Dental therapist clueless about scope of practice (news article attached)

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TJNova2011

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Saw this on dental town (link and regulations) and felt it is extremely important that the public can understand a dental therapist's mentality and quite possible, one's arrogance.

"To know that you do not know is the best.
To pretend to know when you do not know is a disease."
Lao-Tzu

Maybe the disease the therapists are trying to fill, is within themselves.

DT: At no surprise, the new dental therapy graduating class is unaware of their practice boundaries. Under the Minnesota Statute Section 150A.10., dental therapists, which Allred is, are not allowed to completed comprehensive, periodic or limited oral examinations. Advanced dental therapists are allowed to completed periodic and limited oral evaluations under general supervision. Basic dental therapists are allowed to place SSC on primary or permanent teeth under indirect supervision. I am curious how his statement is close to reality and their regulations.

Ironically, dental therapist take few courses with the dental students and participate in a majority of the courses that the University of Minnesota's dental hygienists complete. They lack any course work in microbiology, endodontic treatment (aside basic lectures in pedodontics course) and very limited in pathology.

This is a private practice dentist in Wadena, MN at Woodland Dental under Dr. Ryan Anderson

Allred also said his range of care is more limited than that of a conventional dentist, but he can provide exams, x-rays, fillings, some crowns and almost all aspects of child dental care, for those on medical assistance. However, extractions of teeth, dentures and root canals for adults would have to be referred to someone else, Allred said.

http://www.perhamfocus.com/event/article/id/23019/

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I don't understand why there is a need for this new type of occupation? Especially considering the saturation of dental professionals in large metropolitan areas. Another for-profit education industry ploy perhaps?
 
I don't understand why there is a need for this new type of occupation? Especially considering the saturation of dental professionals in large metropolitan areas. Another for-profit education industry ploy perhaps?

yes. also after education is done making a profit off all the warm bodies the heath care admin crowd (politicians, bureaucrats, insurance companies, etc) will invariably use it as a pathway to detour the dentist as intelligent cash flow manager.
 
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I don't understand why there is a need for this new type of occupation? Especially considering the saturation of dental professionals in large metropolitan areas. Another for-profit education industry ploy perhaps?

You nailed it!
 
I don't understand why there is a need for this new type of occupation? Especially considering the saturation of dental professionals in large metropolitan areas. Another for-profit education industry ploy perhaps?

Yes, because post graduation does not look too bright for the therapists. On a positive side, a majority reside in the metro area. Additionally, most could not achieve admissions into dental school. Hopefully the law suits start against them or the therapists attempt to sue the institution for being poorly trained in their 10.5 month short course of clinical dentistry. This does not include many breaks and vacations that they take. They see an equivalent of 3.5-4 months of patients (2 a day) and, not surprisingly, come out grossly undereducated in clinical dentistry.

It is important to note that more students claim they are held to the same standard as the University of Minnesota dental students, and it is a false claim. They take a majority of courses with hygiene and a few with the dental students (graded on a different curve, too!),
 
Yes, because post graduation does not look too bright for the therapists. On a positive side, a majority reside in the metro area. Additionally, most could not achieve admissions into dental school. Hopefully the law suits start against them or the therapists attempt to sue the institution for being poorly trained in their 10.5 month short course of clinical dentistry. This does not include many breaks and vacations that they take. They see an equivalent of 3.5-4 months of patients (2 a day) and, not surprisingly, come out grossly undereducated in clinical dentistry.

It is important to note that more students claim they are held to the same standard as the University of Minnesota dental students, and it is a false claim. They take a majority of courses with hygiene and a few with the dental students (graded on a different curve, too!),

This is a best case scenario.

Worst case, a bunch of corporate sized business/politicos get together and start up a bunch of chain 'Dental Therapy Clinics' and they pop up all over the U.S. like so many Taco Bells. Within a couple of years adios to the bread and butter of dentists. The real reason this is repulsive and just wrong is because the procedures are IRREVERSIBLE and dental care will be forever lowered to third world quality.
 
This article mentioned that Allred is “no typical dentist.” Well, guess what? He’s not a dentist at all! Unfortunately, the general public probably won’t realize this or most likely, won’t care. Dentists are going to be taking one in the kisser if this legislation expands to all 50 states (which it probably will).
 
This article mentioned that Allred is “no typical dentist.” Well, guess what? He’s not a dentist at all! Unfortunately, the general public probably won’t realize this or most likely, won’t care. Dentists are going to be taking one in the kisser if this legislation expands to all 50 states (which it probably will).

[YOUTUBE]http://www.youtube.com/watch?v=AzQaHD2-oV4[/YOUTUBE]

The therapist think they are dentists. They cannot diagnose, although Allred claims he can. I'd probably want dentistry done by the folk in the video versus a therapist :idea:
 
[YOUTUBE]http://www.youtube.com/watch?v=AzQaHD2-oV4[/YOUTUBE]

The therapist think they are dentists. They cannot diagnose, although Allred claims he can. I'd probably want dentistry done by the folk in the video versus a therapist :idea:

^^It is heartening to see there is still ZERO tolerance for this sort of thing.

"June 10, 2011
ADA responds to AAPHD educational plan for two-year dental therapist programs":


http://www.ada.org/news/5940.aspx

^^"“AAPHD believes that adding dental therapists as members of the dental team may help meet growing U.S. oral health needs, particularly among underserved populations,” read a news release from AAPHD...

...“While we appreciate the work that went into [the AAPHD papers], we disagree on a critical point: The ADA does not believe a nondentist should perform surgical/irreversible procedures."...

... "the Association will not erode its unequivocal opposition to nondentists performing surgical/irreversible procedures, or to other proposals that we believe run contrary to the public good.”"

Read the entire ADA comment here: http://www.ada.org/5939.aspx.
 

"Dental therapist Jason Allred will soon be setting up shop inside Woodland Dental in Wadena. However, he’s no ordinary dentist. In fact, there are only about 20 people like him in the entire country, Allred said."

^^the ignorance displayed by the writer of such tripe as this knows no bounds. The reader is led to believe by the end of the second sentence that this NON-dentist is somehow even BETTER than a genuine Dentist.:rolleyes:

Misleading, inaccurate and undermining of what goes into the title 'dentist'.:thumbdown:
 
Stop the partial truths or complete lies. Microbiology is a pre-req or co-req for U of MN dental therapy profession. A couple of courses are graded on a curve but please note that these courses were when the 1st year dental therapists took courses with the 2nd year dental students. The most important argument is that dentists and soon to be dentists will always be in a higher professional status than the midlevel provider. I have read too many insults on the SDN about dental therapists (i.e. can’t even add 1+1 etc.) I have completed a rigorous math major (including Vector Calculus, differential equations etc. ) for my bachelors and I graduated with honors. I am not unique in my qualifications as I know other DTs who are also very qualified. We have made tremendous sacrifices for this profession and the market is very difficult. Some comments are degrading, hurtful and insulting. Stop them and focus on real issues to solve a growing and difficult problem.

The obvious consensus is that the reimbursement rates from government insurances are too low, overhead is high, student loans are high, and growing numbers of populations including children suffer from high amounts of tooth decay. This problem will continue to get worse. The fact that medical midlevel providers have been successful for 30+ years in the US should not be overlooked. Many other countries use a dental midlevel provider. The University of Minnesota researched these different models and is very concerned about the quality of the dental therapist who graduate from the dental school. The idea that assigning a midlevel provider to complete easier procedures which then allows a dentist to work on more complex and profitable treatments is happening now. Please see:
Dr. John Powers: http://www.youtube.com/watch?v=fP7M2hRzCrU
Dr. Shiraz Asif: http://www.youtube.com/watch?v=nGQmHPonScM&feature=youtu.be
Obviously the dental therapist may not be the right solution for different offices and hopefully government insurance companies will increase the reimbursement rate as this still needs to happen. It is too early to make good statistical measurements although the ADA attempted as the profession is still very new. I know that many dentists are still anti-dental therapy. I would just ask these professionals and soon to be dental professionals to be civil. Definitely proper training of DTs and scope of practice are very important concerns. This dentist’s site is useful for discussion. http://www.higleydentalcare.com/den...factor-or-a-serious-competetion-for-dentists/ as some have voiced concerns about this. DTs have a limited scope and if a place needs a dentist, they will always hire the dentists over the therapists. He makes very valid points. I have read other anti-therapy concerns too. I know that I took a risk that might not prove to be very marketable but I do believe in this cause for which I took this risk.
 
