The Tipping Point for Dental Therapy
Frank Catalanotto, DMD
The first dental therapists in the United States started treating patients in Alaska in December of 2004. Fifteen years later, there are now 12 states that have authorized dental therapists. This progress occurred despite the desperate attempts of some in organized dentistry who opposed authorizing legislation. I believe that the United States is now at a "tipping point," where the strong evidence base will help push other states to authorize dental therapy. The data demonstrate that dental therapy is needed across the country and is capable of providing high-quality, safe, and effective care.
The benefits of access to dental care as well as the negative effects of a lack of access are well documented. For example, a September 25, 2018, press release from the Blue Cross Blue Shield Association reported that "people with serious dental conditions are 25% more likely to suffer from heart disease and more likely to have autoimmune disorders, anemia, gastrointestinal disorders, and renal disease" and that "members with these conditions have nearly 2 fewer years of healthy life."
Dental therapists help dentists provide quality oral healthcare to more patients. A literature review of 1,100 studies and evaluations assessed dental therapists' performance in 26 countries and concluded that dental therapists provided various services with a level of safety and quality that was on par with that of dentists. In addition, the senior author of a systematic review of the dental therapy literature conducted by the American Dental Association's Council on Scientific Affairs in 2013 commented that "the results of a variety of studies indicate that appropriately trained midlevel providers are capable of providing high-quality services, including irreversible procedures such as restorative care and dental extractions."
The Yukon-Kuskokwim Health Corporation, a part of the Alaska Tribal Health System, serves 25,000 native Alaskans. An analysis from 2006 to 2015 showed that high exposure to dental therapists was associated with a reduction in the number of extractions involving the front four teeth in children under the age of 3, an increase in preventive care for children under the age of 18, and fewer extractions and more preventive care among adults.
Dental therapists work under general supervision; therefore, they can be used by private and public practices to extend office hours into evenings and weekends without a dentist required to be on-site. They also work remotely in underserved areas or at off-site locations, such as schools, day care centers, and nursing homes, to bring care to those who face challenges travelling to a dental office.
Private, for-profit dental clinics located in designated dental health professional shortage areas in Minnesota increased revenue and the number of patients served with the addition of dental therapists. Main Street Dental Care, a private practice in Minnesota, made an additional $24,000 in profit and served 200 more Medicaid patients in its first year with a therapist. Overall, the practice increased patient visits by 27%. The net benefit for Grand Marais Family Dentistry was 13% of its average monthly revenue, and the clinic increased the number of patient visits by 17%.
Apple Tree Dental Clinic, a nonprofit organization in Minnesota, sends a dental team, including a dental therapist, to provide on-site care at a nursing home for veterans. The dental therapist provided 8-to-10 dental visits each day for an average daily production of up to $3,122. The average employment costs per day for the dental therapist were $222 less than what they would be for a dentist, which resulted in a total savings of $52,000 per year for the practice.
HealthPartners in Minnesota found that the productivity (ie, billable procedures) of its dental therapists was only 9% lower than that of its dentists; however, the compensation package for dentists was almost triple that of dental therapists.
The evidence revealing the need for improved access to dental care and the quality, safety, and efficacy of the care provided by dental therapists is overwhelming. If organized dentistry is in fact an evidenced-based profession, dentists must recognize the evidence and support the implementation of dental therapists into the oral healthcare team. Dental therapists are a positive development for both patients and dentists.
About the Author
Frank Catalanotto, DMD, is a professor in the Department of Community Dentistry at the University of Florida College of Dentistry. The views expressed in this article are his own and do not reflect the official viewpoint of any organization that he is associated with.