Dental therapists?

[FLOSS UR TEETH]

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Have any of you heard of this.. "dental therapists" performing dental procedures such as extracting teeth. I was moved back by this when I saw it on the Alaskan news today. With a bachelor's degree these people are performing surgical and restorative procedures including root canals. Unbelievable. IMO, I would not trust someone with such limited education and "expertise." What happens if a patient has a stroke or heart attack in the chair? or something terrible goes wrong during the procedure?

apparently the president of the ADA is not to fond of it as well.

I guess the positives would be low cost care to underserved areas but still there is also a concern revolving around the fact that the procedures can be accompanied by serious complications that "dental therapists" may or may not be able to handle..

any comments?

 

[Red Britton]

I heard of this last year in an interview, and the same this year. I think it is actually a cool idea. Not to many dentist in remote areas of Alaska, Montana, and other less populated states, so why not allow those residents to get the basic care.

I'm sure a dental therapist doing a root canal or some specialized procedure would only be necessary in an emergency case, or with a dental therapist that is well trained and experienced in the procedure. I haven't researched the topic that in depth, but I'm sure they have some restrictions on what they can and cannot do.

 

[2th Doc]

I heard of this last year in an interview, and the same this year. I think it is actually a cool idea. Not to many dentist in remote areas of Alaska, Montana, and other less populated states, so why not allow those residents to get the basic care.

Sure, if the therapists went to all the areas that are completely and perpetually lacking in dentists, this would be a spectacular idea as far as providing access to basic care (although I'm not too convinced it's a good idea for the patients if therapists don't know their own limitations). But where's the guarantee that all therapists will go to these areas? There isn't one, and when they start infiltrating all the areas with established dentist presence, it could have a serious impact on dentists' market.

I see the point in providing more diversity in the options that patients have, which probably has good intentions of getting basic care to a larger proportion of the population, but it would be more favorable if somehow it were structured in a way that doesn't affect the areas that are operating just fine on the base of dentists they now have. I'm not a fan of ideas that try to shortcut the system and undermine the industry of dentistry, which I believe dental therapists can easily do, if not intentionally.

 

[Pat Kelly]

Have any of you heard of this.. "dental therapists" performing dental procedures such as extracting teeth. I was moved back by this when I saw it on the Alaskan news today. With a bachelor's degree these people are performing surgical and restorative procedures including root canals. Unbelievable. IMO, I would not trust someone with such limited education and "expertise." What happens if a patient has a stroke or heart attack in the chair? or something terrible goes wrong during the procedure?

apparently the president of the ADA is not to fond of it as well.

I guess the positives would be low cost care to underserved areas but still there is also a concern revolving around the fact that the procedures can be accompanied by serious complications that "dental therapists" may or may not be able to handle..

any comments?

get off your ****ing high horse man. Are you a dentist right now? If not, then you are just as "uneducated" as the dental therapists. Dental school is only 4 years of training and you may only get 3 years of clinical training IF you are lucky and attend schools that give you that much time. You are saying that dental therapists can't do the same thing that dentists do given the same amount of time training? Give me a freaking break. You think your bachelors degree in sciences or other field makes you MORE qualified? you DO know that every dental professional - whether you are a dentist, dental hygienist, dental assistant, or dental therapist, receive the same CPR training and has the same legal responsibilities right? What the hell do you think that a dentist is going to do anything different than a dental hygienist or assistant when it comes to patients having medical emergencies?

 

[mitrieD]

get off your ****ing high horse man. Are you a dentist right now? If not, then you are just as "uneducated" as the dental therapists. Dental school is only 4 years of training and you may only get 3 years of clinical training IF you are lucky and attend schools that give you that much time. You are saying that dental therapists can't do the same thing that dentists do given the same amount of time training? Give me a freaking break. You think your bachelors degree in sciences or other field makes you MORE qualified? you DO know that every dental professional - whether you are a dentist, dental hygienist, dental assistant, or dental therapist, receive the same CPR training and has the same legal responsibilities right? What the hell do you think that a dentist is going to do anything different than a dental hygienist or assistant when it comes to patients having medical emergencies?