Stop the partial truths or complete lies. Microbiology is a pre-req or co-req for U of MN dental therapy profession. A couple of courses are graded on a curve but please note that these courses were when the 1st year dental therapists took courses with the 2nd year dental students. The most important argument is that dentists and soon to be dentists will always be in a higher professional status than the midlevel provider. I have read too many insults on the SDN about dental therapists (i.e. can’t even add 1+1 etc.) I have completed a rigorous math major (including Vector Calculus, differential equations etc. ) for my bachelors and I graduated with honors. I am not unique in my qualifications as I know other DTs who are also very qualified. We have made tremendous sacrifices for this profession and the market is very difficult. Some comments are degrading, hurtful and insulting. Stop them and focus on real issues to solve a growing and difficult problem.

The obvious consensus is that the reimbursement rates from government insurances are too low, overhead is high, student loans are high, and growing numbers of populations including children suffer from high amounts of tooth decay. This problem will continue to get worse. The fact that medical midlevel providers have been successful for 30+ years in the US should not be overlooked. Many other countries use a dental midlevel provider. The University of Minnesota researched these different models and is very concerned about the quality of the dental therapist who graduate from the dental school. The idea that assigning a midlevel provider to complete easier procedures which then allows a dentist to work on more complex and profitable treatments is happening now. Please see:
Dr. John Powers: http://www.youtube.com/watch?v=fP7M2hRzCrU
Dr. Shiraz Asif: http://www.youtube.com/watch?v=nGQmHPonScM&feature=youtu.be
Obviously the dental therapist may not be the right solution for different offices and hopefully government insurance companies will increase the reimbursement rate as this still needs to happen. It is too early to make good statistical measurements although the ADA attempted as the profession is still very new. I know that many dentists are still anti-dental therapy. I would just ask these professionals and soon to be dental professionals to be civil. Definitely proper training of DTs and scope of practice are very important concerns. This dentist’s site is useful for discussion. http://www.higleydentalcare.com/den...factor-or-a-serious-competetion-for-dentists/ as some have voiced concerns about this. DTs have a limited scope and if a place needs a dentist, they will always hire the dentists over the therapists. He makes very valid points. I have read other anti-therapy concerns too. I know that I took a risk that might not prove to be very marketable but I do believe in this cause for which I took this risk.

Are you trolling? This doesn't seem real.

Anyway, DTs are probably not harmful if utilized as they are elsewhere. It's just that they may not be all that helpful either.

To suggest that dental therapists wouldn't be harmful to dentists from a business standpoint is kind of silly though. Regardless of the fact that dentists are more desirable for hire, the presence of technicians that can (legally) fulfill many of the same functions with a small fraction of the educational cost will almost certainly displace some dentists. And because of that, I wouldn't expect dentists, as a group, to respond positively to dental therapists for a very long time.

No worries about marketability though. I'd hire a DT. I mean, I could probably work him to the bone and pay him less knowing that he can't leave and set up his own practice. Hopefully dental therapists remain only semi-autonomous, and in levels low enough to avoid their fueling of the corporate dental model in the near future. That's the only way I could see them being harmful to patients, and that's only if you buy into the idea that corporate dental chains adhere a lower ethical standard.
 
...and that's only if you buy into the idea that corporate dental chains adhere a lower ethical standard.

Sorry sir, this is generally a fact, not a idea. I've known many people in corporate dentistry, my wife included, and I did my time as a corporate dentist.

The corporate chains would bar none hire a DT over a dentist because they could pay them less to do the same [marginal] work. In fact, I would probably hire a DT over a dentist if I worked as a corporate manager because on average, the DTs probably know just enough dentistry to make themselves dangerous. I.e. they wouldn't know enough about high levels of care or even comprehensive dentistry enough to think they could do better themselves. It will be a cash cow for these corporations.

If you are a DT and think otherwise, of course you do. I've known so many EFDAs that thought they knew everything about dentistry but, in reality, knew just enough to throw some material into a tooth and think otherwise.

Sorry for the reality check but to think anything else would just be lying.
 
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Stop the partial truths or complete lies. Microbiology is a pre-req or co-req for U of MN dental therapy profession. A couple of courses are graded on a curve but please note that these courses were when the 1st year dental therapists took courses with the 2nd year dental students. The most important argument is that dentists and soon to be dentists will always be in a higher professional status than the midlevel provider. I have read too many insults on the SDN about dental therapists (i.e. can’t even add 1+1 etc.) I have completed a rigorous math major (including Vector Calculus, differential equations etc. ) for my bachelors and I graduated with honors. I am not unique in my qualifications as I know other DTs who are also very qualified. We have made tremendous sacrifices for this profession and the market is very difficult. Some comments are degrading, hurtful and insulting. Stop them and focus on real issues to solve a growing and difficult problem.

The obvious consensus is that the reimbursement rates from government insurances are too low, overhead is high, student loans are high, and growing numbers of populations including children suffer from high amounts of tooth decay. This problem will continue to get worse. The fact that medical midlevel providers have been successful for 30+ years in the US should not be overlooked. Many other countries use a dental midlevel provider. The University of Minnesota researched these different models and is very concerned about the quality of the dental therapist who graduate from the dental school. The idea that assigning a midlevel provider to complete easier procedures which then allows a dentist to work on more complex and profitable treatments is happening now. Please see:
Dr. John Powers: http://www.youtube.com/watch?v=fP7M2hRzCrU
Dr. Shiraz Asif: http://www.youtube.com/watch?v=nGQmHPonScM&feature=youtu.be
Obviously the dental therapist may not be the right solution for different offices and hopefully government insurance companies will increase the reimbursement rate as this still needs to happen. It is too early to make good statistical measurements although the ADA attempted as the profession is still very new. I know that many dentists are still anti-dental therapy. I would just ask these professionals and soon to be dental professionals to be civil. Definitely proper training of DTs and scope of practice are very important concerns. This dentist’s site is useful for discussion. http://www.higleydentalcare.com/den...factor-or-a-serious-competetion-for-dentists/ as some have voiced concerns about this. DTs have a limited scope and if a place needs a dentist, they will always hire the dentists over the therapists. He makes very valid points. I have read other anti-therapy concerns too. I know that I took a risk that might not prove to be very marketable but I do believe in this cause for which I took this risk.

Let's be honest here, dental therapists are dental therapists because they couldn't get into dental school. I remember watching a panal of about 5 dental therapy students at U of MN talking about themselves (on their website btw), and when they were asked why they choose dental therapy, all of them responded by saying that they were not able to get accepted into a US dental school, and this new program was the next best thing.

Next, you can't compare midlevels like PAs to dental therapists, they are completely different. If you look at other countries with dental therapy models, lots of research concluded that dental therapists have NOT overall improved dental decay, particularly in children. It's a model that is historically unsuccessful, so why are we bringing it to the US?

This country has the highest standard in dental care, no need to bring those standards down just because there is an "access to money" issue that won't be solved by bringing in midlevels that will do subpar, irreversible work.
 
Bold is true. For surgical fields PA do some clinic work and are a second set of hands in the OR. They don't actually do the surgery. Let's get some DT that earn a masters and do histories and follow up appointments. or maybe they can assist an OS.

I don't see why an average dental office would have much need for them as they exist today. Mid levels have NOT bent the cost curve in medicine. They will not in dentistry either.

Let's be honest here, dental therapists are dental therapists because they couldn't get into dental school. I remember watching a panal of about 5 dental therapy students at U of MN talking about themselves (on their website btw), and when they were asked why they choose dental therapy, all of them responded by saying that they were not able to get accepted into a US dental school, and this new program was the next best thing.

Next, you can't compare midlevels like PAs to dental therapists, they are completely different. If you look at other countries with dental therapy models, lots of research concluded that dental therapists have NOT overall improved dental decay, particularly in children. It's a model that is historically unsuccessful, so why are we bringing it to the US?

This country has the highest standard in dental care, no need to bring those standards down just because there is an "access to money" issue that won't be solved by bringing in midlevels that will do subpar, irreversible work.
 
Bold is true. For surgical fields PA do some clinic work and are a second set of hands in the OR. They don't actually do the surgery. Let's get some DT that earn a masters and do histories and follow up appointments. or maybe they can assist an OS.

I don't see why an average dental office would have much need for them as they exist today. Mid levels have NOT bent the cost curve in medicine. They will not in dentistry either.

