GUEST COMMENTARY: Dental therapists solution for rural oral health

Tuesday, February 2, 2010 | 12:01 a.m. CST; updated 10:52 a.m. CDT, Tuesday, May 4, 2010

Missouri’s oral health is among the worst in the nation. The Centers for Disease Control and Prevention ranked the state 47th in terms of the percentage of the population that visited a dentist last year, and according to the Missouri Department of Health and Senior Services, 50 of Missouri’s 114 counties have a shortage of dental professionals.

In response to this public health crisis, the Missouri Department of Health and Senior Services released its 2009 statewide oral health plan, which addressed the difficulty of recruiting dentists to rural areas.


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Although the plan points out that enabling improved oral hygiene and regular visits to a dental practitioner would narrow the disparity, it fails to address an underlying cause of Missouri’s dental predicament: the professional licensing law, and its restrictive definition of who can provide dental care in Missouri.

Alaska had a similar dental problem in its tribal areas, which had the worst rates of oral health in the country. Alaskan dental therapists — trained to do most basic dental work such as drilling and cleaning but not oral surgery — became a much-needed solution to the problem. The American Dental Association sued the Alaskan Native Tribal Health Consortium as a result, and the two groups ultimately reached an agreement that limited the program’s scope.

The American Dental Association argued that dental therapists cannot adequately provide health care. However, a 2008 pilot study of the Alaskan program, funded by Texas A&M University, did not find any significant differences between the quality of care provided by dental therapists and dentists.

Other groups have argued that there are too many dentists already, and that opening the market to para-professionals is unnecessary. If dentists are so accessible, though, why are Missouri’s oral health outcomes so much lower than other states?

Cost and access are both issues, even those who can conveniently reach a dentist may deem dental services to be too expensive when money is tight. Dental therapists, because they require less training, are able to provide comparable care for a wide range of dental services at a more affordable rate. Those who need more than basic drilling and cleaning can be referred to a professional dentist.

Dental therapists would not replace dentists. Already, dental hygienists provide the majority of basic dental care before patients see a dentist. Also, in the same way that some people prefer to see a general practitioner rather than a nurse practitioner, some will always prefer a professional dentist to a para-professional. Dental therapists merely provide a less expensive alternative for those who cannot afford a professional dental checkup.

Dental therapists have been successful in England, Canada and Australia at providing quality dental care. In Australia, dental therapists are proving their worth beyond the provision of basic oral care. A recent study from the Australian and New Zealand Journal of Public Health found that nearly 94.6 percent of restorations performed by dental therapists were successful and that patients were satisfied. The National Academy for State Health Policy published an article in 2007 explaining how dental therapists can improve children's oral health, especially in areas without proper coverage.

Throughout the United States, new legislation is capitalizing on the international success of dental therapists. In the spring of 2009, Minnesota passed a bill creating a bachelor’s degree program in dental therapy.

Opening the market to dental therapists provides more than just quality, affordable health care. It also provides jobs, especially in depressed rural economies that have trouble attracting professional dentists on a permanent basis. A change in the law would benefit both those newly employed therapists and their patients, who would have significantly better access to dental care. This is an important contributing factor to general human welfare, because improving oral health helps to improve overall health. A study from the University of Genoa in Italy has indicated that gum disease is correlated with increased risk — and is potentially a contributing factor — for other health problems, such as heart disease.

Dental therapists provide an economical way to combat tooth decay, and public health officials have already suggested plans to implement training programs in the United States. The only obstacle to their introduction in Missouri — and to subsequent improvement in the oral health of Missourians — is the regulatory barrier of Missouri’s professional licensing law.

Caitlin Hartsell is a public health graduate student at Washington University and an intern for the Show-Me Institute.

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Kathy Reincke February 2, 2010 | 3:31 p.m.

Thank you for this thoughtful piece on the promise of dental therapists to improve dental health in Missouri. Unfortunately, the problems facing your state are all too common across the United Sates. There are approximately 48 million children and adults in this country who live in areas without enough dentists to provide routine oral health care.

Here at the W.K. Kellogg Foundation, we supported the development of the dental therapist training program in Alaska that you mention along with three partner foundations. Prior to establishing this U.S.-based training program, students traveled to New Zealand for training, and returned to practice in Alaska. Today, there are 12 dental therapists practicing in Alaska, six more graduated from the Alaska-based training program in December 2009, and could be certified in June 2010.

In December 2009, the W.K. Kellogg Foundation released a report authored by Dr. Burton Edelstein, offering an independent analysis of the training of dental therapists and other existing and proposed dental health professionals. You can download the report here: I encourage you to take a look at the report to learn more about this mid-level oral health provider.

Kathy Reincke, Communications Manager
W.K. Kellogg Foundation

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