Dental Therapist. Opinions.

[sharkdent]

Just curious how many here applying for dental schools know about dental therapist?

Anyone here have concern on how dental therapist will affect the dental profession?

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[cooliyak]

This goes against popular opinion, but I am actually in favor of them to a certain extent. Until access to care issues are actually addressed, dental therapists are going to continue being pushed by Kellogg and other organizations. It’s a supremely complicated, multifaceted issue, so there is no “one solution,” but I, personally, would love to have a dental therapist or two working with me in the rural, primary care setting. Dentists can’t just be opposed to them, yet not take Medicaid (yes I know reimbursement is horrible) or be willing to move outside of big cities where the need is. People need care and if they can’t get it from dentists, they need it from someone in the dental field. Some care is better than no care (and no, I didn’t say lesser care. I said some care as in any care.)
Dental therapists aren’t that bad. Change my mind.

 

[ThisCrazyAvacado]

It will most likely lower wages for dentists across the board. Why would corps pay someone $60/hr+ when they can pay someone $30/hr to fill cavities and do the bread and butter dentistry. It would be their only way to keep their bottom line healthy when insurances are cutting fees. Wage issues can become more magnified with an abundance of dentists entering the market unless schools start decreasing class sizes.

Just another issue future dentists will have to face, to the already compounding problems they face.

 

[ThisCrazyAvacado]

This goes against popular opinion, but I am actually in favor of them to a certain extent. Until access to care issues are actually addressed, dental therapists are going to continue being pushed by Kellogg and other organizations. It’s a supremely complicated, multifaceted issue, so there is no “one solution,” but I, personally, would love to have a dental therapist or two working with me in the rural, primary care setting. Dentists can’t just be opposed to them, yet not take Medicaid (yes I know reimbursement is horrible) or be willing to move outside of big cities where the need is. People need care and if they can’t get it from dentists, they need it from someone in the dental field. Some care is better than no care (and no, I didn’t say lesser care. I said some care as in any care.)
Dental therapists aren’t that bad. Change my mind.

Places where dental therapists are present, its still not helping to address the need for dentistry in rural areas. Most end up working in urban areas and competing with dentists. Ultimately everything remains the same and those people that need care still can't get it.
The same issue is sort of happening in the medical field with PA's. They were there to provide medical care in rural areas but that doesn't happen for the most part. This issue is much more complex and can't be solved simply by creating a mid-level provider. I'm all for a solution that can actually work with DT's but simply pumping out thousands of DT's each year will not work and help patients that need the care.

MyView: State's failed dental therapy experiment

 

[cooliyak]

Places where dental therapists are present, its still not helping to address the need for dentistry in rural areas. Most end up working in urban areas and competing with dentists. Ultimately everything remains the same and those people that need care still can't get it.
The same issue is sort of happening in the medical field with PA's. They were there to provide medical care in rural areas but that doesn't happen for the most part. This issue is much more complex and can't be solved simply by creating a mid-level provider. I'm all for a solution that can actually work with DT's but simply pumping out thousands of DT's each year will not work and help patients that need the care.

MyView: State's failed dental therapy experiment

Yeah, I’ve heard it all. I’m still not convinced that it’s a bad idea. The best idea? Probably not. But with the right structuring of laws/policies, I don’t see how it doesn't have potential. What would a better solution be?
Why not restrict them to only function in rural areas? Wouldn’t that solve that specific issue? Some states do that with dentists. They will grant a restricted license for their state to an out of state dentist if the dentist agrees to only work in rural areas/FQHCs. Can’t the same thing work for DTs?
Also, an article in an ADA publication is about the most useless thing you can do to convince me. The ADA has no authority in my eyes, especially an opinion piece.

 

[321931]

Yeah, I’ve heard it all. I’m still not convinced that it’s a bad idea. The best idea? Probably not. But with the right structuring of laws/policies, I don’t see how it doesn't have potential. What would a better solution be?
Why not restrict them to only function in rural areas? Wouldn’t that solve that specific issue? Some states do that with dentists. They will grant a restricted license for their state to an out of state dentist if the dentist agrees to only work in rural areas/FQHCs. Can’t the same thing work for DTs?
Also, an article in an ADA publication is about the most useless thing you can do to convince me. The ADA has no authority in my eyes, especially an opinion piece.