Yeah, seriously. I started a thread the other day about how my visit with an NP cost me the same as a Physician visit: 150 bucks. WTF!
 
Stop the partial truths or complete lies. Microbiology is a pre-req or co-req for U of MN dental therapy profession. A couple of courses are graded on a curve but please note that these courses were when the 1st year dental therapists took courses with the 2nd year dental students. The most important argument is that dentists and soon to be dentists will always be in a higher professional status than the midlevel provider. I have read too many insults on the SDN about dental therapists (i.e. can’t even add 1+1 etc.) I have completed a rigorous math major (including Vector Calculus, differential equations etc. ) for my bachelors and I graduated with honors. I am not unique in my qualifications as I know other DTs who are also very qualified. We have made tremendous sacrifices for this profession and the market is very difficult. Some comments are degrading, hurtful and insulting. Stop them and focus on real issues to solve a growing and difficult problem.

The obvious consensus is that the reimbursement rates from government insurances are too low, overhead is high, student loans are high, and growing numbers of populations including children suffer from high amounts of tooth decay. This problem will continue to get worse. The fact that medical midlevel providers have been successful for 30+ years in the US should not be overlooked. Many other countries use a dental midlevel provider. The University of Minnesota researched these different models and is very concerned about the quality of the dental therapist who graduate from the dental school. The idea that assigning a midlevel provider to complete easier procedures which then allows a dentist to work on more complex and profitable treatments is happening now. Please see:
Dr. John Powers: http://www.youtube.com/watch?v=fP7M2hRzCrU
Dr. Shiraz Asif: http://www.youtube.com/watch?v=nGQmHPonScM&feature=youtu.be
Obviously the dental therapist may not be the right solution for different offices and hopefully government insurance companies will increase the reimbursement rate as this still needs to happen. It is too early to make good statistical measurements although the ADA attempted as the profession is still very new. I know that many dentists are still anti-dental therapy. I would just ask these professionals and soon to be dental professionals to be civil. Definitely proper training of DTs and scope of practice are very important concerns. This dentist’s site is useful for discussion. http://www.higleydentalcare.com/den...factor-or-a-serious-competetion-for-dentists/ as some have voiced concerns about this. DTs have a limited scope and if a place needs a dentist, they will always hire the dentists over the therapists. He makes very valid points. I have read other anti-therapy concerns too. I know that I took a risk that might not prove to be very marketable but I do believe in this cause for which I took this risk.

Get off the jungle juice Karl self has fed you...dagone. Even your post history shows you couldn't make the cut into dental school. Y'all therapists have as much training in pharm fixed prosthodontics or even endo as a googledontics mother. Accept the poor judgement and educational investment, and move on. You're not colleagues but a dangerous disservice to the community.
 
Supporters of the dental therapist model are so wrong I can't regard anything they say as anything other than a big bowl of derp.
 
Stop the partial truths or complete lies. Microbiology is a pre-req or co-req for U of MN dental therapy profession. A couple of courses are graded on a curve but please note that these courses were when the 1st year dental therapists took courses with the 2nd year dental students. The most important argument is that dentists and soon to be dentists will always be in a higher professional status than the midlevel provider. I have read too many insults on the SDN about dental therapists (i.e. can’t even add 1+1 etc.) I have completed a rigorous math major (including Vector Calculus, differential equations etc. ) for my bachelors and I graduated with honors. I am not unique in my qualifications as I know other DTs who are also very qualified. We have made tremendous sacrifices for this profession and the market is very difficult. Some comments are degrading, hurtful and insulting. Stop them and focus on real issues to solve a growing and difficult problem.

The obvious consensus is that the reimbursement rates from government insurances are too low, overhead is high, student loans are high, and growing numbers of populations including children suffer from high amounts of tooth decay. This problem will continue to get worse. The fact that medical midlevel providers have been successful for 30+ years in the US should not be overlooked. Many other countries use a dental midlevel provider. The University of Minnesota researched these different models and is very concerned about the quality of the dental therapist who graduate from the dental school. The idea that assigning a midlevel provider to complete easier procedures which then allows a dentist to work on more complex and profitable treatments is happening now. Please see:
Dr. John Powers: http://www.youtube.com/watch?v=fP7M2hRzCrU
Dr. Shiraz Asif: http://www.youtube.com/watch?v=nGQmHPonScM&feature=youtu.be
Obviously the dental therapist may not be the right solution for different offices and hopefully government insurance companies will increase the reimbursement rate as this still needs to happen. It is too early to make good statistical measurements although the ADA attempted as the profession is still very new. I know that many dentists are still anti-dental therapy. I would just ask these professionals and soon to be dental professionals to be civil. Definitely proper training of DTs and scope of practice are very important concerns. This dentist’s site is useful for discussion. http://www.higleydentalcare.com/den...factor-or-a-serious-competetion-for-dentists/ as some have voiced concerns about this. DTs have a limited scope and if a place needs a dentist, they will always hire the dentists over the therapists. He makes very valid points. I have read other anti-therapy concerns too. I know that I took a risk that might not prove to be very marketable but I do believe in this cause for which I took this risk.

Im sure you are very well trained. The issue is the job isnt needed. Ask how many private practitioners are so busy they would need an MLP and the number is very low. You guys will work in corporations and take away from new associate gigs and continue to reinforce the corporate dentistry model which most dentists oppose. You will also find a place in health clinics.

FYI mid level providers in medicine didnt lower the cost of medical care.

FYI there was a monte carlo simulation study on the economic model your job is based on and only in 10% of the simulations was it even viable. IE, no cost reduction to the patient.

I do think you picked a very lucrative career. Youll work for a corp who will pay you less than an associate which will still be 80kish a year. Good job.

If we really want to go the MLP route we need to close a few dental schools as they just simply arent all needed.

The real solution is to raise the fees for medicaid and lower the red tape. Boom.
 
Supporters of the dental therapist model are so wrong I can't regard anything they say as anything other than a big bowl of derp.

I have no idea where this dental therapist thing came from but it's obvious that it will not lower the cost of dental care? They have all the same variable expenses and fixed expenses as a dentist. Yea a dentist has more expensive schooling but that's only 2-4 thousand a month compared to most offices generating over 90K a month in revenue. People say they will be able to work in rural undeserved areas that dentist can't afford to make it in but again, DT have all the same overhead and operating expenses as a dental office but with lower revenue. Still not going to happen. I also would wager that those who have gone such a long time without regular dental visits are past the simple drill n' fill stage and have more serious and debilitating diseases that only a doctor can fix.

The only way it could ever work is if they are employed by a dentist working in a dental office or under a dentist in a hospital. The easiest and quickest way would be to increase reimbursement for medical assistance and to open up state run clinics with loan repayment incentive programs for new graduates to work there for a contracted period of time. They money is being spent anyways in emergency rooms so why not control it a bit more and help out another group that seems to never get mentioned in these public discussion - the new dental students whose debt dictates where and how they practice?
 
I have no idea where this dental therapist thing came from but it's obvious that it will not lower the cost of dental care? They have all the same variable expenses and fixed expenses as a dentist. Yea a dentist has more expensive schooling but that's only 2-4 thousand a month compared to most offices generating over 90K a month in revenue. People say they will be able to work in rural undeserved areas that dentist can't afford to make it in but again, DT have all the same overhead and operating expenses as a dental office but with lower revenue. Still not going to happen. I also would wager that those who have gone such a long time without regular dental visits are past the simple drill n' fill stage and have more serious and debilitating diseases that only a doctor can fix.

The only way it could ever work is if they are employed by a dentist working in a dental office or under a dentist in a hospital. The easiest and quickest way would be to increase reimbursement for medical assistance and to open up state run clinics with loan repayment incentive programs for new graduates to work there for a contracted period of time. They money is being spent anyways in emergency rooms so why not control it a bit more and help out another group that seems to never get mentioned in these public discussion - the new dental students whose debt dictates where and how they practice?

It's obvious to anyone with a functioning frontal lobe.
 
It's sad to see this cynical attitude being spread by so many entering the dental proffesion. I hear the same arguments every day by practicing dentists and it makes me sad. Dentists commonly complain about insurance reimbursments being to low and in the same breath that DTs are stealing patients away. There are over 1 million in the US that go without dental care each year and properly implementing DTs into the workforce could do a lot to help reduce that number. Stop looking at them as competitiors.

It's going to be all about how they are implemented. If we can do it right we can improve oral health for everyone and keep the dental proffession as the stable well paying job it is. Enough with the baseless criticism, there are solutions are there and we are the ones that need to find them.

