The Great Dental Therapist Debate

Like many other dental students, I’m from a state that doesn’t have its own dental school. Unfortunately, this leads to a very high lack of access to care for the residents of my home state, New Mexico. When speaking to several members of the NMDA about issues that are impacting our state, the words “mid level care providers” and “dental therapists” inevitably pop up. My basic assumption of these words (which are one in the same) at the time was “a non-dentist” that can perform “dentist” duties. Those are scary words to hear as a dental student, investing hundreds of thousands of dollars and four years of my life, only to have the same job done by somebody who has only received a bachelor’s degree. I decided to dive a little further into the subject about the pros, cons, regulations, and education requirements surrounding the dental therapist…so here we go!

The Basics….  

• Dental therapists operate under a dentist’s license in an office or satellite clinics. Their basic duties vary depending on each state’s rules.
  • Scope of practice includes fillings, seating crowns, performing extractions, adjusting dentures, diagnosing radiographs, making treatment plans
• Dental therapists are currently practicing in Minnesota, Maine, and Alaska. There are different names for the profession popping up in legislature all over the country (including Colorado)
• Two types:
  • Dental therapist-
    • Requires a bachelors’ degree in Dental Therapy with several licensure and competency exams in order to practice. May perform some services under “indirect supervision,” which means a dentist must be on-site to authorizes procedures, or under “general supervision,” which means the dentist is off-site and must still authorize procedures.
  • Advanced dental therapist-
    • Dental therapy degree along with a masters’ degree in Advanced Dental Therapy which requires 2,000 hours of clinical practice and a certification exam. They may do all that a dental therapist can do, and also perform oral evaluations, treatment plans, and non-surgical extractions of teeth.
    • Practices under the supervision of a dentist, but all procedures can be completed under “general supervision.”

The Case FOR Dental Therapists…

• Contrary to what many believe, there isn’t a lack of dentists in certain “at need” states, rather a lack of distribution. This can be alleviated by dental therapists working at satellite clinics in rural areas addressing basic needs of the community without patients being forced to travel to far-away dental offices.
• They only perform routine care, so it opens up the dentist’s schedule to perform more complex care like endodontics, prosthodontics, and implantology, while still addressing basic needs of the office’s patient pool. This is viewed as a way to expand a dentist’s practice and maximize profit.

The Case AGAINST Dental Therapists…  

• It is a common opinion within the dental community that if Medicaid and insurance reimbursements didn’t drive practitioners to lose money on certain procedures, many more would practice in areas where fee-for-service dentistry isn’t the norm. Many dentists believe that more changes to Medicaid and insurance reimbursements need to be made in order to drive practitioners to “low income” areas.
• States should address access to care issues by reimbursing dentists who work in rural areas. Dental therapists have the ability to work on simple cases, but comprehensive care is the only way to effectively provide dentistry that is at the standard of care.
• The ADA believes that the “one-size-fits-all” model provided by dental therapists is not the best way to reach populations that live in rural communities.
• Dentists do not want their profession’s quality to be in jeopardy with the addition of therapists who are less educated in dentistry.

In the end, it is up to YOU as a dental professional to decide what is best for you, and most importantly, the patients in your home state. Being involved in your local ASDA and ADA chapter will make a difference whether dental therapists become a reality where you live.