So you think the ADA has no authority...but expect the state/local dental districts to structure laws/policies to enforce it.

You have a pretty positive outlook on the profession and positive heart...but I think wall street thinks differently.

 

[sharkdent]

I know someone that is working hard to establish and expand dental therapist in US. Her plan is to produce thousands of dental therapists. She wants dental therapist to be in everyone dental office in the US. We are talking about 200,000 dental therapist in the future.

The Commission on Dental Accreditation and Federal Trade Commission are paving ways to establish more dental therapy programs. Many more states are looking into the dental therapist occupation.

If looking at a macro economic stand point, dental therapist will cause dentist wage to decrease.

I'm curious if dental student (pre-dental) knows what they are up against in the future.

 

[AppalachianDentalBoy]

I know someone that is working hard to establish and expand dental therapist in US. Her plan is to produce thousands of dental therapists. She wants dental therapist to be in everyone dental office in the US. We are talking about 200,000 dental therapist in the future.

The Commission on Dental Accreditation and Federal Trade Commission are paving ways to establish more dental therapy programs. Many more states are looking into the dental therapist occupation.

If looking at a macro economic stand point, dental therapist will cause dentist wage to decrease.

I'm curious if dental student (pre-dental) knows what they are up against in the future.

I’m predental. I plan to hire them instead of associate dentists. Can’t beat the corps then emulate them.

 

[321931]

I’m predental. I plan to hire them instead of associate dentists. Can’t beat the corps then emulate them.

I currently work 4 days a week...if I take off a day and make it a 3 day week, I would have to hire a dentist for 600-800$ a day. Regardless if its busy or not busy. If I could hire a DT for 20-30$ an hour thats 160-240$ a day.....well I think I know what most dental owners including corporate would choose.

 

[sharkdent]

So you think the ADA has no authority...but expect the state/local dental districts to structure laws/policies to enforce it.

You have a pretty positive outlook on the profession and positive heart...but I think wall street thinks differently.

ADA has no authority, State/local dental organization have even less authority. Elected state officials sees dental therapist as a solution for dental medicaid patients. No dentists wants medicaid because of low reimbursement and too much paperwork. Not cost effective.
State legislature wants dental therapist to help treat medicaid patients. But, people don't always do as planned. Dental therapists, just like everybody else, wants to get paid as much as possible, and to live in the most desirable area. Law makers think all the dental therapist will go to rural areas making $30/hr.

I think most Dental therapist will end up in the cities making $40/hr from big dental corp/chains. I can't see a new grad making more then dental therapist.

 

[ThisCrazyAvacado]

I currently work 4 days a week...if I take off a day and make it a 3 day week, I would have to hire a dentist for 600-800$ a day. Regardless if its busy or not busy. If I could hire a DT for 20-30$ an hour thats 160-240$ a day.....well I think I know what most dental owners including corporate would choose.

This will pretty much destroy most dentists over time. If your not on the top of the pyramid, you will be left to bite the dust. Currently with PA's, some of them pretty much work and manage private medical offices on their own. All they need is a doc to plaster their name on the office while the doc can be a 1000 miles away and have nothing to do with patient management. It would suck being one of those dentists with $400k+ in debt and having a hard time finding a job or making 80k a year without the possibility of ever paying off your student debt. However, if your a dentist that owns the offices, this opportunity would be sweet. Slash OH and labor by nearly a third. However, with the number of corps owning more and more offices, very few will ultimately benefit.

 

[ThisCrazyAvacado]

Also, an article in an ADA publication is about the most useless thing you can do to convince me. The ADA has no authority in my eyes, especially an opinion piece.

If facts are facts and there is an actual truth to it, then it shouldn't matter who writes it. If its nothing more than a fluff piece, facts are twisted in such a way or contains false info I'd understand.

