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Pontics & Politics: The Skinny on Dental Therapists

Our ASDOH vs. Midwestern Pontics & Politcs debate is happening a in a few hours! Here’s what to know beforehand:

Who are dental therapists? Dental therapists fall into the category of midlevel providers. Essentially, dental therapists are to dentists as physician assistants are to medical doctors. Dental therapists can provide simple diagnostic, preventative and restorative care. Examples of procedures they perform include filling cavities, placing temporary crowns, and extracting teeth. [2]

Why are they here? Dental therapists as an idea grew out of the need to address access to care challenges. The goal with dental therapists is to reach a greater expanse of vulnerable populations. Interestingly, the concept of dental therapists is not new to the international community. Countries like the United Kingdom, Australia, New Zealand and the Netherlands amongst others, already employ dental therapists. Although their training and specific responsibilities may differ, they all serve to expand the supply of dental services, especially in underserved areas. [4][6]

Are they effective? Who is for and against it? The literature is limited concerning the impact dental therapists have on the quality of patient care or utilization of dental services in the US. Global literature too is limited. Some papers appear to shine a positive light on the effectiveness of dental therapists, specifically in the setting of public, school-based programs. [5] Canada, however, closed their last dental therapy training program in 2011 and the country seems to be phasing out dental therapists, looking toward an alternative model to alleviate their access to care concerns. [7] Though US data on the subject is still growing, the debate is on, and there are a number of organizations that have responded to this new issue.

The PEW Charitable Trust (non-profit/NGO that funds the third largest think tank in DC, the PEW Research Center) is part of the campaign to authorize dental therapists in Arizona, as is the Arizona Rural Health Coalition and Navajo Nation. They believe the underlying problem to access to care is the shortage in the supply of dental providers, and by implementing midlevel providers, we can increase the supply and meet the demand. [2]

The AzDA on the other hand believes the underlying problem to access to care is the cost of dental services, not necessarily the lack of dental providers. They state the net number of dentists has actually increased over the last decade and has matched population growth. They feel that by increasing Medicaid coverage of dental services, they can reach a greater population of the underserved. AzDA executive director, Kevin Earle says, “We believe it is the wrong diagnosis and the wrong prescription.” [1] The ADA believes it is more beneficial to bring together underserved people seeking dental care and dentists already available to provide care rather than adding a new category of providers. This would be accomplished via outreach by community health care centers and Medicaid reform. ADA’s Health Policy Institute has concluded that adding 1% to the Medicaid budgets of 22 states can add extensive dental benefits to their existing program, which would in turn increase the number of dentists participating in the program and expand to care to underserved areas. [3]

– Chandani Shukla, ASDOH ’20

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