If you live in an area with lots of dentists to choose from, count yourself lucky. More than 48 million people in the U.S. live in areas that don’t have an adequate supply of dentists.
In addition, only about 38 percent of dentists participate in Medicaid and the Children’s Health Insurance Program, according to the American Dental Association, which means that care is also hard to come by for the more than 74 million people enrolled in those programs.
The field of dental therapy evolved to help provide care to those underserved patients. Often compared to nurse practitioners in medicine, these providers can usually perform routine restorative and preventive services, like taking X-rays, providing examinations and cleanings, preparing and placing fillings, and performing some tooth extractions.
Their precise role depends on the therapist's education and the guidelines and regulations where they practice, says Karl Self, D.D.S., associate professor in the department of dental care at the University of Minnesota.
Their work is done under the supervision of a dentist, either in the dentist’s office or remotely using “telehealth technology” like direct video conversations and the online exchange of X-rays and records, says Kristen Mizzi Angelone, an officer at the Pew Charitable Trusts. “As a result, they can work in a range of settings in addition to dentists’ offices, including community health centers, nursing homes, private clinics, and schools,” she says.
Dental therapy new to U.S.
Although dental therapy can trace it roots to New Zealand in the 1920s and has since spread to more than 50 countries, its history is the U.S. is relatively recent. Dental therapists began working with American Indian tribal communities in Alaska in 2006. In 2009 Minnesota became the first state to authorize the licensing of dental therapists.
Today they also practice in Maine and Vermont, and work with tribal communities in Washington and Oregon. A dental therapy designation is also being considered in Arizona, Connecticut, Hawaii, Kansas, Maryland, Michigan, New Hampshire, New Mexico, North Dakota, Ohio, Texas, and Washington, according to the Pew Charitable Trusts.
What the studies show
Recent research gives an early indication of the positive impact dental therapists can have on underserved communities. In 2014 a Minnesota Department of Health study found that between August 2012 and December 2013, clinics that hired dental therapists saw 6,338 new patients; 84 percent of them were enrolled in public programs. And one-third of all patients experienced a reduction in wait times for an appointment, especially in rural areas.
A study published in August 2017 by the University of Washington found that both children and adults had lower rates of tooth extractions and more preventive care in Alaskan native communities served by dental therapists.
Regardless of the research, not everyone is enthusiastic about dental therapy. “I am sure dental therapists would be qualified to do cleanings and most exams but, depending on their training, I would hesitate to have them do fillings and extractions," says Robert Peri, D.D.S., a dentist in Berkeley, Calif., and a member of the editorial board of BerkeleyWellness.com, which is published in collaboration with the University of California, Berkeley, School of Public Health. "I would worry about extraction complications especially if they are not under the immediate direct supervision of a dentist.”
Rather than add a new category of providers, says Jane Grover, director of the Counsel for Advocacy for Access and Prevention at the American Dental Association, more should be done to connect underserved people seeking care with dentists ready to treat them.
“This can be accomplished through outreach by community health workers, and improved reimbursements for dental services under Medicaid, which in turn would increase the number of dentists participating in the program,” she says. Plus, she adds, data from the American Dental Association’s Health Policy Institute indicates the number of dentists will continue to grow through 2035.
But Self, who is also the director of the division of dental therapy at the University of Minnesota, thinks more dentists won’t necessarily solve the problem. “I’ve been working in the community health world for about 30 years, and there has always been a significant segment of the population that’s not able to access care from a dental office,” he says. “Our students have a passion to increase access to care. When it comes to a dental team, I think everyone who wants to help should be welcomed.”