I would personally like to see them implemented under the umbrella of a DDS or DMD and give incentives for them to focus on preventive care and minor procedures.
 
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It's sad to see this cynical attitude being spread by so many entering the dental proffesion. I hear the same arguments every day by practicing dentists and it makes me sad. Dentists commonly complain about insurance reimbursments being to low and in the same breath that DTs are stealing patients away. There are over 1 million in the US that go without dental care each year and properly implementing DTs into the workforce could do a lot to help reduce that number. Stop looking at them as competitiors.

It's going to be all about how they are implemented. If we can do it right we can improve oral health for everyone and keep the dental proffession as the stable well paying job it is. Enough with the baseless criticism, there are solutions are there and we are the ones that need to find them.

I would personally like to see them implemented under the umbrella of a DDS or DMD and give incentives for them to focus on preventive care and minor procedures.

The problem with your above statement is that dentists work in areas that are already saturated/have just the right amount of dentists. So having MLP work under a licensed dentist is only adding to the saturation and not solving the so-called access to care crisis. Of course, the access to care problem is a whole other debate and the 1 million number you quoted isn't accounting for the people who CHOOSE not to see a dentist and thus MLPs will not solve this still.

No matter how you shake it, I fail to see how adding a mid-level provider solves anything.
 
It's sad to see this cynical attitude being spread by so many entering the dental proffesion. I hear the same arguments every day by practicing dentists and it makes me sad. Dentists commonly complain about insurance reimbursments being to low and in the same breath that DTs are stealing patients away. There are over 1 million in the US that go without dental care each year and properly implementing DTs into the workforce could do a lot to help reduce that number. Stop looking at them as competitiors.

It's going to be all about how they are implemented. If we can do it right we can improve oral health for everyone and keep the dental proffession as the stable well paying job it is. Enough with the baseless criticism, there are solutions are there and we are the ones that need to find them.

I would personally like to see them implemented under the umbrella of a DDS or DMD and give incentives for them to focus on preventive care and minor procedures.
Please get off the galaxy you're on and come to earth. Dentist would be welcoming if there was a need. However, let's create an entire "profession" to treat low income people instead of focusing on the issue......dagone...... There baseless criticism comes from the bottom line. There was a lecture how a dentist employed a dirty therapist and lost $60k that year. Supply and demand. They are almost all jobless, because medicaid in MN doesn't pay much $20 or so for a two surface filling, and then you pay them 20% production. 4 bucks for a DO.

Preventative care... they do not do prophies- They have NO periodontal training. That is not within their scope of practice, unless they were a dental hygienist first.

You need to UNDERSTAND before you comment. NEXT.....dagone
 
JASON "NAPA KNOW HOW" Aldred why are you not responding???? How is Wadena?
 
Preventative care... they do not do prophies- They have NO periodontal training. That is not within their scope of practice, unless they were a dental hygienist first.

You need to UNDERSTAND before you comment. NEXT.....dagone

The best part is the fact that prophylaxis is outside of the scope of training but adult extraction & local anesthesia is within the scope.

This just simply tells you that our ADA is a weak num-nutz group and the ADHA has more influence.

Get ready folks, it will come some day and it will all fall under the scope of "access to care" What a joke :laugh:
 
Get off the jungle juice Karl self has fed you...dagone. Even your post history shows you couldn't make the cut into dental school. Y'all therapists have as much training in pharm fixed prosthodontics or even endo as a googledontics mother. Accept the poor judgement and educational investment, and move on. You're not colleagues but a dangerous disservice to the community.

Tearing another person down is perfectly demonstrated by your message. I was hoping to help direct this forum into a more productive sharing of ideas in order to address a real problem. Some have caught on. I have read anti-therapy arguments that holds some merit but too many especially on this forum are focused on tearing down the individual(s) who decides (or decided) to pursue dental therapy.

An oral surgeon and Hillenbrand fellow recommended this profession to me as I was waitlisted into dental school. I tutored his son. (You can gloat in the “I knew it—a dentist wannabe”) I researched this possibility and its’ purpose before I made this huge decision. I wasn’t brainwashed by Dr. Self. There are dentists and dental professionals throughout the United States that find merit in this solution as they recognize the current problems. It is not just politicians or public health advocates. This oral surgeon was absolutely convinced that oral midlevel providers would permeate all 50 states because the need is there just as P.As and nurse practitioners has in the medical field. He expressed the ADAs fierce opposition but was convinced the midlevel market would prevail. His wife with an MBA who ran his office had the same opinion.

I believe that dual hygiene skills makes more sense, and is more marketable especially in remote areas. As I said earlier, I think we need to also campaign for higher reimbursement from Medicaid/ state insurances but this also is a complex and difficult problem. As others have mentioned, employing DTs could potentially lower business costs while improving access. I know doctors who greatly value their nurse practitioners and P.A.s. They have become a desired asset to doctors and the medical community. Dentists who treat these underserved populations can play an important role in directing the education and training of these midlevel providers. Hopefully, this will prove marketable for them over time as well. In less than a year, the numbers eligible for dental care on Medicaid/state insurance will dramatically increase. Dr Powers, a private practice dentist, believes that dentists can help employ DTs so that it is not just the corporate dental chains. I know many dentists, dental students and especially key leaders of the ADA are hoping to squash the idea of a midlevel provider. IF there is truly no need, the forces of supply and demand will stop it. The ADA has lobbied a lot of money against the midlevel provider. Likewise, if you don’t want a dental therapist, you don’t hire one. If you do not trust their skills or expertise, you let them go. Clearly, as the dentist, you are the boss. Currently, DTs are employed in private practice, non-for –profits, and corporate dental chains.

I am not a person who likes heated debates at all. Trolling as another posted earlier? I caught on pretty quickly the purpose of this forum thread and others like it. I didn’t start it. I researched quite a few threads for a presentation. Its’ design and others are to belittle the intelligence of DTs. I was just hopeful that productive discussion could occur without being riddled with insults. And some thankfully are able to do this.
 
"remote/rural areas" is always popping up in discussions like these.

I am looking forward to seeing where DTs start working and in what capacity. I bet the distribution will be very similar to dentists.
 
personally, i like the idea of programs designed to reimburse or accelerate payback for doctoral degree holding dental professionals in underserved areas supplemented by the inclusion of CDHCs.

can someone essplain to me what a 'dagone' is?

day-gahn or duh-goh-knee?
 
Supply and demand shouldn't be the deciding factor for whether DTs prevail because it would encourage patients to choose a cheaper and sub-par option. Further, as everyone has mentioned, they will most likely end up in cities versus rural areas because more people want to live in cities. The scariest thing about DTs is that they don't know what they don't know. They are not the answer to addressing access to care. It's about how to influence dentists to serve these populations that aren't getting their needs met and you do that through financial programs that encourage (more so than they do now) for dentists to relocate.
 
personally, i like the idea of programs designed to reimburse or accelerate payback for doctoral degree holding dental professionals in underserved areas supplemented by the inclusion of CDHCs.

can someone essplain to me what a 'dagone' is?

day-gahn or duh-goh-knee?


day-gahn.....TJ stole it from shanksalot....dagone thieves....
 
it's all become clear to me now
 
IF there is truly no need, the forces of supply and demand will stop it.

Laws of supply and demand don't really pertain to healthcare as much because there is too many areas ripe for abuse. Our professional leaders in healthcare support healthcare laws that are meant to protect the public from this abuse. Most people aren't intelligent to know the difference between a mid-level provider DT and a dentist because you, by nature, will want to put on a "white coat." Heck... go around to the hospitals and you'll see PAs ans nurses wearing long white coats.

Then again, I guess supply and demand also stopped the following abuse?

I'm sure all of her patients thought she was a doctor or properly educated technician of some capacity.

Dentists are fighting back against this creation of a completely new provider because it's just not necessary. The country is saturated with dentists and the only problem is "access to free care". DTs will not be able to offer a cheaper solution, just a watered down one.
 
It's sad to see this cynical attitude being spread by so many entering the dental proffesion. I hear the same arguments every day by practicing dentists and it makes me sad. Dentists commonly complain about insurance reimbursments being to low and in the same breath that DTs are stealing patients away. There are over 1 million in the US that go without dental care each year and properly implementing DTs into the workforce could do a lot to help reduce that number. Stop looking at them as competitiors.

It's going to be all about how they are implemented. If we can do it right we can improve oral health for everyone and keep the dental proffession as the stable well paying job it is. Enough with the baseless criticism, there are solutions are there and we are the ones that need to find them.

