Dental Therapist

[Undecided__]

I start dental school in the fall, and I was wondering if Dental Therapist is something that will come into dentistry soon?

I left the dental office due to getting a cleaning. The hygienist said she wish they will let dental therapist become a thing in all states so that they can pull teeth, do simple fillings, and clean teeth without supervision from a dentist. She doesn't like that the dentist make money off of her production...

What is a simple filling? Why should they do procedures it takes us 8 years and a ton of debt to do/learn??? Honestly, what would be a point for a dentist? I understand other medical careers have midlevels, but the scope of dentistry is soo narrow to have a midlevel...

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[DMD12345]

“Access to care.” Buckle up, you’re gonna love it

 

[Undecided__]

“Access to care.” Buckle up, you’re gonna love it

The hygienist said medicaid pays $20 for a cleaning. If she doesn't want to be $20 now for a cleaning, how will she want to make $20 for a cleaning as a therapist??? I mean she left the rural area to go to a more urban area because she wants more money, but then is upset younger dentist leave or don't go to rural areas


just a bunch of contradictory excuses

 

[Lemillion]

Dental therapists have been the hot topic in certain states since I was in dental school. The primary idea is that they could help provide more care in rural, underserved communities. Honestly, I think the hygienist is just venting. He/she should consider going back to dental school if they want to provide a wider scope of care. Making money off their production applies to associate dentists as well. It's basically the owners cut for providing the patients, equipment and resources for them to do their job.

To answer your question, simple fillings are supposed to be like class I or class V restorations. A simple filling on the surface level could easily become a indirect pulp cap or extend to multiple surfaces of the tooth. Quality care stems from proper diagnosis which is difficult if you have dental therapists diagnosing and working without supervision in a setting where their limited knowledge would inevitably lead to less than ideal treatment planning and care.

 

[redchesus]

LMAO yeah... they're all gung-ho about fillings and extractions when they see me do them in minutes but they don't realize how much training I've had to go through to be able to do that. Everything is simple until it isn't. A simple occlusal filling is simple until you unroof it and realize it's blown out underneath. A simple extraction is simple until a root tip breaks off. Diagnosing and treatment planning is the hardest part... that's what the doc is getting paid for during exams.

That RDH does not seem to comprehend the business aspect of being an employee either if she's thinking that the dentist "is making money off of her production"

 

[Undecided__]

LMAO yeah... they're all gung-ho about fillings and extractions when they see me do them in minutes but they don't realize how much training I've had to go through to be able to do that. Everything is simple until it isn't. A simple occlusal filling is simple until you unroof it and realize it's blown out underneath. A simple extraction is simple until a root tip breaks off. Diagnosing and treatment planning is the hardest part... that's what the doc is getting paid for during exams.

That RDH does not seem to comprehend the business aspect of being an employee either if she's thinking that the dentist "is making money off of her production"

how is the dentist not making production off of her?

 

[redchesus]

how is the dentist not making production off of her?

is she paying overhead? who is paying for her supplies, equipment, DA/FD/OM wages, utilities, marketing to get those patients into her chair... basically all the business costs that allows her to do her job and produce?
if she wants to be paid on production she needs to negotiate that, but she has to understand she's gonna have to pay for all the "costs in" as well, not just keep all her revenue as profit (at which point she will realize her take-home is less than her hourly wage now and want to go back, it's happened before)

 

[GoDental101]

Honestly if more of the new grads don't start going rural or to urban under served communities then yeah dental therapy is going to become more and more prevalent. They will basically be doing the same stuff as dentists just with less education. I think this is going to become reality especially when you see how spoiled most dental students are and will basically refuse to work in certain areas of this great country.

Supply and demand is basically pushing to mid-level dental providers due to the lack of care in in these areas. If I was a fresh high school grad I'd seriously look at doing dental therapy. It could be great and save lots of time.

 

[GoDental101]

I start dental school in the fall, and I was wondering if Dental Therapist is something that will come into dentistry soon?

I left the dental office due to getting a cleaning. The hygienist said she wish they will let dental therapist become a thing in all states so that they can pull teeth, do simple fillings, and clean teeth without supervision from a dentist. She doesn't like that the dentist make money off of her production...

What is a simple filling? Why should they do procedures it takes us 8 years and a ton of debt to do/learn??? Honestly, what would be a point for a dentist? I understand other medical careers have midlevels, but the scope of dentistry is soo narrow to have a midlevel...

The scope of dentistry is not narrow lol

It doesn't take us 8 years to learn how to do a filling or an exo or any of that...it's actually laughable to think about spending 8 years dedicated to learning how to do a filling or how to pull a tooth haha it's not that complicated. A large part of our education as dental professionals is unrelated to the actual doing of procedures.

