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Dental therapists may be key to serving more patients

By Melissa Busch, associate editor

October 19, 2022 -- Dental therapists contributed to delivering dental care to patients in Alaska, according to a study in the Journal of the American Dental Association. The number of diagnostic, preventive, and restorative services in the Yukon-Kuskokwim Delta rose since the introduction of dental therapy.

Tribal areas in Alaska were the first in the U.S. to authorize these midlevel providers. Diagnostic and preventive services delivery increased for therapists while they remained stable or decreased for dentists, the authors wrote.

"(The) authorization of dental therapy in Alaska sustained positive impacts and bolstered support for dental therapy practice as an effective upstream policy solution to address provider shortages in the United States," wrote the authors, led by Dr. Donald Chi, PhD, a professor and the associate dean for research at the department of oral health sciences at the University of Washington in Seattle (JADA, October 11, 2022).

Since dental therapy practice was introduced in Alaska, 12 state legislatures in the U.S. have passed dental therapy legislation. Although the authorization of midlevel providers has been controversial, understanding the long-term effect of dental therapists could help inform policy decisions in the U.S. Until now, researchers believe no other studies have compared secular trends in dental service delivery between therapists and dentists.

To investigate secular trends in dental service delivery between dental therapists and dentists in the Yukon-Kuskokwim Delta region of Southwest Alaska, researchers analyzed the electronic health record transactions for 27,459 patients from 2006 to 2015. Using current dental terminology procedure codes, they identified diagnostic, preventive, restorative, endodontic, and oral surgery services.

During the 10-year period, there were 722,272 dental services provided to the 27,459 Alaska Native community members. Overall, the number of dental services delivered increased annually since dental therapists began practicing in the state, according to the study.

Dental service type Annual change by number (95% confidence interval [CI])
Diagnostic 1,220 (364 to 2,075)
Preventive 1,468 (429 to 2,506)
Restorative 326 (-100 to 754)
Oral surgery -33 (115 to 69)
Endodontic -47 (-91 to -2)
Other 4 (-14 to 22)

When the data were broken down by services, there was a 3.5% annual decrease observed for dentists (95% CI, -5.13% to -1.86%; p value < .001) and a 4.07% annual increase for dental therapists (95% CI, 2.82% to 5.33%; p < .001) for diagnostic services, according to the study.

For restorative and oral surgery services, there were similar trends. For preventive services, there was no change for dentists (-0.14%; 95% CI, -2.30% to 2.02%; p = .89) and a 4.77% annual increase for dental therapists (95% CI, 3.51% to 6.03%; p < .001). Similar trends were observed for endodontic services, the authors wrote.

However, the study was not without limitations, including that the data records analyzed were only for patients who used dental services. Researchers did not have access to the total number of people who were eligible to use a dental service in the area, meaning that the primary main outcomes are summarized as counts and relative percentages rather than proportions, they wrote.

The positive effects sustained by allowing dental therapists to practice in Alaska indicate that there is a role for dental therapy in addressing poor access to oral health care in underserved communities, the authors wrote.

"Dental therapists have contributed substantially to the delivery of dental services in Alaska Native communities and suggest that dental therapy practice is a potential solution to address dental provider shortages in the United States," Chi et al concluded.

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Last Updated ka 10/19/2022 10:02:25 AM

4 comments so far ...
10/19/2022 2:25:25 PM
Wonder why my post didn't post?
Is it because my opinion varied from what is wanted?

10/19/2022 3:16:06 PM
What is so surprising about community recruited, Associates Degreed dentist extenders, costing less than 10% of what it costs to educate a dentist and providing a relatively narrow, but important scope of services, having a positive impact upon that community?
The hub and spoke delivery model, incorporating dental therapists, as educated in Alaska; community college rather than requiring four-year college or university and an RDH, offers the best hope for improving access to oral health care, so long problematic for almost 100 million Americans. It should challenge those who believe an RDH, a baccalaureate or a masters is essential. This should be seen for what it is, a means to deter, rather than make DT education accessible and relatively inexpensive. Otherwise, it is simply about protecting turf.
Dentistry has long recognized the importance of developing an effective relationship, as key to "bending the curve" of primarily behavioral oral diseases.  If one studies the ANTHC/DHAT type therapist, it will become clear that prevention is central, surrounded by needed basic clinical services provided locally. Celebrating the patient, within a community setting, is not comparable to a traditional Medicaid dental model, in which dentists and hygienists work as fast as they can, to treat as many patients as they can, on any given day. Therapists and hygienists in Alaska Native communities are not dealing with high appointment failure rates, cultural barriers or language difficulty. It is also apparent how well the hub and spoke works.
This model can easily be replicated on tribal lands nationwide. Sadly, opposition, not from among Native Tribes, has slowed the process. Still, it will come.
Therapists are likely to be effective in FQHCs, CHCs, SBHCs and within private dental offices, where Medicaid supported and other lower income patients might not otherwise be cared for. 
I recognize that some dentists might fear adverse impact upon private practitioners, "Disruptive Technology" concerns.
Educating Dental therapists, creating schools, will take a long time. Numbers will grow slowly, decades perhaps. It has taken 17 years for the DHATs to show even a small difference in Alaska Native populations. Surely, it will take even longer, outside Native Lands, in "The Lower 48." It will also be challenging to recruit and retain therapists, where dentists have been reluctant to practice. While it will not satisfy naysayers, the "Only A Dentist" types among us, it hopefully should provide a sense of non-urgency, among others, as far as fear-based opposition is concerned.
Long term, what could it mean? Dental education could start to incorporate dental assistants and hygienists, along with DTs with dental clinical experiences, from the get-go. Dental students should not have to graduate with only a minimum of team based delivery. A subtle shift, from a wholly individual patient-based success towards population benefit might also occur. Add growing needs for integration and watch what happens!
It is not the end of the world.
In the meantime, while CODA has adopted Standards for Accreditation and has accredited two dental therapy schools, a significant number of states have passed dental therapy enabling legislation, the ADA persists in opposing or at least deterring candidates from seeking this legitimate form of dental education.  This, while a workforce shortage continues, and we find it ever more difficult to attract staff.

10/20/2022 3:07:49 PM
here is an about paying actual professional dentists what they are worth instead of having untrained mechanics work on the "less fortunate"

10/22/2022 7:28:26 PM
You can say whatever you wish, but facts get in the way.
It would be a far more useful discussion, if you gathered evidence, with which to support whatever claim you wish to make.
Dental therapists have 17 yeas of history in Alaska and more than a decade in MN. They are safe and effective, within scope. They have been well received by the public which they serve. Dentists, who lead them, as team members, have not resigned in waves. Real studies have resulted in positive findings which have survived peer review.
CODA has created and adopted Standards for Accreditation, which has been granted to two schools. Several states have enacted DT legislation, too many requiring that anyone wishing to become a dental therapist, must first become a hygienist, have a baccalaureate degree and more, rather than the associates degree, which CODA accreditation allows.
We have long passed the rock throwing and name calling.  There is work yet to do.