 

[wwdentist]

There’s already been a fairly lengthy discussion on dental therapists recently

Dental Therapists

Thoughts on dental therapists? Will they have full prescription rights and do everything essentially a general dentist does?

forums.studentdoctor.net

 

[sharkdent]

This will pretty much destroy most dentists over time. If your not on the top of the pyramid, you will be left to bite the dust. Currently with PA's, some of them pretty much work and manage private medical offices on their own. All they need is a doc to plaster their name on the office while the doc can be a 1000 miles away and have nothing to do with patient management. It would suck being one of those dentists with $400k+ in debt and having a hard time finding a job or making 80k a year without the possibility of ever paying off your student debt. However, if your a dentist that owns the offices, this opportunity would be sweet. Slash OH and labor by nearly a third. However, with the number of corps owning more and more offices, very few will ultimately benefit.

Avacado, the sad thing is only one student responded. The rest are dentists. I think majority of the students trying to get into dental school have no idea of the changing dental landscape. I had no idea until my friend told me she just got hired by the state to expand the dental therapy program. She got me shaking in my boots!

 

[cooliyak]

So you think the ADA has no authority...but expect the state/local dental districts to structure laws/policies to enforce it.

You have a pretty positive outlook on the profession and positive heart...but I think wall street thinks differently.

I never said anything about state local dental “districts.” I’m not expecting anything from any of those organizations (other than their opposition). They don’t make laws or policies. State dental boards make the policies once the state legislators allow them room to do so with laws that are passed (or however it happens in your state of choice). If the ADA/state/local component societies want to get in on the ground level and help shape DT restrictions, etc., then they are more than free to do so. I just get tired of dentists putting a hard stop to DTs because of competition. What about the people who need the dental care? Dentists say only dentists should be able to treat, but then refuse to treat (indirectly by not accepting Medicaid). Where are the patients supposed to go then? I’m not saying DTs are the answer. Just that they could offer a solution.

 

[sharkdent]

Apparently this survey is not working....lol. No one responded to my Yes/No answers.

 

[cooliyak]

If facts are facts and there is an actual truth to it, then it shouldn't matter who writes it. If its nothing more than a fluff piece, facts are twisted in such a way or contains false info I'd understand.

I agree. Facts are facts. I’ve just already read that article (and more). I have yet to be convinced.
I also just have an extremely low opinion of the ADA.

 

[cooliyak]

Apparently this survey is not working....lol. No one responded to my Yes/No answers.

I did. I also see that there are 7 answers that have been submitted.

 

[321931]

I never said anything about state local dental “districts.” I’m not expecting anything from any of those organizations (other than their opposition). They don’t make laws or policies. State dental boards make the policies once the state legislators allow them room to do so with laws that are passed (or however it happens in your state of choice). If the ADA/state/local component societies want to get in on the ground level and help shape DT restrictions, etc., then they are more than free to do so. I just get tired of dentists putting a hard stop to DTs because of competition. What about the people who need the dental care? Dentists say only dentists should be able to treat, but then refuse to treat (indirectly by not accepting Medicaid). Where are the patients supposed to go then? I’m not saying DTs are the answer. Just that they could offer a solution.

Well...that's the million dollar question. What do you think of just doing away with our current model and doing universal healthcare that encompasses dental care?

 

[sharkdent]

I agree. Facts are facts. I’ve just already ready that article (and more). I have yet to be convinced.
I also just have an extremely low opinion of the ADA.

My friend is trying to expand the dental therapist big time... More dental therapist are coming. That is a fact.

 

[cooliyak]

Well...that's the million dollar question. What do you think of just doing away with our current model and doing universal healthcare that encompasses dental care?

That’s a good question and my answer is I don’t know. I work in public health so I am not as scared at that thought as most. I just know that the current system is leaving a lot of people out to dry and all the reasons I hear to oppose it appear to be selfish on dentists’ part (competition, decreased salaries, etc.).

 

[cooliyak]

My friend is trying to expand the dental therapist big time... More dental therapist are coming. That is a fact.

Most likely unless something better comes along.