I would personally like to see them implemented under the umbrella of a DDS or DMD and give incentives for them to focus on preventive care and minor procedures.

There are many more than 1 million people in the usa who dont see a dentist per year. Also " There are over 1 million in the US that go without dental care each year and properly implementing DTs into the workforce could do a lot to help reduce that number. Stop looking at them as competitiors. " This has been disproven by fact and analysis. Multiple times. If this is the case and I just havent came across the new research please forward me to the correct resource.

Its not "baseless criticism" and Im not sure why you would think that as the arguments are found all over the place against them, supported by economic analysis. Some would call it a baseless argument.

The problem is, proponents of the MLP use this argument over and over. They believe this will happen, they think xyz will happen etc. Without providing a basis for why they would think that beyond "it just makes sense". Those with MBA's and knowledge of the profession have done the analysis and shown that it will not provide a cost savings to the public and it is the wrong answer to a very real problem. This is why you get antagonized here as we would like to have a good discussion on the matter, but we arent getting any logical arguments based in fact. I have the appropriate education and experience in economics and healthcare and will lay out the facts. Please, if youd like to address these comments I think people here would be more than happy to think on your arguments.

1. 99% of metropolitan areas are saturated with dentists. The only people not being seen are those on medicaid and without insurance. MLP's wont lower cost of care so they wont help the without insurance demographic. They can help the medicaid segment by working for a health clinic. But again the better solution would be a better medicaid system so the patients can be seen by the already existing dental capacity. The model of MLP being employed by private dentists to see medicaid proved uneconomical and unsustainable.

2. rural areas - there are very few places in the usa where you cant drive an hour or two to a dental facility. If youre suggesting we make a new job for these few places well then we will have to agree to disagree. You make that decision when moving out into the boonies. You dont have access to a heart surgeon, you dont have access to a dentist. The only place this is needed is alaska where some areas arent accessible unless by 4 seater planes. This is where the MLP shines and is needed. If you still believe MLP is needed for these areas, its been shown they wouldnt be able to practice there economically, IE without subsidies. To which I would argue increasing medicaid is an easier and more effective fix.

3. medicaid patients. The big problem here is many dentists wont see medicaid because its hard to keep your doors open while doing so. This is huge and something America needs to address. I think your theory is that dentists would hire MLPs and see medicaid. The profit margin is so slim that while this would work on a small level, its not going to open the floodgates to medicaid patients. Again, MLP's do not lower the cost of dental care a significant amount. We have ran the numbers. Time and time again. A 10% reduction in fee isnt enough to get a sizeable amount of the population to come in. Now, public health clinics can hire the MLP to service the medicaid. The cost savings to the health clinic (IE the american public) will be the difference between the mlp salary and the dds assuming both chaps are as efficient as one another. So yes there is an advantage here. But not one large enough to create an entire job for when again, we should use the existing system and improve medicaid to use existing capacity.

4. MLPs would be an advantage to a practitioner with a thriving practice who is busting at the seams. Instead of hiring an associate the MLP would work out for him as he would be able to have a substantial labor savings and be able to work on the more difficult cases. How many of these practices do you think exist? There are some, but not enough to create a new career. And this would only benefit the owning dds not the public. If the dds kept the same profit margin, the slight reduction in fee would not be enough to bring in new demand, or as we call them here, patients. In real life the dds would increase his profit margin and keep fees the same.

So what Ive done here is succinctly laid out the arguments against MLP's backed by proof, history, and logic. There was no "I believe" or "this person said". I hope this isnt coming off as sarcastic or demeaning as its not meant to be. I would just like a proponent of MLP to argue these points. I have talked to members of congress who have no idea what theyre voting on. Theyve just heard "this program will help combat this problem because why wouldnt more providers be able to treat more people?" and they vote yes. A low level analyst takes the number of people who doesnt see the dentist per year and then divides it by the number of providers it takes to service that segment and comes up with "we need this many more providers", assuming they arent being seen because of full capacity. This study says the country needs 9600 more providers. I hate to sound extreme but thats radical and crazy talk. Thats almost 200 more per state.

If theres anything Ive written you dont agree with or any points youd like me to expand upon please let me know.

Going through D school, you see the vast majority entered the profession to help peoples teeth. They want the public to have a better dentition. They want everyone to get care. While I can see from your viewpoint the backlash is due to "they took our jerbs" I can tell you its not. Its because the proposed solution doesnt address the problem.

The real problems needing addressed are the general public not valuing dental care and our govt insurance program (medicaid) being broken. Just as when we treat the cause of a disease and not the symptoms (ideally) when treating a person, we should do the same when treating socio economic problems.

I just want to add here that I think an MLP is perfectly capable of fulfilling their job role. Basic, bread and butter dentistry isnt rocket science -we are some of the most over educated cats around. Why we put hygienists through so much college and pay them so much to perform a prophy and srp is beyond me. You dont need a doctorate to drill on a tooth while avoiding the pulp and srp a mouth.
 
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Certain areas are saturated based on current dental costs, yes, but there is huge potential to expand the profession by making care more accessable through prevention, education, expansion and cost reduction. Throwing DTs at a population is not going to solve anything and I never suggested that. But instantly percieving DTs as a threat to the dental proffession is simply not true.

I was skeptical of DTs as well, I have a brother and father that are dentists so when I did my MPH I actually set out to show that it would be a detriment to the dental profession more than one paper I wrote. By the end of the program I had done a complete 180. I'm heading of to dental school in a month and I am sure I will get plenty of criticism there as well, but where many see a threat, I see potential solutions.

(By the way I would love to see the journal articles you have stating that a mid level provider model will not help improve access to oral care. I honestly never came across anything even remotely suggesting that when I was researching DTs)
 
This whole advent of dental therapists is mostly backed by the educational institution lobby (Devry and other for-profits) that just want to make money. They use little proxies in academia to show some dubious research that the best way to serve the underserved is to have something like the therapists.

It is very easy to see who the winners are in this whole dental therapist game. The biggest winners are the educational institutions. The next biggest winners are the dental chains, who will be able to replace the dentists to use these lower paid therapists to see a bigger volume of patients at a lower cost. The dentists will be called in for tough cases or just be on the sidelines, or called for any specialty work, and the dentist salary will go down. Having used the therapists for the low-income populations to have a constant source of income, the chains may also use dentists to open up "Olive Garden" type practices, which will cater to PPO patients and effectively outcompete private practice dentists, buy stealing their most valuable clientele.

Parallels like this are already happening in the field of medicine with PAs, FNPs, and MDs.

The losers: the patients and private practice dentists.
 
This whole advent of dental therapists is mostly backed by the educational institution lobby (Devry and other for-profits) that just want to make money. They use little proxies in academia to show some dubious research that the best way to serve the underserved is to have something like the therapists.

It is very easy to see who the winners are in this whole dental therapist game. The biggest winners are the educational institutions. The next biggest winners are the dental chains, who will be able to replace the dentists to use these lower paid therapists to see a bigger volume of patients at a lower cost. The dentists will be called in for tough cases or just be on the sidelines, or called for any specialty work, and the dentist salary will go down. Having used the therapists for the low-income populations to have a constant source of income, the chains may also use dentists to open up "Olive Garden" type practices, which will cater to PPO patients and effectively outcompete private practice dentists, buy stealing their most valuable clientele.

Parallels like this are already happening in the field of medicine with PAs, FNPs, and MDs.

The losers: the patients and private practice dentists.

Excellent points. By and large, the major losers will be the new grads with HUGE loans (500K). That's the scary part. Already, many new grad friends of mine have moved to the sticks because finding work has been tough. This will obviously make it tougher. Just as in medicine, where a doc supervises teams of nurses, so too will a dentist now supervise a team of DTs, which will further toughen an already tough job market for dentists. And yes, I agree--the big winner is the for-profit education lobby.
 
I think you mean supervise a team of "hygienists and dental assistants". DT are no where near becoming ubiquitous like RDH, DA, RN's. I'm in a state where RDH's can do restorations and give local; yet, in PP or chains they're never utilized in that way.

Excellent points. By and large, the major losers will be the new grads with HUGE loans (500K). That's the scary part. Already, many new grad friends of mine have moved to the sticks because finding work has been tough. This will obviously make it tougher. Just as in medicine, where a doc supervises teams of nurses, so too will a dentist now supervise a team of DTs, which will further toughen an already tough job market for dentists. And yes, I agree--the big winner is the for-profit education lobby.