Come on man, give him a break. He's expressing his opinion, not stating a fact. "IMO..."

 

[FLOSS UR TEETH]

get off your ****ing high horse man. Are you a dentist right now? If not, then you are just as "uneducated" as the dental therapists. Dental school is only 4 years of training and you may only get 3 years of clinical training IF you are lucky and attend schools that give you that much time. You are saying that dental therapists can't do the same thing that dentists do given the same amount of time training? Give me a freaking break. You think your bachelors degree in sciences or other field makes you MORE qualified? you DO know that every dental professional - whether you are a dentist, dental hygienist, dental assistant, or dental therapist, receive the same CPR training and has the same legal responsibilities right? What the hell do you think that a dentist is going to do anything different than a dental hygienist or assistant when it comes to patients having medical emergencies?

sorry, didn't mean to come across with arrogance as you explicitly claim.. however, are you aware that their program is only 3 years and they only have 1 year of clinical exposure, if that? no one said they were uneducated, but IMO they are not as educated as a dentist in the field of dentistry. Question for you, are the DMD/DDS programs even comparable to this BS in Dental Therapy when looking at clinical exposure and depth and breadth in the sciences? lets get real, seriously.

I am saying the opposite to your statement of a "BS being more qualified." IMO, a DMD or DDS is way the hell more qualified than a BS hence my original post....

 

[winnie bear]

I talked to a few dentists who had different opinions about (though, not particularly DT's) other dental professionals for example, lobbying to be able to perform more procedures.

One dentist (a specialist) was indifferent for the most part, but did say he doesn't see why a hygienist would be any less qualified than a dentist to do the job. Another dentist (who is retired and volunteers at a nonprofit dental clinic regularly and also started a dentures fund for those in need so has none to gain from advocating one or the other) was concerned about the quality of work on more complicated procedures. I think here the concern is more about the education provided at the trade schools.

I can see both sides of the coin, and I'm not particular heated about it. It is what it is, but I'm very interested in what the future would look like for GP's and had posted something that's somewhat related. http://forums.studentdoctor.net/showthread.php?t=870074

Occupations evolved and whatever direction it takes us in the future, it's good to start thinking about.

 

[uva09]

Have any of you heard of this.. "dental therapists" performing dental procedures such as extracting teeth. I was moved back by this when I saw it on the Alaskan news today. With a bachelor's degree these people are performing surgical and restorative procedures including root canals. Unbelievable. IMO, I would not trust someone with such limited education and "expertise." What happens if a patient has a stroke or heart attack in the chair? or something terrible goes wrong during the procedure?

apparently the president of the ADA is not to fond of it as well.

I guess the positives would be low cost care to underserved areas but still there is also a concern revolving around the fact that the procedures can be accompanied by serious complications that "dental therapists" may or may not be able to handle..

any comments?

In less than 3 months time, someone with a high school diploma can earn medical licensure as an EMT-Basic and respond to that heart attack or stroke, you speak of. And I doubt you have the gall to denounce first responders and their "lack of clinical expertise or limited education".

As a potential private practice owner you are failing to see the incredible business advantage Dental Therapists could one day provide. Much like the MD - PA relationship, a Dental Therapist could provide a General Practitioner or Specialist with an extra mind and an extra pair of hands at a small fraction of the cost of an additional Dentist. And for the vast majority of day-to-day procedures, the level of training would more than suffice and ultimately offer substantial bottom-line growth.

It is unlikely you would ever see stand alone practices with DT practitioners in any areas of mainstream desirability or noteworthy population levels for much of the same reasons you don't see independent PA practices in said locales - politics, perception, economics, etc. The idea of competition is largely hokum and rooted in frivolous fear.

Just like a PA, a Dental Therapist would have a thoroughly evaluated scope of practice, as well as avenues for oversight and risk aversion.