 

[ThisCrazyAvacado]

I agree. Facts are facts. I’ve just already read that article (and more). I have yet to be convinced.
I also just have an extremely low opinion of the ADA.

Thing I don't get is that lawmakers and people are pitching the idea that DT will help rural areas get access to dental care. However, DT's need to be under the supervision of a dentist in the office. How is that going to work if there are no dentists in these areas in the 1st place? Unless, lawmakers give DT's more autonomy and flexibility to practice, its unlikely to change the landscape much. Also, who will be funding the costs to open up offices all over the rural areas? Costs are pretty insane. I mean come on... Some things just don't seem to add up.

Part of the reason why PA's end up working in urban areas, or large city areas rather than those rural areas, is there are simply no positions. Factor in the fact that most people don't want to live in these areas in the 1st place, it's not doing much to bring care to underserved areas. States like NH or Maine allows PA's a lot more autonomy than other states letting them practice pretty much solo yet it's not doing much overall in terms of increasing access to care.

How can you expect the outcome with DT's to be any different?

 

[cooliyak]

Thing I don't get is that lawmakers and people are pitching the idea that DT will help rural areas get access to dental care. However, DT's need to be under the supervision of a dentist in the office. How is that going to work if there are no dentists in these areas in the 1st place? Also, who will be funding the costs to open up offices all over the rural areas? Unless, lawmakers give DT's more autonomy and flexibility to practice, its unlikely to change the landscape much. I mean come on... Some things just don't seem to add up.

Part of the reason why PA's end up working in urban areas, or large city areas rather than those rural areas, is there are simply no positions. Factor in the fact that most people don't want to live in these areas in the 1st place, it's not doing much to bring care to underserved areas. States like NH or Maine allows PA's a lot more autonomy than other states letting them practice pretty much solo yet it's not doing much overall in terms of increasing access to care.

How can you expect the outcome with DT's to be any different?

Yeah, I guess I’m still hung up on the view that they can be restricted to only exist in underserved areas. At risk of falling into a “no true Scotsman” fallacy, I admit that it’s not a perfect system and my ideas may not work or even be possible. Teledentistry is most likely the answer to the other aspect you mentioned. They can work under a dentist remotely, yet still practice in the rural areas where they are needed.

 

[princeafrica]

Yeah, I guess I’m still hung up on the view that they can be restricted to only exist in underserved areas. At risk of falling into a “no true Scotsman” fallacy, I admit that it’s not a perfect system. Teledentistry is most likely the answer to the other aspect you mentioned. They can work under a dentist remotely, yet still practice in the rural areas where they are needed.

But if applicants thinking about becoming mid level dental provider know they will be restricted to work in rural areas only, won’t that just lower the number of applicants? Won’t these DT programs need high volume of applicants since everything is a business now or would they be state funded programs? Most people that will be interested in this position would be people that already live in rural areas. But we also, I’m sure, get a lot of dental applicants saying they are from rural areas and will work in rural places on their personal statement. But I’m not sure how many follow through because like most people they will want to live in desirable places.

Should there maybe be an increase in NHSC sites in these underserved communities? When I looked through the job search tool for NHSC approved sites, I was surprised to see a bunch in urban areas that are surrounded by Corps that take Medicaid such as comfort dental. Pardon any ignorance I may be missing something.

Or let’s cut the military budget and increase Medicaid reimbursements.....the navy spent $37Bn on a ship that doesn’t work.

 

[ThisCrazyAvacado]

Yeah, I guess I’m still hung up on the view that they can be restricted to only exist in underserved areas. At risk of falling into a “no true Scotsman” fallacy, I admit that it’s not a perfect system. Teledentistry is most likely the answer to the other aspect you mentioned. They can work under a dentist remotely, yet still practice in the rural areas where they are needed.

That is definitely a possibility and way to address the issue.