I agree with the sentiment that most everyone has expressed here; which, is the largest block preventing access to care is finances and the perceived value of oral health. Some people will simply not be reached and that is okay. I have personally seen physicians at a free clinic give pts with blood sugars @ 400 mg/dl a hard sell so that they'll take some meds to control it lol. That's right... even though they' feel like crap, faint, and understand they're ruining their organs and can lose a limb they are too lazy to take a medication, diet, and exercise. Some people don't give a rip about their health and that's okay. I agree that the advent of DT will not improve access care in any demographic.
 
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Lethsang, Thank you for joining the discussion as I think you bring in good discussion points. I do not agree that so many devalue their oral health care. This does not mean that I haven’t seen situations where I questioned the misplaced priorities and poor oral care habits. Education of dietary habits and oral care should always be a component in dentistry. However, I have seen many situations where I understand a little of the complexity of problems faced by individuals. Poverty, abuse, mental health problems, illicit drugs usage, etc. wreak havoc on individuals. Likewise, I recognize that even with better dental insurances, annual caps are placed at 1000 -2000 after the patient has paid his/her percentage. With resources tight, people have to choose between rent/mortgage or a crown. I do not quickly agree that they don’t care.

You make claims based on calculations and research. I would really find this data very useful. Please post up links to this information. I ran across another person who posted on Dr Bicuspid forum (http://www.drbicuspid.com/index.aspx?Sec=sup&sub=hyg&pag=dis&ItemID=313099&wf=47) who had first- hand experience with dental therapists utilized in Canada. His arguments are similar to yours. Dr. Todd Hartfields also worked with the dental therapy program in Canada but he has a pro-therapy perspective. I would find a panel with those two very informative.

I have seen some limited data from those offices currently employing dental therapists and heard their accounts. Children’s Dental, a non-for –profit, has indicated that employment of DTs has reduced overhead as expected. The two other private dentists for which I included the youtube links have been favorable and hinted economic profitability as it permits the dentists to do more complex procedures. I also recognize that experience is important. A newly graduating dentist or DT will not be as efficient and profitable at the start. Although it is early to gather substantial data, I believe that if dentists can utilize a MLP to do simpler procedures, that it will give them the time to do the more complex and profitable ones.

As of employment, I can think of 4 DTs that are employed in rural areas and a couple in corporate dental and non-for-profits. One or two have started up for smaller offices in the city. Currently several offices that currently employ MLPs have a sliding scale and accept medical assistance. So, yes, DTs do help lower the costs to individuals.

I do not agree with claims that the University of Minnesota is “out for money” in the creation of the dental therapy program. This does not mean that I think that they have the perfect DT program. There are areas for improvement. I believe it reflects poorly on a dental institution if they cannot employ their graduates. I believe leaders of the school agree with this and are refining the program to meet the needs of the market. Employment rates of DTs are improving.

I still have confidence in supply and demand. The collaborating dentist will insure that DTs are providing quality work. As before mentioned, medical assistance reimbursement rates are too low especially for dentists. I am hopeful that improved rates are also in the future. With larger numbers of those who will qualify on the horizon through Obamacare, I think dentists should definitely look at marketable ideas and explore these possibilities. From the literature review conducted on dental therapy recently, I think dentists in rural areas or who serve these patients should definitely consider employment of dental therapists. (see: http://www.wkkf.org/news/articles/2...nce-that-dental-therapists-expand-access.aspx)

From my review and experience, I believe that a midlevel provider can help improve access to care. I know that dentists work hard to get accepted into school, study diligently and make great sacrifices to make successful businesses. I am saddened to hear about dentists who retire early due to financial reasons with down-turns in the economy and/or extremely low rates for medical assistance. Likewise, I am disheartened to know of many who are not able to get oral care and these numbers will increase. I know many dental schools that have outreach opportunities for these individuals but it is not in all needed areas and it is not enough. I believe dental therapy might be a viable solution.

I know that ADA has the Community dental health coordinators at two pilot sites. The scope is similar to Primary Dental Health Aides in Alaska. Dr. Mary Williard from Alaska reported that they did not get the success they hoped with just the addition of these providers (oral educators with very limited dental procedures). Dr. Williard then created the dental health aide therapist (very similar to New Zealand’s model of dental therapy) following. These therapists first received their education in New Zealand. I have had the opportunity to meet Dr. Williard and listen to her story. I have read numerous reports and studies on the DHAT model as well as dental therapy utilized in Canada and New Zealand. There is definite support to explore this idea of a MLP. MLPs are successful in the US in the medical field and oral MLPs are successfully utilized in many developed countries. I know that current employers of dental therapists are keeping data. These collaborating dentists are not going to continue to employ a dental therapist who does inferior work. Likewise, improving access to care and improving profit margin are also important factors. Lethsang, I am looking forward to seeing links that support your theories.

Lastly, to address the original post that references the ignorance of scope of practice. All licensed dental professional including DTs are required to pass and take a MN jurisprudence exam. The collaborating dentist has to sign and submit an agreement to the board of dentistry of what the DT will do in his/her office within their scope of practice. I don’t think a collaborating dentist would risk suspension of license.
 
Lethsang, Thank you for joining the discussion as I think you bring in good discussion points. I do not agree that so many devalue their oral health care. This does not mean that I haven’t seen situations where I questioned the misplaced priorities and poor oral care habits. Education of dietary habits and oral care should always be a component in dentistry. However, I have seen many situations where I understand a little of the complexity of problems faced by individuals. Poverty, abuse, mental health problems, illicit drugs usage, etc. wreak havoc on individuals. Likewise, I recognize that even with better dental insurances, annual caps are placed at 1000 -2000 after the patient has paid his/her percentage. With resources tight, people have to choose between rent/mortgage or a crown. I do not quickly agree that they don’t care.

You make claims based on calculations and research. I would really find this data very useful. Please post up links to this information. I ran across another person who posted on Dr Bicuspid forum (http://www.drbicuspid.com/index.aspx?Sec=sup&sub=hyg&pag=dis&ItemID=313099&wf=47) who had first- hand experience with dental therapists utilized in Canada. His arguments are similar to yours. Dr. Todd Hartfields also worked with the dental therapy program in Canada but he has a pro-therapy perspective. I would find a panel with those two very informative.

I have seen some limited data from those offices currently employing dental therapists and heard their accounts. Children’s Dental, a non-for –profit, has indicated that employment of DTs has reduced overhead as expected. The two other private dentists for which I included the youtube links have been favorable and hinted economic profitability as it permits the dentists to do more complex procedures. I also recognize that experience is important. A newly graduating dentist or DT will not be as efficient and profitable at the start. Although it is early to gather substantial data, I believe that if dentists can utilize a MLP to do simpler procedures, that it will give them the time to do the more complex and profitable ones.

As of employment, I can think of 4 DTs that are employed in rural areas and a couple in corporate dental and non-for-profits. One or two have started up for smaller offices in the city. Currently several offices that currently employ MLPs have a sliding scale and accept medical assistance. So, yes, DTs do help lower the costs to individuals.

I do not agree with claims that the University of Minnesota is “out for money” in the creation of the dental therapy program. This does not mean that I think that they have the perfect DT program. There are areas for improvement. I believe it reflects poorly on a dental institution if they cannot employ their graduates. I believe leaders of the school agree with this and are refining the program to meet the needs of the market. Employment rates of DTs are improving.

I still have confidence in supply and demand. The collaborating dentist will insure that DTs are providing quality work. As before mentioned, medical assistance reimbursement rates are too low especially for dentists. I am hopeful that improved rates are also in the future. With larger numbers of those who will qualify on the horizon through Obamacare, I think dentists should definitely look at marketable ideas and explore these possibilities. From the literature review conducted on dental therapy recently, I think dentists in rural areas or who serve these patients should definitely consider employment of dental therapists. (see: http://www.wkkf.org/news/articles/2...nce-that-dental-therapists-expand-access.aspx)

From my review and experience, I believe that a midlevel provider can help improve access to care. I know that dentists work hard to get accepted into school, study diligently and make great sacrifices to make successful businesses. I am saddened to hear about dentists who retire early due to financial reasons with down-turns in the economy and/or extremely low rates for medical assistance. Likewise, I am disheartened to know of many who are not able to get oral care and these numbers will increase. I know many dental schools that have outreach opportunities for these individuals but it is not in all needed areas and it is not enough. I believe dental therapy might be a viable solution.