At the end of the day, the country faces a serious oral healthcare shortage - especially in rural and underserved regions of the country. A Dental Therapist could bridge these gaps in a cost-effective manner. And as a future Dentist, I would think widespread oral health should be one of your tenets.

 

[uva09]

And as a general note for those worrying about quality of care or what a DT can or can't do. Don't. Have a little sense.

Like it or not, we live in a world of regulation, hyper-litigation, and poisonous fraud.

Do you really think the ADA - or for that matter, the United States Department of Health and Human Services would ever allow a professional free reign without an exhaustively vetted system of checks and balances with regards to scope of practice and standard of care?

Come on.

 

[FLOSS UR TEETH]

In less than 3 months time, someone with a high school diploma can earn medical licensure as an EMT-Basic and respond to that heart attack or stroke, you speak of. And I doubt you have the gall to denounce first responders and their "lack of clinical expertise or limited education".

As a potential private practice owner you are failing to see the incredible business advantage Dental Therapists could one day provide. Much like the MD - PA relationship, a Dental Therapist could provide a General Practitioner or Specialist with an extra mind and an extra pair of hands at a small fraction of the cost of an additional Dentist. And for the vast majority of day-to-day procedures, the level of training would more than suffice and ultimately offer substantial bottom-line growth.

It is unlikely you would ever see stand alone practices with DT practitioners in any areas of mainstream desirability or noteworthy population levels for much of the same reasons you don't see independent PA practices in said locales - politics, perception, economics, etc. The idea of competition is largely hokum and rooted in frivolous fear.

Just like a PA, a Dental Therapist would have a thoroughly evaluated scope of practice, as well as avenues for oversight and risk aversion.

At the end of the day, the country faces a serious oral healthcare shortage - especially in rural and underserved regions of the country. A Dental Therapist could bridge these gaps in a cost-effective manner. And as a future Dentist, I would think widespread oral health should be one of your tenets.

this is good information, thank you for your response. I do agree with a lot of what you have to say. And yes, I do believe in making access to oral health care much more widespread. I guess my concern was more along the lines of the scope of work a DT would be doing compared to a dentist and would this put a patient at risk? Also, is there a guarantee that these DT's will go into underserved areas?

I do like your point about them benefiting the dentist IF they work for one. However, are they allowed to work alone or can they compete against the dentist? They are allowed to do many procedures for the fraction of the cost of going to a dentist. I guess there are pros and cons to it unless I am missing something. By the way, I live in a city that does have quite a few stand alone PA practices. In fact, my school's health center is run solely on a stand alone PA practice. But seriously, you have some really good valid points, but IMO there can be some cons.

FYI, the ADA president was in big disagreement to having DT's when he was speaking in the news.

 

[FLOSS UR TEETH]

And as a general note for those worrying about quality of care or what a DT can or can't do. Don't. Have a little sense.

Like it or not, we live in a world of regulation, hyper-litigation, and poisonous fraud.

Do you really think the ADA - or for that matter, the United States Department of Health and Human Services would ever allow a professional free reign without an exhaustively vetted system of checks and balances with regards to scope of practice and standard of care?

Come on.

read this

http://www.dental-tribune.com/articles/content/id/6347/scope/politics/region/usa

and please do me a favor and watch this

[YOUTUBE]http://www.youtube.com/watch?v=KDM2ykj1K70[/YOUTUBE]

your argument is very invalid. The ADA is definitely against it. I mean look at what the ADA president has to say lol. Look at 4:50.

 

[SeattleRDH]

I could go on and on about this topic but I'll try to keep it about Alaska. The original DHATs were sent to New Zealand to a program that was 2 years post high school. They were not required to take any prereqs as far as I know. It took me over a year to just complete the prereqs to apply for hygiene school which was also a 2 year program. Hygienists in Alaska take the WREB exam and are licensed to perform preventive perio therapy and give local anesthetic. DHATs are not required to take the WREB nor even get licensed as a hygienist yet they are allowed to practice independently whereas a hygienist cannot legally start cleaning someone's teeth without a dentists exam first.

