Recently, the state of Arizona signed the bill to allow for a mid-level, licensed dental professional, called a “dental therapist,” to provide care in underserved areas.1 A dental therapist is a mid-level, licensed oral care provider who provides preventative and restorative oral care.2 The admittance of such a new oral health provider has caused conflict between state officials and dental professionals. However, the dental therapist profession has seemed to gain momentum since 2009, regardless of the opposition and criticism it faces.
The states which have allowed the practice of the dental therapist, set forth regulations and limitations that dictate the amount of education needed, the settings in which they may work, the types of patients they may see, and the dental procedures they may perform. Typically, the practice of dental therapist is limited to preventive and basic restorative care for the under-served, such as rural or tribal regions, community dental health clinics, or non-profit dental practices.
The concept of the dental therapist was first introduced in 1913 by Dr. Norman K. Cox, who wanted to address the dental needs of children ranging from age six to fourteen. Although, Dr. Cox’s proposal was rejected, in 1920 the New Zealand Dental Association approved the proposal of a school “dental nurse” to provide diagnostic and restorative dental services to the children. By 2000, twenty-eight countries have advocated and implemented the dental therapist role to increase access to dental care in underserved areas. Alaska, Minnesota, Maine, Vermont, Washington, and now Arizona, have implemented this concept and introduced the dental therapist to the dental world.2
The dental therapist’s responsibilities include preventative hygiene care, minor restorative treatment, and non-surgical extractions. However, these responsibilities may contain limitations and can vary from state to state. Aside from the education requirements, dental therapists have qualities that allow them to communicate well with children, parents, and colleagues, as well as build rapport and trust with the patient.
The dental therapist has been implemented to decrease the rising number of adults and children that do not receive dental care. One of the challenges for seeking dental care in rural areas is the lack of accessibility to dentists. This causes patients to seek dental treatment in the emergency room for dental pain, which results in a high expense for the state, and more importantly, the pain is being managed, but the dental problem is not being corrected to prevent future visits. Other factors include limited public funding for health programs and lack of Medicare and Medicaid coverage. Delta Dental insurance company stated, “Three times as many people nationwide are without dental insurance.3”
Despite the states amending the problem of high cost and lack of accessibility to dental care by implementing a new category of dental provider, the American Dental Association (ADA) and dentists state-wide oppose the use of dental therapist. The ADA is firm in its position against the dental therapist. The ADA has stated it “does not consider the one-size-fits-all mid-level dental provider to be a viable solution to the diverse set of barriers that impede millions from getting dental care.”3 According to data from the American Dental Association’s Health Policy Institute (HPI), “The number of dentists will continue to grow through 2035,” and more than twenty-seven percent of existing dentists indicate they have the ability to add more patients and growth4. The HPI research also supports a one percent increase in states’ Medicaid budget allocations that would be used to replace mid-level providers. Currently, most states allocate less than two percent of their total budget to Medicaid expenses, but evidence has shown that, when states reform their budget, they are successful in dealing with the issues at hand.4
Overall, there are pros and cons to the implementation of mid-level dental care providers. Although they are educated on the principle that they are to care for the underserved, they also open up the question, “Do the under-served deserve sub-par treatment?” The role of the dental therapist as a mid-level provider in under-served populations does not address major dental treatment needs. The dental needs of the population who do not have dental insurance, and will not meet the requirements for state-provided health care benefits, will also not be addressed. However, opposition to the dental therapist may pave the road for legislation to take a closer look at health care on a state or federal funded level and thereby actualizing a cost-effective solution that is in the best interest of the population.
- Kelsey Mo. (2018). Gov. Ducey signs bill allowing ‘dental therapists’ to practice in Arizona; May 17, 2018. Retrieved from https://www.azcentral.com/story/news/politics/arizona/2018/05/17/ducey -signs-bill-allowing-dental-therapists-practice-arizona/587163002/
- Wikipedia. Dental therapist; Retrieved from https://wikipedia.org/wiki/Dental_therapist
- Alicia McElbaney. USA Today. (2014). Dental therapists aim to fill in oral health shortfalls; May 6, 2014. Retrieved from https://www.usatoday.com/story/news/nation/2014/05/06/dental-therapists-oral-health-disparities/7422773
- ADA. (2017). ADA responds to New Coverage of Dental Therapists; February 21, 2017. Retreived from: https://ada.org/en/press-room/news-releases/2017-archives/February/ada-responds-to-news-coverage-of-dental-therapists