If we really wanted to push/force/send providers to rural areas, lawmakers could implement limits on the number of dentists that can work in a specific area. Create some sort of system that restricts the number of dentists per capita. Sort of how certain business industries work. Limit the # of licences in an area based on the size of the population. However, this would bring up many other issues. Something like 2/3's of dentists work in urban areas which is comprised of like 50% of the population. If we already have enough dentists in 'merica to take care of the population, having that strategy would spread them out evenly. This sort of system would truely suck due to limited mobility and freedom, but it would be one way to ensure quality care gets recieved to the population.

That or hike up tuition to the point that dental students will not be able to pay them, force them on new government repayment plans and limit them to work in rural areas to pay back their debt.

 

[cooliyak]

But if applicants thinking about becoming mid level dental provider know they will be restricted to work in rural areas only, won’t that just lower the number of applicants? Won’t these DT programs need high volume of applicants since everything is a business now or would they be state funded programs? Most people that will be interested in this position would be people that already live in rural areas. But we also, I’m sure, get a lot of dental applicants saying they are from rural areas and will work in rural places on their personal statement. But I’m not sure how many follow through because like most people they will want to live in desirable places.

Should there maybe be an increase in NHSC sites in these underserved communities? When I looked through the job search tool for NHSC approved sites, I was surprised to see a bunch in urban areas that are surrounded by Corps that take Medicaid such as comfort dental. Pardon any ignorance I may be missing something.

Or let’s cut the military budget and increase Medicaid reimbursements.....the navy spent $37Bn on a ship that doesn’t work.

Supply and demand are definitely going to play a role. One way to address it is to offer grants/scholarships to those who already live there. I know certain states do that as well as certain Native American reservations (pay for or subsidize the cost as long as they come back and practice “at home”).
Increased NHSC sites and funding is also a good thought.
I have no opinion on military spending.

 

[cooliyak]

That is definitely a possibility and way to address the issue.

If we really wanted to push/force/send providers to rural areas, lawmakers could implement limits on the number of dentists that can work in a specific area. Create some sort of system that restricts the number of dentists per capita. Sort of how certain business industries work. Limit the # of licences in an area based on the size of the population. However, this would bring up many other issues. Something like 2/3's of dentists work in urban areas which is comprised of like 50% of the population. If we already have enough dentists in 'merica to take care of the population, having that strategy would spread them out evenly. This sort of system would truely suck due to limited mobility and freedom, but it would be one way to ensure quality care gets recieved to the population.

That or hike up tuition to the point that dental students will not be able to pay them, force them on new government repayment plans and limit them to work in rural areas to pay back their debt.

All possibilities. I’m generally more on the side of less restrictions instead of more, but it is for sure a difficult situation. Something has to give whether that is the comfort of dentists (incentivizing them to move out of urban areas) or the loosening of their grip on the profession to allow for increased access to dental services (allowing for midlevel providers).

 

[ThisCrazyAvacado]

Or let’s cut the military budget and increase Medicaid reimbursements.....the navy spent $37Bn on a ship that doesn’t work.

How dare you say that

We need to build more ships, big purty walls and have more trillion dollar programs to create the F-35 Fighter jets to keep us safe. Let the military industry spend how they please without any sort of repercussion and accountability. We needa keep our country safe from the big bad meanies.

When it comes to military, we have plenty of money to flush down the toilet but when it comes to increases to healthcare or the education system (stuff that actually matters for most) we broke dude.

 

[sharkdent]

Dental therapist good or bad, should have it or not is not my concern. My concern is that those students trying to get into dental school. Do they know about this issue? Not much feed back from applicants. It's tragic. My biggest complaint is that dental school are misinforming applicants. Applicants need to know what they are up against after they graduate.

To graduate with the highest debt of any profession and then to go up against dental insurance companies, dental corporations, and now dental therapist. It's crazy. I don't see dental salary going any higher anytime soon. I can't see how they can afford a a$500K debt. Just absurd.

Dental applicants. Opinions? Thoughts?

 

[cooliyak]

Dental therapist good or bad, should have it or not is not my concern. My concern is that those students trying to get into dental school. Do they know about this issue? Not much feed back from applicants. It's tragic. My biggest complaint is that dental school are misinforming applicants. Applicants need to know what they are up against after they graduate.