 

[redchesus]

Honestly if more of the new grads don't start going rural or to urban under served communities then yeah dental therapy is going to become more and more prevalent. They will basically be doing the same stuff as dentists just with less education. I think this is going to become reality especially when you see how spoiled most dental students are and will basically refuse to work in certain areas of this great country.

Supply and demand is basically pushing to mid-level dental providers due to the lack of care in in these areas. If I was a fresh high school grad I'd seriously look at doing dental therapy. It could be great and save lots of time.

I'll patently disagree with you on the rural thing... it's not just about new grads being spoiled. You gotta look at population trend and demographic not just dentist-to-population ratio. A lot of rural areas have DECREASING population trend which is not a good thing if you're looking at settling down and setting up a practice. And if you're trying to pay off $300K+ of debt which most new grads are coming out with, a Medicaid-heavy population will leave you in poverty at the current reimbursement rates... or you're running ragged doing crappy volume work.

That's why most people end up in the suburbs.

 

[GoDental101]

I'll patently disagree with you on the rural thing... it's not just about new grads being spoiled. You gotta look at population trend and demographic not just dentist-to-population ratio. A lot of rural areas have DECREASING population trend which is not a good thing if you're looking at settling down and setting up a practice. And if you're trying to pay off $300K+ of debt which most new grads are coming out with, a Medicaid-heavy population will leave you in poverty at the current reimbursement rates... or you're running ragged doing crappy volume work.

That's why most people end up in the suburbs.

The rural areas I'm taking about are not Medicaid heavy areas they are usually agriculture communities, but I agree trying to practice in a medicaid heavy population is definitely gonna be very difficult for a dentist to make ends meet, emphasizing the need for mid-level providers in these types of areas.

 

[DrJeff]

The economics of a therapist can be very challenging to make it work if one considers the following things. There won't be a separate fee schedule for therapists. They will be billing the same say $100 for a filling that a dentist would be, and as well if it's a medicaid patient, they will be reimbursed the same say $25 for that filling that the dentist will be. The materials they use, will cost the same as the materials that a dentist uses, the therapist will likley have an assistant getting the same, or very similar, hourly pay that the dentist's assistant gets. That therapist will then expect to be paid more than a hygenist, and in many cases that will likely mean something in the 100k a year range (the therapist will have loans to repay and will expect to be paid at a level that accounts for that.

Ultimately the main "issue" is that for medicaid reimbursement rates, they are very often at a level that is below what a practices overhead level is, and as such, there are only so many medicaid patients that you can see in a practice that isn't say subsidized by some gov't program, and still remain a viable business. The concept of a dental therapist may seem great to many public health officials, however the economic realities of it, often are in conflict with the public health wishes in the real world

 

[Undecided__]

The scope of dentistry is not narrow lol

It doesn't take us 8 years to learn how to do a filling or an exo or any of that...it's actually laughable to think about spending 8 years dedicated to learning how to do a filling or how to pull a tooth haha it's not that complicated. A large part of our education as dental professionals is unrelated to the actual doing of procedures.

How is dentistry not narrow when you’re only dealing with the mouth? I didn’t say dentist only do fillings and pull teeth.

 

[Undecided__]

The economics of a therapist can be very challenging to make it work if one considers the following things. There won't be a separate fee schedule for therapists. They will be billing the same say $100 for a filling that a dentist would be, and as well if it's a medicaid patient, they will be reimbursed the same say $25 for that filling that the dentist will be. The materials they use, will cost the same as the materials that a dentist uses, the therapist will likley have an assistant getting the same, or very similar, hourly pay that the dentist's assistant gets. That therapist will then expect to be paid more than a hygenist, and in many cases that will likely mean something in the 100k a year range (the therapist will have loans to repay and will expect to be paid at a level that accounts for that.

Ultimately the main "issue" is that for medicaid reimbursement rates, they are very often at a level that is below what a practices overhead level is, and as such, there are only so many medicaid patients that you can see in a practice that isn't say subsidized by some gov't program, and still remain a viable business. The concept of a dental therapist may seem great to many public health officials, however the economic realities of it, often are in conflict with the public health wishes in the real world

That’s what I was concerned with. But, they don’t look at the other cost… I hope dentists don’t allow this to happen

 

[2TH MVR]

… I hope dentists don’t allow this to happen

Anything a dentist says about dental therapists being a bad idea will seem "self-serving" to the general public. Everyone wants to protect their turf right or wrong.

How about this comparison? Dentists don't want "lesser" trained midlevels doing the "easier" dental procedures. Kind of like specialists don't like "lesser" trained general dentists doing the "easier" specialty procedures. It's all about protecting patients. Right?

It's all a turf war. General dentists can't have it both ways.

 

[redchesus]

Anything a dentist says about dental therapists being a bad idea will seem "self-serving" to the general public. Everyone wants to protect their turf right or wrong.

