Dental Therapists Fill a Void but Dentists Question Their Credentials

PHOTO: Dental therapists, and non-dentists are now able to earn a certificate so they may be able to pull teeth, fill cavities and perform root canals.
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Nearly 17 million U.S. children fail to see a dentist every year, according to the Pew Charitable Trust. Now, a new group of dental professionals, called dental therapists, is hoping to bring them treatment.

Dental therapists receive specialized training, including how to perform local anesthetic, cleanings and apply sealants in kids and adults. The hope is that the specialized groups trained in some dental procedures will ease the burden of the growing gap in dental care, particularly for children, the Los Angeles Times first reported Sunday.

"They say they're only going to do simple procedures but, oftentimes, you can't say whether it was simple or not until after you're finished and you decide it was simple," said Dr. Howard Gamble, president of the Academy of General Dentistry.

Gamble said even most dentists right out of dental school do not jump into their own private practice. Instead, many work under another dentist who has more experience for a few years.

Alaska set up the first dental therapy program in 2005 for people living in rural tribal areas.

The Minnesota legislature passed legislation in 2008 that created a task force to determine how a midlevel dental provider should be created in the next legislative session, said Dr. Karl Self, head of the department for Dental Therapy Programs at the University of Minnesota School of Dentistry in Minneapolis.

Students enter the dental therapy program after completing a minimum of one year of prerequisite college course work. The full-time, 28-month program blends a solid dental clinical education, with the biological, behavioral, and social sciences, and the liberal arts, said Self.

California, New Hampshire, Oregon and Connecticut are states that are considering the practice.

"Our country's health-care system needs to continue to evolve in order to improve the health of its citizens," Self said. "This includes reducing health disparities as well as meeting the challenges of increasing access to care while increasing the quality of care and lowering the cost of care."

But Dr. Bill Calnon, president of the American Dental Association, said the solution isn't so simple.

"This is a very one-dimensional answer to an extremely complex problem," Calnon said. "People who are proposing this believe that more people treating individuals will solve the problem, but we're finding this won't necessarily help."

Neither Gamble nor Calnon believes the new wave of dental therapists will make general dentists lose business, but there are a "tremendous" number of barriers that should be examined, including education, cultural differences and geographical location, Calnon said.

"The vast majority of dental disease in this country is preventable," Calnon said. "That's good news and bad news. We have to figure out how to convince and educate people on oral health literacy."

Instead, to curb the growing gap of dental care in the United States, Gamble suggested education is key in teaching people how and when to brush and floss. It's also important to encourage people to put down the sugary foods and drinks. Gamble also suggested giving tax credits to dentists who work in underserved or rural populations.

But Self said dental therapy could be another tool in the arsenal to help kids get the dental care they need, particularly in the development years.

"While there is no one solution that will eliminate access to care issues or eliminate health disparities for our underserved populations, I believe that dental therapy can be an important piece that will contribute to improving those issues," said Self. "In Minnesota, legislation requires the dental therapist to work primarily in settings that serve low-income and underserved patients or in a dental health professional shortage area."

Self said the idea of midlevel professionals to provide basic dental work has been discussed for years. Now, he said, it's time to take action.

"It is encouraging that new and creative solutions are being discussed in every state," Self said. "But we need to do more than just talk, we need to implement some of these ideas."

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