher-level procedures. One dental therapist contributed to saving approximately $95,000 in Medicaid outlays for travel by providing early preventive care and treatment.
  • The Virtual Dental Home is a demonstration project operated by the University of the Pacific School of Dentistry at sites throughout California. The project tests delivery of health-related services and information via telecommunications technologies to provide dental care to populations that would otherwise not receive care. It targets patients in community settings such as elementary schools, Head Start programs, and nursing homes in low-income areas. The dental therapists collect dental information that is sent electronically to a supervising dentist, who creates a treatment plan for the hygienist to implement.

Families USA would like to see more states investigate expanding their oral health workforce to meet the needs of all of their residents, but in particular to meet the needs of underserved children. “Improving children’s oral health will involve many policy and public health changes, and strategies to expand the oral health workforce are a critical component of these changes.”