I know that ADA has the Community dental health coordinators at two pilot sites. The scope is similar to Primary Dental Health Aides in Alaska. Dr. Mary Williard from Alaska reported that they did not get the success they hoped with just the addition of these providers (oral educators with very limited dental procedures). Dr. Williard then created the dental health aide therapist (very similar to New Zealand’s model of dental therapy) following. These therapists first received their education in New Zealand. I have had the opportunity to meet Dr. Williard and listen to her story. I have read numerous reports and studies on the DHAT model as well as dental therapy utilized in Canada and New Zealand. There is definite support to explore this idea of a MLP. MLPs are successful in the US in the medical field and oral MLPs are successfully utilized in many developed countries. I know that current employers of dental therapists are keeping data. These collaborating dentists are not going to continue to employ a dental therapist who does inferior work. Likewise, improving access to care and improving profit margin are also important factors. Lethsang, I am looking forward to seeing links that support your theories.

Lastly, to address the original post that references the ignorance of scope of practice. All licensed dental professional including DTs are required to pass and take a MN jurisprudence exam. The collaborating dentist has to sign and submit an agreement to the board of dentistry of what the DT will do in his/her office within their scope of practice. I don’t think a collaborating dentist would risk suspension of license.

Certain areas are saturated based on current dental costs, yes, but there is huge potential to expand the profession by making care more accessable through prevention, education, expansion and cost reduction. Throwing DTs at a population is not going to solve anything and I never suggested that. But instantly percieving DTs as a threat to the dental proffession is simply not true.

I was skeptical of DTs as well, I have a brother and father that are dentists so when I did my MPH I actually set out to show that it would be a detriment to the dental profession more than one paper I wrote. By the end of the program I had done a complete 180. I'm heading of to dental school in a month and I am sure I will get plenty of criticism there as well, but where many see a threat, I see potential solutions.

(By the way I would love to see the journal articles you have stating that a mid level provider model will not help improve access to oral care. I honestly never came across anything even remotely suggesting that when I was researching DTs)

I wish i could figure out how to quote paragraphs separately I apologize.

Joshwake - Here is the study which shows dental therapists in conjunction with dentists do not improve a communities dental health. Again, this is because you arent opening up any doors to new patients as Ive gone over in my long post. This is a very important part of this discussion - it's been shown that it doesnt improve access to care.

The cost reduction to the public brought about by the difference in an MLP and an associates salary are not enough to lower the new demand curve to such an extent to tap new demand.

I simply do not understand how yourself and others in your position say they dont know of this research. Or of this next one.

http://www.ada.org/7440.aspx

This one did an economic analysis of introducing MLP's in America. You can read their conclusions. If after reading you still think its a solution then again we will have to agree to disagree.

http://www.ada.org/8096.aspx

Josh please list out here what you found in your MPH research that convinced you and made you do a 180. Bullet points. Links. Research.

Dentamax - It is commonly accepted in the dental world that 100 million americans do not see the dentist each year because of misplaced priorities and the cost of dentistry. Stating you dont believe this is the case without anything to back it up isnt helping the discussion move forward. You dont even give your reasoning.

Your next point says certain clinics employ DT's and are reporting that its economically viable. This isnt the argument. DT's will make a dental office run more profitably if it cannot service their population with their capacity. The clinic will realize the difference between a dentists salary and the DT's compensation. This difference isnt enough to lower the demand curve enough to bring in new demand Do you think lowering a crown from 1000 to 900 will bring in a flood of new people willing to get work done? How about 800? What is the pricing point which will bring in new demand? How did you come up with this number? How can we see if the MLP model can get us to this number? For a fully trained MLP with experience, how much can he comfortably produce on a full fee basis per year using his limited procedure mix? Is this an important number? Has anyone already done it? Why am I asking this?

Your next paragraph you say the dt would allow the operating dds to focus on more complex procedures. Again this isnt the argument. DT's would be the ideal solution, if this were a problem.

Next paragraph you dont think minnesota or other schools are pushing this program because of the money. I am sorry that is naive. There is a large education tuition bubble in this country right now. This isnt an opinion its a commonly held viewpoint in the economic sector. This is why ten new dental schools have opened up or are about to open up recently. it is now 300k to get thru d school compared to 120k just a decade ago. Compare that with inflation since 2000 and you see a huge jump.

Scrolling down you continue to quote dentists employing DT's and it working out. Again, this isnt addressing our national access to care issue. Its allowing the dentist who is already at capacity to see more patients who would still be seen otherwise. Its not bringing in patients who had an access to care issue. I sincerely feel like you two arent understanding what access to care means in this regard, as it pertains to dentistry. I feel like I laid it out pretty plainly in my first post.

quoting
"As of employment, I can think of 4 DTs that are employed in rural areas and a couple in corporate dental and non-for-profits. One or two have started up for smaller offices in the city. Currently several offices that currently employ MLPs have a sliding scale and accept medical assistance. So, yes, DTs do help lower the costs to individuals."

Sliding scale clinics arent run at a profit. Theyre run with government subsidies. Having one with mlp's and keeping their doors open does not mean they help lower costs to individuals. It doesnt even suggest it. The argument can be made that this would lower the subsidy the clinic would need to keep its doors open which is a logical argument to make, and not one either have you have even touched on. However, the better solution would be to fix the broken medicaid system. Why do you think an mlp would be the better solution?

I read the study you linked which expounds the virtues of a DT. It specifically says they can work on children and increase the access to care. This is referring to medicaid children. Children which we have the capacity to see if we fixed the rates and the red tape. Why do you propose to create an MLP instead of fix medicare? I know the answer you should say.....but sadly I dont think you do as I dont believe you have a firm grasp of the situation. What they talk about here is putting the DT in our school systems to get these kids care. Where do you think the money comes to pay for these dental therapists? Uncle Sam. You, me, aunt betty. So yes if you do this, its like putting a nurse in school. The kids have more access to care. This would work. But youve just created a new position on uncle sams dime. Medicaid is already paid for by the people and is already in place. Why not fix it so these kids get care? What concerns me is neither of you bring up the few arguments you have going for you. This scenario here would be the main reason you would want MLP's introduced. And if you do so, what you have done, in effect, is provide a medicaid clinic without a copay. It ends by saying it costs 99 per child compared to 198 per child in the private sector. Of course its going to reduce overall cost when comparing MLP to private pay instead of their version of medicaid, which those children are on. If this happened in the usa, do you know what we just did? We solved the access to care problem, the facet of "people dont value their oral health as they should enough to take their child to the medicaid clinic" by providing free care at school where no one has to make an appointment. You could argue that this in fact has merit. Neither of you have. I even like it. Welcome to socialism. Is that what we want? Making our neighbors pay because we dont want to be an adult and take our child to the dentist?

You then end saying you are interested in seeing stuff that supports my theories. For the third time, very little of what Ive wrote is opinion or theoretical. Everything Im reading from both of your posts is all theory, "i think", "i heard in canada/new zealand". One of you even quoted MLP's in medicine....not realizing they DID IN FACT have an access to care issue brought about by too few providers. A different problem than what dentistry has Again, ask yourself to define what our access to care problem is. I highly suspect you think its different from what it really is. Read my first post. Its numbered. Its laid out. For whats its worth in medicine we still have an access to care issue because the MLP's arent working on the population segment they were made for. Theyre now saturating already saturated areas. Ask a medical doctor who keeps up with this stuff their opinion on them.

And lastly you say mlp is successful in other countries. Again, their access to care issue was a different one. I feel like im a broken record.

If youd like to do your own analysis. Create a spreadsheet. Make it a P and L of a dental office. Populate it with real numbers. Overhead, loan payments, salaries, rents, cost of production, insurance, write offs etc. Put in the cost of your associate vs the cost of the mlp. Put in the increase in gross production from the mlp. Compare it to the one where you employ an associate. And then come back and tell us what the reduction in fee was to the american public. I am going to guess and say you cant. If you can't, how are you possibly making the argument that this is economically viable. Guess what - people who do that for a living have and it doesnt work.

Ive done it - it doesnt work. The government has done it - it doesnt work.

How many dentists are in America? Whats the population in the USA? How much population can a dentist treat per year? Do either of you know without looking it up and crunching the numbers? How many dentists will be needed to service the growing baby boomer retirees? Have we compared that to the sudden influx in dental schools and graduates and compared them to dental retirees? Whats the picture look like 20 years down the road? Why am I asking this?