How about this comparison? Dentists don't want "lesser" trained midlevels doing the "easier" dental procedures. Kind of like specialists don't like "lesser" trained general dentists doing the "easier" specialty procedures. It's all about protecting patients. Right?

It's all a turf war. General dentists can't have it both ways.

This is true. Look at what's happening with family practice doctors and medical midlevels (NPs, PAs). And turf war is why very few medical students want to go into family medicine. Ultimately I think it comes down to public perception of "access to care" versus individual cases of bad outcomes from midlevels.

The "access to care" line is a real joke in my opinion though, because in states with established dental therapists (that are not limited to tribal land for example), the majority of them stay in urban areas just like dentists... so the rural patients will get screwed regardless

 

[yappy]

It’s just not needed. There are no shortages.

 

[PerioDont]

I start dental school in the fall, and I was wondering if Dental Therapist is something that will come into dentistry soon?

I left the dental office due to getting a cleaning. The hygienist said she wish they will let dental therapist become a thing in all states so that they can pull teeth, do simple fillings, and clean teeth without supervision from a dentist. She doesn't like that the dentist make money off of her production...

What is a simple filling? Why should they do procedures it takes us 8 years and a ton of debt to do/learn??? Honestly, what would be a point for a dentist? I understand other medical careers have midlevels, but the scope of dentistry is soo narrow to have a midlevel...

What kind of hygienist has this conversation with a patient…that’s just weird.

If she doesn’t want the dentist to make money off of her she is free to spend 4 years to go to dental school and then take on hundreds of thousands of dollars in liability to open her own practice just as the dentist has done.

 

[Undecided__]

What kind of hygienist has this conversation with a patient…that’s just weird.

If she doesn’t want the dentist to make money off of her she is free to spend 4 years to go to dental school and then take on hundreds of thousands of dollars in liability to open her own practice just as the dentist has done.

lol she not going to do that. She’s not that concerned with serving the poor because otherwise, she would’ve stayed working there. She left to make more money, just like the dentists she talked about

 

[D1Bound]

What’s next? Letting hygienists cowboy around with sedation?

 

[Undecided__]

What’s next? Letting hygienists cowboy around with sedation?

lol, I thought they could use laughing gas

 

[OMSDoc]

So, clearly, dental therapists are dentistry's version of the mid-level provider. There are a lot of legislators who think that this is the correct approach.

I have had referrals from dental therapists, and I have seen nothing amiss. I have been impressed with their assessments.

On the medical side, I work with a lot of nurse practitioners and nurse anesthetists, and I think they are excellent. Indeed, one of my son's pediatric nurse practitioners was the first one to discover his exotropia. A lot of the preoperative physicals that I get are performed...very well...by physicians associates and nurse practitioners. Moreover, I have a great respect for CRNAs. So in my practice, we have great respect for nurse practitioners and CRNAs.

In Minnesota, the original legislation pushing dental therapists did not mandate that they practice only in under-served areas. Indeed, I don't know how you could even enforce this.

This ended up being passed through our state legislature only because of politics. Years ago, a new majority in the state legislature stripped some members of their committee assignments, and those people didn't show up for a couple of votes....that is how it was passed.

 

[OMSDoc]

Moreover, I disagree with those who say there will not be a different fee schedule for the dental therapist.

I am certain that the “dental insurance“ companies will say, “We are not going to pay dental therapists the same thing we pay a dentist because they don’t have the same training.“

So, they will lower their reimbursement to the dental therapists.

Then, they will turn around and tell the dentist that “We are not going to pay you this for that, because we are paying for the exact same procedure to these other practitioners for quite a bit less.”

Everyone looks after their own best interests, including “dental insurance” companies.

I have very good friends who are nurse practitioners, and they have complained to me about not getting paid the same thing as a family medicine physician. And I am thinking to myself, “But this is why they created this in the first place.“

 

[Undecided__]

Moreover, I disagree with those who say there will not be a different fee schedule for the dental therapist.

I am certain that the “dental insurance“ companies will say, “We are not going to pay dental therapists the same thing we pat a dentist because they don’t have the same training.“

So, they will lower their reimbursement to the dental therapists.

Then, they will turn around and tell the dentist that “We are not going to pay you this for that, because we are paying for the exact same procedure to these other practitioners for quite a bit less.”

Everyone looks after their own best interests, including “dental insurance” companies.

I have very good friends who are nurse practitioners, and they have complained to me about not getting paid the same thing as a family medicine physician. And I am thinking to myself that, “Butthis is why they created this in the first place.“

Yeah. NPs tend to think they have the same or higher knowledge than MDs. I'm sure a few NPs may be more knowledgeable than MDs, but the majority isn't in terms of medicine.