Dental therapy in the United States: Are developments at the state level a reason for optimism or a cause for concern?

Abstract

Access to dental care continues to be a challenge for millions of vulnerable Americans. In more than 50 nations worldwide, dental therapists (DTs), midlevel providers who deliver a limited scope of dental care under the supervision of a dentist, have helped increase access to needed care. Since 2003, when the Alaska Native Tribal Health System introduced DTs as part of the Federally authorized Alaska Community Health Aide Program, a total of 13 states have adopted the role. However, as of April 2020, there are fewer than 150 DTs in practice throughout the country, and educational and licensing requirements as well as scope of practice vary between each state. Such heterogeneity makes the training and recruitment of future DTs a challenge. This article summarizes the current state of the DT workforce in the United States and discusses the possible future of the profession as other states contemplate adopting the model in the face of ongoing oral health disparities.

Comparison of Dental Care Visits Before and After Adoption of a Policy to Expand the Dental Workforce in Minnesota

“…9 In the United States, the Alaska Native Tribal Health Consortium was the first body to authorize dental therapists to practice in 2004; as of 2020, 13 states and tribal nations had authorized dental therapists, and many others are considering it. 8,[10][11][12] The primary aim of adding dental therapists to the dental team is to improve the affordability of dental care to expand access for underserved populations, particularly low-income and uninsured individuals in rural and tribal areas. 10 Critics of the policy have raised concerns about the quality of care provided by dental therapists and the overall influence on population oral health.…”

“…9,[15][16][17] This situation is in part due to the small number of individuals practicing (approximately 150 in all) with the majority of dental therapists practicing in Minnesota. 11 Regardless of the debate over dental therapists, the adoption of this model is increasing, and it is emblematic of states' willingness to adopt scope-of-practice policies as a key strategy to eliminate disparities in oral health care access. Seven states recently authorized dental therapy; Arizona and Michigan adopted the policy in 2018, and Connecticut, Idaho, Montana, Nevada, and New Mexico adopted it in 2019.…”

“…12 In 2009, Minnesota authorized dental therapists to practice in underserved communities, including health professional shortage areas and in settings with at least 50% of patients with Medicaid coverage or uninsured. 11,12 The aim of this study was to examine whether authorizing dental therapists was associated with improved dental care use. Our hypothesis was that dental therapists, although few in terms of measuring direct influence, can be used as a proxy for gauging attention to the issue and willingness to innovate at the state level.…”

“…9,[15][16][17] This situation is in part due to the small number of individuals practicing (approximately 150 in all) with the majority of dental therapists practicing in Minnesota. 11 The synthetic control approach is similar to the difference-in-differences design, which is a common quasi-experimental design used to examine policy effects. However, it requires fewer assumptions and also controls for unmeasured time-varying factors.…”

Inequity Along the Medical-Dental Divide

“…Yet as we work to bring about needed change both inside and outside of health care, there is also an opportunity to rectify the exclusion of oral health care from health policy and health delivery systems. Many groups are making remarkable strides to do so-from sovereign tribal nations training a unique oral health workforce to meet community need 4 to accountable care organizations that integrate oral health services into primary care funding. 5 Health policy initiatives to increase integration of behavioral and physical health and to address the social determinants of health can serve as paths forward for oral health care innovation as well.…”