To graduate with the highest debt of any profession and then to go up against dental insurance companies, dental corporations, and now dental therapist. It's crazy. I don't see dental salary going any higher anytime soon. I can't see how they can afford a a$500K debt. Just absurd.

Dental applicants. Opinions? Thoughts?

I had no clue what a dental therapist was when I applied. I only learned about them during my interview at the University of Minnesota and understandably so (they were relatively new when I was going through the process and the University of Minnesota was just a year or two into their DT program which was the first in the US).
Either way, I actually don’t think it is the school’s job to inform applicants about this type of thing. The student should do their due diligence in researching the profession before they apply.

 

[2TH MVR]

Everything changes and overall those changes do not seem to favor the dentistry profession. Aligners have changed the orthodontic specialist profession forever. Orthodontists lost with this, but the GPs have an additional treatment that they can offer in house. I still remember when Hygeinists wanted to open stand alone hygeine practices (Colorado). Dentists said no, but it still happened. Corporate dentistry adds to the saturation of dentistry in urban areas which is a loss for the profession, but new graduates have job availability that wasn't there years ago .... good or bad.

The overall concept of DTs is admirable, but you cannot put stipulations on a DT where they can live and work. The current dental profession cannot offer an unbiased opinion on this and everyone knows it. It reeks of protectionism. The Corps will just salivate over the prospect of employing DTs. All the Corps care about is saving money and increasing their bottom end. Not their fault. They are a for profit business just like private practice.

DTs are coming .... just like the current PAs. Heck ... I actually like my PA better than my PC doc.

In 26 years ... I've witnessed some of these changes. Some good. Some bad. The bad is mostly in the urban areas. The point is that change WILL OCCUR regardless what anyone here opines.

 

[sharkdent]

I had no clue what a dental therapist was when I applied. I only learned about them during my interview at the University of Minnesota and understandably so (they were relatively new when I was going through the process and the University of Minnesota was just a year or two into their DT program which was the first in the US).
Either way, I actually don’t think it is the school’s job to inform applicants about this type of thing. The student should do their due diligence in researching the profession before they apply.

Not sure applicants can do their due diligence when DT is not even on the radar. I've been practicing for 15 years and I never heard of it until my friend told me she just got hired by the government to expand DT programs.

 

[cooliyak]

Not sure applicants can do their due diligence when DT is not even on the radar. I've been practicing for 15 years and I never heard of it until my friend told me she just got hired by the government to expand DT programs.

I wouldn’t say it’s not on the radar at all. It is something that ASDA has a position on and it comes up a good amount. If they are serious about dentistry, hopefully they are predental ASDA members. And if they are, they’d know a whole lot more about the profession than someone who isn’t. Regardless, I don’t think it is the school’s job to inform all of their prospective students about every single issue that comes up in the profession. That is the student’s job to research their own profession of interest.

 

[sharkdent]

I wouldn’t say it’s not on the radar at all. It is something that ASDA has a position on and it comes up a good amount. If they are serious about dentistry, hopefully they are predental ASDA members. And if they are, they’d know a whole lot more about the profession than someone who isn’t. Regardless, I don’t think it is the school’s job to inform all of their prospective students about every single issue that comes up in the profession. That is the student’s job to research their own profession of interest.

At least 10% of the reader now knows about DT.

 

[lwergod]

At least 10% of the reader now knows about DT.

is your friend a dentist too?

 

[sharkdent]

Of course.

 

[Cookie_nibbler]

I am a huge advocate for dental therapy to be passed. I understand that they would be rivals to dentists, but look at like this. Dental therapists could do the light work that dentists can do and leave the more serious procedures and more revenue to the dentist to make. Dental therapists can save so much time for a dentist in a private office and offer more time to the general dentist in the office and let him/her make more money through more serious procedures such as implants and so on.

 

[AppalachianDentalBoy]

Dental therapists could do the light work that dentists can do and leave the more serious procedures and more revenue to the dentist to make.