I apologize if any part of this post sounds harsh. I just cant believe both of you came back and still used the argument of "i think" and "i feel" and then asked me to provide two major studies found by a google search. One of you then suggested something Ive written was a theory. I didnt originally post links because I wrongly assumed you guys were familiar with the subject matter. It would have been like linking the wikipedia entry on potassium after I stated your heart would quit from a lack of potassium. Two papers that should be familiar by anyone wanting to discuss the pros and cons of such a large issue.

I just want everyone to know, full disclosure. It is in my personal best interests and in the interest of my financial success that MLP's do start to sweep the nation. I could just as easily post here and sway some of your opinions the other way. It would certainly behoove me personally to do so.

However, it has got to be realized that we have looked at this model and it is not solving any access to care issues. Any extra amount being seen is being paid for by your taxes. In no way do they lower the cost of dentistry to the consumer in an amount significant enough to increase access to care.

This entire post by me was not needed as all pertinent facts were laid out in my original as well as many other posts by other contributors. In this thread. On this page. That you read before you replied.
 
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Did you guys write your real infos (name adress phone number etc) when registering on dentaltown???
 
Did you guys write your real infos (name adress phone number etc) when registering on dentaltown???

Yes. You can get the DentalTown magazine mailed to you. FYI: dentaltown is far superior to SDN
 
Yes. You can get the DentalTown magazine mailed to you. FYI: dentaltown is far superior to SDN

Thanks! Ive been sticking to SDN because I highly dislike giving my personal infos on internet... I mean they even ask about name school and phone number... But if its a common thing, I mean everybody seems to be on DentalTown so I guess there is no harm in giving them my infos
 
Just wanted to get your input on the recent report by community catalyst. http://www.communitycatalyst.org/doc_store/publications/economic-viability-dental-therapists.pdf

I recognize that the numbers are extremely small but that cannot be helped and the time frame is limited. I also recognize that the contributors are pro-therapy. Yet, there is promise in the numbers.

I have a solid math background. I have taken MBA courses and accounting. If you reduce overhead.....then how is this bad? (Obviously without lowering the standard of care)

The Medicaid system does need modification and reimbursement needs to improve. This is not an easy solution. Unfortunately, I do not think with more recipients around the corner in 2014 and the deficits in government budgets that we are going to see much in improvement in Medicaid reimbursement rates very soon.

There is ample data out there to support lack of oral care for certain populations. Even the ADA has acknowledged this fact. I personally know individuals in this situation.
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=32 has listed a number of references.
http://www.pewtrusts.org/news_room_detail.aspx?id=57449
(has links to full report and list of data).
I could list quite a few more but I don't think this is necessary. I believe the consensus by most from the data is that there are groups that are not receiving adequate care. Can the problem be solved by redistribution and improved Medicaid reimbursement? I know that NHSC and IHS offer scholarships or loan forgiveness programs. Dr. Williard, IHS from Alaska, has data showing that this was not sufficient to improve oral care for those populations in Alaska. The program is not as new as MN and there is more data from AK.
http://www.innovations.ahrq.gov/content.aspx?id=1840. http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=305995 references the 2 year study by RTI.

The review of literature of global dental therapy as referenced by WKKF has been distributed and positively critiqued recently in favor of dental therapists. Likewise the forum discussion below is not so favorable. http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=313302&wf=33 in reference to the error on the PEW report of dental therapy in New Zealand due to mislabeled charts in CDC.

Once again, thank you for taking the time to give your reasons. I do still believe that there is enough research and evidence in favor of an oral MLP for dentists of underserved population. (And definitely merits serious consideration from states and state dental boards)
 
Would it not just be cheaper to pay for transport for these people and increase the reimbursement? It seems that you are only going after part of the problem. Let's say a DT can't treat the problem they have due to scope limitations, then who will? You are back to square one. Also, there are many people with the same problems when it comes to non-dental related healthcare, yet MLP have done little to solve this. I have a few NP friends who work for private clinics, because it allows them to make more money and live in the city. How would creating a new workforce solve access to care, as most people will just want to practice where they live?

Also, if you look at the new ADA reports, the whole decrease in the number of dentist isn't really happening, as more dental schools are opening up and more dentists are delaying retirement. I tried looking for the source (a powerpoint presentation by the ADA), but I cannot find it. If someone can, can they please post this.
 
Just wanted to get your input on the recent report by community catalyst. http://www.communitycatalyst.org/doc_store/publications/economic-viability-dental-therapists.pdf

I recognize that the numbers are extremely small but that cannot be helped and the time frame is limited. I also recognize that the contributors are pro-therapy. Yet, there is promise in the numbers.

I have a solid math background. I have taken MBA courses and accounting. If you reduce overhead.....then how is this bad? (Obviously without lowering the standard of care)

The Medicaid system does need modification and reimbursement needs to improve. This is not an easy solution. Unfortunately, I do not think with more recipients around the corner in 2014 and the deficits in government budgets that we are going to see much in improvement in Medicaid reimbursement rates very soon.

There is ample data out there to support lack of oral care for certain populations. Even the ADA has acknowledged this fact. I personally know individuals in this situation.
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=32 has listed a number of references.
http://www.pewtrusts.org/news_room_detail.aspx?id=57449
(has links to full report and list of data).
I could list quite a few more but I don't think this is necessary. I believe the consensus by most from the data is that there are groups that are not receiving adequate care. Can the problem be solved by redistribution and improved Medicaid reimbursement? I know that NHSC and IHS offer scholarships or loan forgiveness programs. Dr. Williard, IHS from Alaska, has data showing that this was not sufficient to improve oral care for those populations in Alaska. The program is not as new as MN and there is more data from AK.
http://www.innovations.ahrq.gov/content.aspx?id=1840. http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=305995 references the 2 year study by RTI.

The review of literature of global dental therapy as referenced by WKKF has been distributed and positively critiqued recently in favor of dental therapists. Likewise the forum discussion below is not so favorable. http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=313302&wf=33 in reference to the error on the PEW report of dental therapy in New Zealand due to mislabeled charts in CDC.

Once again, thank you for taking the time to give your reasons. I do still believe that there is enough research and evidence in favor of an oral MLP for dentists of underserved population. (And definitely merits serious consideration from states and state dental boards)

Ugh, just going over what im about to write in my head sounds antagonistic and i apologize but Im not sure how to say it differently. The response to all of your points have already been written.

In your own words. What is the access to care problem. Who isnt being seen. Then, I want you to write down how the benefits a DT brings to the table helps this segment of the population to be seen.

Proving a dentist can employ a DT and it be economically viable isnt the argument here. Of course the dentist will make money. Hes paying someone to do dental procedures at a lower salary. Its how we make money on an Expanded functions DA. If this has been your cross to bear no wonder you are frustrated that no ones agreeing. This isnt the argument.

We already all agree there is a segment not being treated and there is a problem. We already all agree a DT can be employed by certain dentists and be economically viable (for the dentist and the DT). These arent points you need to prove here. When we use the term economics previously we are talking countrywide. As in, it makes economic sense for the consumer. I am going to assume you think one of the benefits of the DT is a lower fee for the public.

Finally, all of your questions youve just asked. All of the questions you should be asking. And most of the answers are in my two long posts above or mentioned by other users here. I think you are glossing over points you dont at first agree with and not really thinking about them and how it meshes with your opinions. Its human nature to do so Im not hating on you.

Do the exercise in bold above. Print them here, I will check at some point and we will walk through it. Or save us some time and just reread my previous responses.

To answer the one specific question you brought up. As was mentioned already, and actually had a few paragraphs dedicated to it, the cost reduction to the public by employment of a DT isnt enough to open up a new demand point.

Again I truly apologize if my language is antagonistic.
 
I don't think a dentist hiring a DT is going to really reduce costs much either. I assume a DT will want to make more than a DH. What's a full time DH make? 70k? So will a DT want 90k or more? I imagine the dentist will want to charge the about the same price of the DT's work in order to cover the DT's pay while also making a profit himself.
 
I don't think a dentist hiring a DT is going to really reduce costs much either. I assume a DT will want to make more than a DH. What's a full time DH make? 70k? So will a DT want 90k or more? I imagine the dentist will want to charge the about the same price of the DT's work in order to cover the DT's pay while also making a profit himself.


you are correct sir. The monte carlo analysis has been done and the cost reduction isnt low enough to open up a new demand point. The study was referenced at some point in this thread.

Ive even done it in my own personal spare time.
 
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