New Dental Therapy Program Could Ease Shortage

But the Oregon Dental Association remains critical of the effort despite its success in Minnesota and Alaska
The Lund Report

May 19, 2010 -- Serious discussions are under way about creating a new category of dental care providers to deal with the impending shortage of dentists, similar to efforts in Minnesota and Alaska. But the Oregon Dental Association is raising red flags.  

“Will the program be able to deliver quality care at a reduced cost? That’s a huge question mark,” said Dr., Rick Asai, president of the ODA, who’s critical of the effort and believes prevention is the best approach. “The dental therapist’s salary will be less than a dentist, but what they can deliver will also be less.”

Dr. Gary Brooks, who practices dentistry in Willamina, believes dentistry will be “dragged in screaming and kicking. It will happen whether the Oregon Dental Association wants it or not. They need to get on board,” he told the Rural Health Coordinating Council recently.  
“Every place this legislation has moved forward, it has done so without the support of the dental community,” Brooks added. Sources close to the legislative effort in Minnesota confirmed that the Minnesota Board of Dentistry was not on board before lawmakers approved the program last year.  

Before a new educational program gets under way in Oregon, the legislature would need to give its blessing. These mid-level dental care therapists would receive training at a two-year community college, and work in community clinics and county health departments.
Senator Laurie Monnes Anderson (D-Gresham), who chairs the Senate Health Care Committee, has heard that “there’s something coming down the pike,” but hasn’t been briefed on the details.
Mid-level providers would fill a crucial gap in Oregon’s oral healthcare delivery system, said Monnes Anderson, who’s concerned about its potential price tag. “Access is a huge issue, but so is cost containment.”

The lack of a dedicated dental therapy training facility is a definite stumbling block, Brooks said. “A school would have to be built and paid for by the state, and [the students’] education would likely be paid by the state because they would work in a public health clinic.”
Heidi Jo Grubbs, a dental hygienist, welcomes the idea of dental therapists working with other oral healthcare providers. “Mid-level providers would be a benefit. They’d help us address how short we still are on providing care. There are conversations going on about this nationwide. This ball is rolling; we’re not going to stop it.”

Dr. Karl Self, who runs the dental program at the University of Minnesota and helped design the school’s dental therapy curriculum, said the greatest acceptance came when dental therapists were part of a team and were able to train with other dental providers.  

“Our dental therapy students take classes together with dental and dental hygiene students,” said Self. “That way, the dental team understands each other’s education level and skill set.”

The W.K. Kellogg Foundation, which lent its support, looked at countries such as Australia and New Zealand where dental therapists have been part of the oral healthcare system for decades. They found that “the biggest barrier in those countries was acceptance [of the therapists] by dentists,” said Self. “The greatest acceptance came where dental therapists were part of a team and other dental providers got to train with them.”

Alaska, meanwhile, established its dental health aide therapist program in 2003 where native Alaskans work in a rural village similar to where they grew up.

Oregon received a “C” grade from the Pew Center on the States in 2007 for only meeting half of the eight benchmarks for providing quality oral healthcare to children. According to a 2006 report by the Oregon Oral Health Coalition, 67 percent of all Oregonians visited a dentist in 2004, but just 19 percent of those on the Oregon Health Plan did, despite this subgroup’s high incidence of oral disease. This underscores the vast amount of unmet need in low-income populations.

Learn More

For a press release summarizing report on MN, AK programs click here.

Summary of dental therapy program at University of Minnesota click here.

Official UMN page for dental therapy program click here.

Official Alaska DHAT program page click here.

Web link to full Kellogg Foundation report click here.

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The proposed dental care initiative is one of many such efforts that are absolutely required, in more than one area of health care, if we are to democratize access to care and deal with the shortage of providers for basic health services. Our safety net is overloaded everywhere, but basic dental care is one of the worst examples.