I am not against mid-level providers but they MUST be mid-level educated as in a masters degree level. DHATs are nowhere close. As an Alaskan I am saddened by people's "not in my backyard" attitude. The people of Alaska deserve better too! Only a DDS (doctor of dental SURGERY) should be performing surgeries.

I am one of those providers who is as close to a midlevel as they come (as Washington has the largest scope of practice for hygienists) and I'll say that yeah, I could probably drill some of those preps that I fill with composite but every once in a while there is a really big cavity that didn't look that big on the xray which goes below the bone level, approaches the pulp, or cracks the tooth, and I would HATE IT if the only option at that point was extraction because that was the only thing that was in my scope of practice. Point being? Mid-levels should only practice in conjunction with a dentist, and in rural areas there aren't dentists, so when you become a dentist...... Move to Alaska!

I know I'll be going back.

 

[Jackson-Ave-Dental]

And as a general note for those worrying about quality of care or what a DT can or can't do. Don't. Have a little sense.

Like it or not, we live in a world of regulation, hyper-litigation, and poisonous fraud.

Do you really think the ADA - or for that matter, the United States Department of Health and Human Services would ever allow a professional free reign without an exhaustively vetted system of checks and balances with regards to scope of practice and standard of care?

Come on.

I'm assuming people will pay LESS for the work of a therapist... am I correct?

Dentistry is expensive as hell to run! I don't know how these guys will survive all on their own

 

[uva09]

this is good information, thank you for your response. I do agree with a lot of what you have to say. And yes, I do believe in making access to oral health care much more widespread. I guess my concern was more along the lines of the scope of work a DT would be doing compared to a dentist and would this put a patient at risk? Also, is there a guarantee that these DT's will go into underserved areas?

I do like your point about them benefiting the dentist IF they work for one. However, are they allowed to work alone or can they compete against the dentist? They are allowed to do many procedures for the fraction of the cost of going to a dentist. I guess there are pros and cons to it unless I am missing something. By the way, I live in a city that does have quite a few stand alone PA practices. In fact, my school's health center is run solely on a stand alone PA practice. But seriously, you have some really good valid points, but IMO there can be some cons.

FYI, the ADA president was in big disagreement to having DT's when he was speaking in the news.

You are missing a few things. Firstly, there are federal rules and regulations. And then there are state-wide rules and regulations. With regards to PA's there are rules and regulations in accordance with the state board of medicine. The scope of practice is always controlled.

If Dental Therapists are afforded mainstream viability - all of the questions you have posed would be thoroughly and systematically considered, answered, and regulated.

A PA may operate independently under their own medical license. However, in most states - and most every place where the typical Dentist would want to live (admittedly, I generalize on that point) - a PA is bound to a Physician Supervisor, either remotely or in-house.

So even if you see a stand-alone PA practice, there will be a Physician Supervisor.

Also, I do believe you are somewhat misguided in your use of the word 'competition'. I think you must think of it as collaboration, not competition.

In theory, I would like to see DT's operate independently in rural and underserved areas with remote supervision and function as in-house collaborative assistance in populated, desirable locations.

I speak with a level of candor, but I think it's safe to assume that the market and associated cliental of government insured or uninsured eager to take advantage of discount dental care from mid-level providers bound to strip malls and big chains simply do not overlap with the market you probably aim to target. And are the patients looking for a bottom dollar job really the patients you are worried about losing to competition?

 

[FLOSS UR TEETH]

I could go on and on about this topic but I'll try to keep it about Alaska. The original DHATs were sent to New Zealand to a program that was 2 years post high school. They were not required to take any prereqs as far as I know. It took me over a year to just complete the prereqs to apply for hygiene school which was also a 2 year program. Hygienists in Alaska take the WREB exam and are licensed to perform preventive perio therapy and give local anesthetic. DHATs are not required to take the WREB nor even get licensed as a hygienist yet they are allowed to practice independently whereas a hygienist cannot legally start cleaning someone's teeth without a dentists exam first.