Yep that's the lie that y'all keep spreading. In reality the only ones to benefit will be the corps, they will fire almost all of their dentists and have the one they keep supervise the DTs.

 

[SkinnyT]

30 an hr? RDHs already make much more than that. DT rates would deff. be higher than that considering they would do added functions.

 

[princeafrica]

I am a huge advocate for dental therapy to be passed. I understand that they would be rivals to dentists, but look at like this. Dental therapists could do the light work that dentists can do and leave the more serious procedures and more revenue to the dentist to make. Dental therapists can save so much time for a dentist in a private office and offer more time to the general dentist in the office and let him/her make more money through more serious procedures such as implants and so on.

I have no opinion on dental therapist
But maybe it would be favorable to more people if implants and more "serious procedures" were taught across all schools

 

[Cello]

This goes against popular opinion, but I am actually in favor of them to a certain extent. Until access to care issues are actually addressed, dental therapists are going to continue being pushed by Kellogg and other organizations. It’s a supremely complicated, multifaceted issue, so there is no “one solution,” but I, personally, would love to have a dental therapist or two working with me in the rural, primary care setting. Dentists can’t just be opposed to them, yet not take Medicaid (yes I know reimbursement is horrible) or be willing to move outside of big cities where the need is. People need care and if they can’t get it from dentists, they need it from someone in the dental field. Some care is better than no care (and no, I didn’t say lesser care. I said some care as in any care.)
Dental therapists aren’t that bad. Change my mind.

I was ASDA political advocacy chair in my local chapter last year when the dental therapy bill was proposed a 2nd time in the Arizona state legislature (it died early the year before). We spent a lot of time on this issue, coordinating with the Arizona Dental Association, and testifying before lawmakers why dental therapists as proposed in the Arizona bill would not work and actually presented a danger to the public.

The bill that was proposed here in Arizona was brazen to say the least. Dental therapists would have only required 3-years of training after high school and been allowed to perform anesthesia and nearly the full suite of restorative dental procedures. Additionally, they could perform simple extractions, and pulpectomies, all without direct supervision by a dentist. Imagine, someone with three years education, to your eight, having a large scope of practice without knowing the implications or fully understanding the risks. That bill was the camel's nose under the tent, as Arizona would have been the incubator for the same kinds of dental therapy laws around the nation. "They train them in three years in Arizona, and look how good it's worked out!" As the AzDA pointed out to the state legislature during hearings here, there was no data to track malpractice from DTs in Alaska (the place they used as an example of how effective DTs are) because the malpractice claims fall under the overseeing dentist. So, when DTs claim they have a "perfect record," they are in essence lying by omission.

I'll give you two good reasons Dental Therapists are not a good solution for access to care issues:

1.) Dental therapists in Minnesota are largely collected in the Minneapolis-Saint Paul area working at private clinics under doctors who are often running Medicaid mills. Access to dental care in rural areas of Minneapolis has not budged since the introduction of dental therapists. In the end, dental therapists want to live in the same places that dentists do. Why wouldn't they?

2.) The New Zealand model of having dental therapists in the school system to provide preventive dental interventions has not had a significant impact on childhood caries in New Zealand's schools. Furthermore, overall caries incidence across New Zealand has increased slightly over time, particularly in remote regions, suggesting that dental therapists have been ineffectual at preventing this increase or providing better care to rural populations. The same may be said for Minnesota and Alaska as well.

 

[cooliyak]

I was ASDA political advocacy chair in my local chapter last year when the dental therapy bill was proposed a 2nd time in the Arizona state legislature (it died early the year before). We spent a lot of time on this issue, coordinating with the Arizona Dental Association, and testifying before lawmakers why dental therapists as proposed in the Arizona bill would not work and actually presented a danger to the public.

