Midlevel practitioners known as “dental therapists” are improving the retention rates of dental practices and enabling them to serve more low-income patients, dentists told researchers conducting a site visit to the University of Minnesota School of Dentistry on November 14.
Dental therapists are trained to perform numerous preventive oral care services and minor procedures as members of a dental team supervised by a licensed dentist. Uncommon in the United States, the profession of dental therapy originated in New Zealand in 1921 and is practiced in more than 50 countries and territories, according to A Review of the Global Literature on Dental Therapists, a 2012 report by the W.K. Kellogg Foundation.
Alaska, Minnesota, and a Native American tribe in Washington State have dental therapists currently practicing. Maine and Vermont have approved legislation authorizing licensure of dental therapists, and Oregon has cleared two Native American tribes to hire dental therapists, according to The Pew Charitable Trusts.
In Minnesota, dental therapists must obtain a baccalaureate or master’s degree from a dental therapy program, demonstrate clinical competency, and pass an exam on the state’s dentistry regulations. “Advanced dental therapists” must hold a master’s degree in dental therapy, pass additional testing, and have practiced at least 2,000 hours under a dentist’s supervision.
Dr. David Maki is dental director at Dental Associates Minnesota, a for-profit practice with a mission of increasing access for low-income patients.
Dental Associates of Minnesota employs a dental therapist and two advanced dental therapists. Maki says his offices in St. Paul and Savage would be unable to treat their current volume of low-income patients without them.
“Without dental therapists, our dentists would be booked out for weeks,” Maki said during a panel at the University of Minnesota School of Dentistry site visit.
Another panelist, Alyssa Beaulieu, operations manager at Children’s Dental Services in Minneapolis, said dental therapists free up time for dentists to perform tasks requiring a dentist’s license.
“Dental therapists are community-based and more continuously present than dentists,” Beaulieu said. “They free dentists to operate at the top of their licenses.”
Higher Retention Rates
Maki says hiring dental therapists has resulted in more return business.
“We’ve seen about a 15 percent increase in our patient retention since bringing on dental therapists,” Maki said.
Dr. Kevin Nakagaki, a dentist at the nonprofit health care organization HealthPartners, says dental therapists offer patients value dentists sometimes do not.
“They are much more education-motivated, so they are often much more articulate in explaining care to patients,” Nakagaki told the panel audience. “Your retention level can go up.”
Dental practices and health care organizations in the state bill patients, insurers, and Medicaid for care provided by dental therapists at the same rate as care given by dentists. The lower salary of therapists compared to dentists maximizes profits for dental practices and savings for nonprofit organizations treating Medicaid patients.
In this way, dental therapy makes taxpayers’ money go further, Nakagaki says.
“I don’t see the Medicaid reimbursement rate in Minnesota increasing, so we need to work smarter,” Nakagaki said.
Scope of Practice
The investment required for an employer to train a dental therapist is comparable to that of training an associate dentist, Nakagaki says.
“It’s very similar to managing a new associate [dentist] in your practice, so it gets easy fast,” Nakagaki said.
Beaulieu says dental therapist training is equal to that of licensed dentists within the therapist’s narrower scope of practice.
“Advanced dental therapists and dental therapists undergo the same licensure tests [as dentists] for the services they provide,” Beaulieu said.
Nakagaki says a narrower scope of practice allows dental therapists to receive more training than dentists for certain procedures.
“Dental therapists are actually doing more of the same kinds of procedures by the time they leave school than dental students, because the dental students spread out,” Nakagaki said. “They have to do more kinds of procedures.”
Every dental therapist practices under the indirect or general supervision of a dentist, usually the employing dentist with whom the therapist has a collaborative management agreement. Therapists performing procedures requiring indirect supervision must treat patients at the same site as their supervisor. Tasks requiring only general supervision can be performed without a dentist on site.
Nakagaki says he rejects objections from dentists who say dental therapists are not qualified to identify tooth decay.
“What I say to that is we train dental therapists to cut into a tooth and train them when to stop when they see decay,” Nakagaki said. “If you know what decay is, you know what decay is.”
Naysayers of dental therapy are crying wolf, Nakagaki says.
“There is a lot of talk out there [as if] you’re going to kill somebody [and] there will be blood in the streets,” Nakagaki said. “Our dental therapists know when to stop. We have not had any concerns by the supervising dentists, so it’s not a quality issue.”
Michael T. Hamilton ([email protected]) is a Heartland Institute research fellow and the managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.
Mary Tillotson, “States Consider Authorizing Dental Therapy to Expand Access,” Health Care News, The Heartland Institute, October 3, 2016.
“Early Impacts of Dental Therapists in Minnesota,” Minnesota Department of Health and Minnesota Board of Dentistry, February 2014.
David Nash, A Review of the Global Literature on Dental Therapists, W.K. Kellogg Foundation, 2012.
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