Nearly 60 million Americans live in “dental deserts,” while many more can’t afford basic dental care even if it is available.
Enter dental therapists.
New research suggests these newly minted health care professionals could help more people get the oral health care they need in low-income areas. They are fast becoming members of a typical dental care team, along with hygienists and dental assistants, in many underserved or low-income areas across the United States.
Dental therapists can’t hang a shingle and practice on their own. Instead, they must be supervised by a dentist. They can fill cavities, place temporary crowns and even pull baby teeth, the researchers explained.
“The cost of having a dental therapist is half as much as that of having a dentist, and they can do 80% of the procedures,” said study author Elizabeth Mertz. She is an associate professor of preventive and restorative dental sciences at the University of California, San Francisco.
In addition to basic dental services, dental therapists, who typically complete a three-year training program after high school, can offer nutrition and smoking cessation advice, take X-rays and perform tooth cleanings.
“The pros of dental therapy are economic development/job creation for underserved communities, better access to care, and culturally competent care as the dental therapists are more diverse and come from the communities they serve,” Mertz said.
For the new study, researchers focused on Minnesota, a state which adopted legislation allowing dental therapists to practice in 2009. (Alaska adopted similar legislation earlier, but only in tribal communities.)
Dental therapists did seem to improve access to dental care among adults, particularly poor adults. More people visited a dentist’s office after dental therapists were authorized, but the study doesn’t say how many people actually saw a dental therapist for care while there. Not only that, racial disparities persisted even with dental therapists in place.
Gaps in access to care
Gaps in access to oral health care still existed among racial and ethnic groups despite the advent of dental therapists in Minnesota. “I believe this is more a factor of how intractable the social determinants of oral health care for this population are,” Mertz said.
The new study was published March 18 in JAMA Health Forum.
To date, dental therapists have been authorized in 13 states and several tribal nations in the United States, and this is likely just the beginning, Mertz said. The Commission on Dental Accreditation, the group charged with accrediting dental schools and dental education programs, officially recognized dental therapy as a profession and adopted national education standards for dental therapists in 2015.
In states where they are authorized, dental therapists can work in tribal, rural or free health clinics, underserved schools, jails and mobile health units. Private practices in these states must see a certain percentage of Medicaid or uninsured patients to be able to take on a dental therapist.
But not everyone is on board with dental therapists providing care.
“Organized dentistry has long argued against dental therapists, but the studies show there are many benefits, and very few downsides,” Mertz said.
The American Dental Association (ADA) has come out strong against dental therapists. In a statement provided to HealthDay, the group said there is no available evidence showing dental therapists lead to improved access to care, lower rates of tooth decay, or a lower cost of care for patients.
“Outside of Native American tribal lands and pilot programs, dental therapists work in just one state — Minnesota — despite legislation passed in several states and millions of dollars expended on programs that have yet to train a single dental therapist,” the association said. “In the 10 years since Minnesota passed legislation, there are 120 licensed dental therapists working in Minnesota and a very small amount of dental therapists working in Census-designated rural areas, according to the Minnesota Dental Board Online Licensure Verification. There is only one Minnesota-trained dental therapist in Maine.”
The ADA pointed out that the current number of dentists will continue to grow through 2040 and outpace population growth, according to data from the ADA’s Health Policy Institute.
“Rather than add a new category of providers, the ADA believes there is a critical need to connect underserved people seeking care with dentists ready to treat them. This can be accomplished through Community Dental Health Coordinators and improved funding for dental services under Medicaid,” according to the ADA statement.
Tera Bianchi sees it differently. She’s the director of the Dental Access Project at Community Catalyst, a Boston-based non-profit.
“The study states what communities with dental therapists have been saying for close to two decades, dental therapists work,” said Bianchi, who has no ties to the research. “Working alongside dentists, dental hygienists and dental assistants, they can provide some of the most commonly needed services like exams and fillings and, by using telehealth to collaborate with their supervising dentist, bring care directly into communities.”
Philadelphia dentist Kelly Holst is still on the fence about what role, if any, dental therapists can play in getting more people to seek dental care, and the new study didn’t sway her one way or the other.
“Dental therapists may provide increased timely use of health care services, but are we getting the best health outcomes with these mid-level providers?” asked Holst, an assistant professor in restorative dentistry at Temple University’s Kornberg School of Dentistry in Philadelphia.
For example, a badly decayed or cracked tooth may need a root canal, but dental therapists can only do simple extractions and may approach it that way, said Holst.
“The way a dentist is trained is appropriate to manage these cases,” she said.
There are other ways to increase access to dental care, including tuition breaks for dental students and higher Medicaid reimbursements for dental services, Holst suggested.
The Dental Access Project at Community Catalyst has more information on dental therapists and the care they can provide.