The bill that was proposed here in Arizona was brazen to say the least. Dental therapists would have only required 3-years of training after high school and been allowed to perform anesthesia and nearly the full suite of restorative dental procedures. Additionally, they could perform simple extractions, and pulpectomies, all without direct supervision by a dentist. Imagine, someone with three years education, to your eight, having a large scope of practice without knowing the implications or fully understanding the risks. That bill was the camel's nose under the tent, as Arizona would have been the incubator for the same kinds of dental therapy laws around the nation. "They train them in three years in Arizona, and look how good it's worked out!" As the AzDA pointed out to the state legislature during hearings here, there was no data to track malpractice from DTs in Alaska (the place they used as an example of how effective DTs are) because the malpractice claims fall under the overseeing dentist. So, when DTs claim they have a "perfect record," they are in essence lying by omission.

I'll give you two good reasons Dental Therapists are not a good solution for access to care issues:

1.) Dental therapists in Minnesota are largely collected in the Minneapolis-Saint Paul area working at private clinics under doctors who are often running Medicaid mills. Access to dental care in rural areas of Minneapolis has not budged since the introduction of dental therapists. In the end, dental therapists want to live in the same places that dentists do. Why wouldn't they?

2.) The New Zealand model of having dental therapists in the school system to provide preventive dental interventions has not had a significant impact on childhood caries in New Zealand's schools. Furthermore, overall caries incidence across New Zealand has increased slightly over time, particularly in remote regions, suggesting that dental therapists have been ineffectual at preventing this increase or providing better care to rural populations. The same may be said for Minnesota and Alaska as well.

Still not convinced that it CAN’T work. Just need better models of training and implementation.

 

[deleted942432]

Pumping out more DT will accomplish it intended goal of providing rural communities with oral care. Just not in the way you think it would. Instead of DT going rural, it will force dentists to go rural because they cannot compete with DT. Job opportunities and wages for dentists will be limited in saturated urban areas, forcing them to move to less competitive rural areas.

 

[Mr. Thirsty]

DT's would have to be allowed to work on their own to effectively increase access to care, otherwise how will they move rural? Build their own dental clinics? And are they going to force them to live in rural areas? To make a salary less than or equal to a hygienist. That's not very appetizing for new applicants. The vast majority of DTs are going to work for a private practice or corporation in a metropolitan area, unless there are restrictions in place.

The corps are going to suck these mid-level providers up and increase their bottom line. The filling / crown / ext will still cost the same to the patient, so how does this improve access to care?

If the government actually cared about access to care then they would increase funding for medicaid or build more FQHC clinics with student loan-refunding incentives. Instead, they would rather blame dentists for not filling their clinics with medicaid. Can you honestly blame dentists with massive debt for not accepting medicaid fees? Look I am all about outreach and helping the poor, but you can only have so much of your schedule be medicaid while offering quality care before you go bottom up.

I am not saying that DT's couldn't exist and be effective at restorative, but the people proposing these programs are pretty naive about what will actually be the result. DT's performing extractions and pulpectomies? No way. Especially since as of now dental therapists would fall under our malpractice insurance.

 

[pubhealthdent]

Minnesota tried this and 60% of their DTs are working in urban areas, competing with dentists for the same patients. The majority aren't going to the rural areas. Is that what we want? Unless we can force them to work rural or underserved.

Better idea would be to improve medicaid reimbursement so as to encourage private practices to accept these patients. Make it so the mom and pop shops in towns of 500 - 5000 can actually afford to see the medicaid patients in their area, rather than forcing them to go to the closest FQHC, which could be 30-50 miles away.

 

[butterchkn]

Minnesota tried this and 60% of their DTs are working in urban areas, competing with dentists for the same patients. The majority aren't going to the rural areas. Is that what we want? Unless we can force them to work rural or underserved.

Better idea would be to improve medicaid reimbursement so as to encourage private practices to accept these patients. Make it so the mom and pop shops in towns of 500 - 5000 can actually afford to see the medicaid patients in their area, rather than forcing them to go to the closest FQHC, which could be 30-50 miles away.

100% agreed. Run for president 2020? Is it too late?

 

[pubhealthdent]

100% agreed. Run for president 2020? Is it too late?

No time for that. Too busy on the front lines trying to treat those medicaid patients that no one else will

 

[butterchkn]

No time for that. Too busy on the front lines trying to treat those medicaid patients that no one else will

Mad respect.