The problem with this article is we are all buying into the trap of perpetuating a paradigm that does not work in a population who's disease is out of control. We are going to waste, in my opinion, prescious time, money and resources putting together a program to create access to care to fix the ravages of a disease, namely cavities in teeth. We do not need anymore whole drillers regardless of how little we pay them. We do not need more extractors of teeth or denture builders. What we need is a system that knows how to get the existing technology implemented that prevents the cavities, the holes in the teeth, the teeth having to be removed and replaced. We have a good dental system that takes pretty good care of 60% of the population, those that know how to self regulate and make their life work. This same dental system does not work for those that are unable, for whatever reason, to self regulate and make their life work. How would it be to have a system that allows people to never have the ravages of the dental infection that is passed from the primary caregiver, usually the mother, to the child in the child's first 6 months of life. We have the technology to do this and amazingly it does not take a dentist to apply it, and it is very inexpensive. Recently, I had a discussion with some County workers who were frustrated because all the children under their care had to drive 35 miles to see a pediatric dentist to get there cavities fixed. I suggested they would not have to do this if they would help get the pregnant mothers to the local dentist to get their oral disease load reduced so they had less chance to pass the infection to their new child. I also suggested they get the 12 month old children to the local dentist before they had cavities. Then they would not have to drive the child the 35 miles to the dentist. All the mobile clinics, school based clinics, mid level providers in theworld are not going to solve the problem of decay in a population whose disease is out of control. We will not be able to fix them fast enough. Why not put these same resources into developing a system that actually prevents the results of the infection that causes the cavities.

I agree to some extent that we need to address the issues related to self maintenance. But the real purpose is to provide care givers that are willing and dedicated to work on the undeserved populations. Regardless of weather you think it or not Dental offices are businesses and DDS practitioners are not in the business of losing money. They regularly forgo care to medical assisted patients due to the poor state payback. The Dental Therapist we be able and also required to take care of this portion of the population. After viewing some of the posts on it is apparent that the current first classes of dental therapy students truly care about easing this shortage and have chosen this career path in order to help rather than profit. This is a GOOD THING!

I can't believe the last comment I just read, that said 40% of the Oregon population is undeserved and 60% know how to make their lives work. Not! No one chooses to be poor unless you have taken a vow of poverty as a monk or a nun would in the Catholic church. The facts are Oregon has a high rate of low income because Oregon's logging industry collapsed leaving a large displaced workforce. So now Oregonians find themselves with a large unemployed workforce and poor children. It is a sad state of affairs when we treat the poor children in this country with contempt. The problem here in Oregon is that almost half of the population is going without dental care of any kind. Just because they can't afford the cost of care. Shame on Oregon for neglecting the children and the poor among us. I just moved down here a few years ago from the Seattle area where I lived and worked for 30 years and I have never seen such a large population of toothless people as I have seen here in Linn County. The dentists here should hang there heads in shame at letting these people go without. I have never seen so many people without teeth. I feel like I have moved into a 3rd world country here in Linn county. It not just a few people either. Where are the Dentists? I can't believe they can't see the state of things. Something needs to change and if it takes the Dental Association to come in and force the Dental community here then so be it. Obviously if the dentists here cared they wouldn't have let this become such an epidemic. So we need to first educate the Dentist Community to see that they need to get out into there communities and get to the children when they are toddlers and in kindergarten. It is part of educating the public is going into the community and doing your best to educate and get to the children. The low income residents would bring there kids in if they could afford the care. So, if they would just start out by serving the children with education and annual visits. They learn early on how important good hygiene is. Studies show that if you take care of baby teeth they grow up and take care of their permanent teeth too. Oregon Dentist please wake up and look around you at the people in your communities and take some pride in doing the right thing. I don't think it says a whole lot for the caliber of Dentists here if they feel the same way as you do. Anyone with eyes can see the needs here. It just makes sense to offer the children good dental care as they will grow up and become the adults. I just wonder how many Dentists or Hygienist in this communities ever went into the schools and showed the children how important dental care is? Parents cannot teach something they don't do themselves. We need to stop the cycle in this state. Get the children into see the dentist earlier the better, offering there parents affordable dental care at the same time. Then allowing the low income to pay by sliding scale. Let's stop making this an issue of the haves and have nots. Let's take pride in our communities helping those most at risk go out into the world with a mouthful of nice healthy teeth. Instead of a mouthful of cavities and disease. Don't you know that the kids with poor dental care do not go on to marching bands, proms, high school graduation and onto college. Without nice teeth they don't even get there first jobs. Because of low self esteem, they get fat sit around in front of the TV and never go to prom or graduate and end up living in poverty having more children that continue this awful cycle. The kids with poor dental care do not end up on honor rolls instead they end up as crimmals. But, with affordable dental care and education we can help stop this cycle. When children are treated like they matter as much as the kids with coverage you will see that they do take advantage of all that is offered. I can't think of a better thing then giving the children of Oregon a mouth full of nice clean teeth, so they will feel good about themselves. Someone needs to explain to these dentists here in this state that they would have more patients if they hooked up the children first. Adults with nice teeth will find away to take care of there teeth so you end up with patients for life. What is there a nicer thing then that?