New Dental Therapy Program Could Ease Shortage
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.
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.