I am not against mid-level providers but they MUST be mid-level educated as in a masters degree level. DHATs are nowhere close. As an Alaskan I am saddened by people's "not in my backyard" attitude. The people of Alaska deserve better too! Only a DDS (doctor of dental SURGERY) should be performing surgeries.

I am one of those providers who is as close to a midlevel as they come (as Washington has the largest scope of practice for hygienists) and I'll say that yeah, I could probably drill some of those preps that I fill with composite but every once in a while there is a really big cavity that didn't look that big on the xray which goes below the bone level, approaches the pulp, or cracks the tooth, and I would HATE IT if the only option at that point was extraction because that was the only thing that was in my scope of practice. Point being? Mid-levels should only practice in conjunction with a dentist, and in rural areas there aren't dentists, so when you become a dentist...... Move to Alaska!

I know I'll be going back.

👍 and must i add MID-LEVEL scoped!

 

[SeattleRDH]

I'm assuming people will pay LESS for the work of a therapist... am I correct?

Dentistry is expensive as hell to run! I don't know how these guys will survive all on their own

They won't. They can only compete with private practice dentistry as part of high-volume chain dentistry or as I like to call it "Sweatshop Dental".

 

[uva09]

read this

http://www.dental-tribune.com/articles/content/id/6347/scope/politics/region/usa

and please do me a favor and watch this


your argument is very invalid. The ADA is definitely against it. I mean look at what the ADA president has to say lol. Look at 4:50.

Alaska is clearly an outlier - an outlier that merits unique needs. So you really hope to extend concerns surrounding nomadic, tribal societies in remote - borderline, inhospitable regions of the country to the rest of the nation? Yikes.

Obviously, it would be handled differently in the lower 48.

If you are dealing with a specific, minute facet of the country - i.e. a small tribal (key word tribal) village in Alaska with highly unique needs and highly limited solutions and the options are A. No oral healthcare or B. Mid-Level provider. What do you think is the better choice?

 

[FLOSS UR TEETH]

You are missing a few things. Firstly, there are federal rules and regulations. And then there are state-wide rules and regulations. With regards to PA's there are rules and regulations in accordance with the state board of medicine. The scope of practice is always controlled.

If Dental Therapists are afforded mainstream viability - all of the questions you have posed would be thoroughly and systematically considered, answered, and regulated.

A PA may operate independently under their own medical license. However, in most states - and most every place where the typical Dentist would want to live (admittedly, I generalize on that point) - a PA is bound to a Physician Supervisor, either remotely or in-house.

So even if you see a stand-alone PA practice, there will be a Physician Supervisor.

Also, I do believe you are somewhat misguided in your use of the word 'competition'. I think you must think of it as collaboration, not competition.

In theory, I would like to see DT's operate independently in rural and underserved areas with remote supervision and function as in-house collaborative assistance in populated, desirable locations.

I speak with a level of candor, but I think it's safe to assume that the market and associated cliental of government insured or uninsured eager to take advantage of discount dental care from mid-level providers bound to strip malls and big chains simply do not overlap with the market you probably aim to target. And are the patients looking for a bottom dollar job really the patients you are worried about losing to competition?

No, patients are not looking for a s*** job but they sure as hell are looking for the most affordable! and I believe you just admitted DT's do a bottom dollar job. Yes, and must I conclude that you may be the one who is "misguided."

 

[SeattleRDH]

Alaska is clearly an outlier - an outlier that merits unique needs. So you really hope to extend concerns surrounding nomadic, tribal societies in remote - borderline, inhospitable regions of the country to the rest of the nation? Yikes.

Obviously, it would be handled differently in the lower 48.

If you are dealing with a specific, minute facet of the country - i.e. a small tribal (key word tribal) village in Alaska with highly unique needs and highly limited solutions and the options are A. No oral healthcare or B. Mid-Level provider. What do you think is the better choice?

👎 You might as well just say "those people"

All Alaskans are Americans and all Americans deserve to have dentistry performed by dentists! There needs to be more of an effort to get dentists out to rural areas.... The Coke delivery truck gets there.....

 

[SeattleRDH]

By the way, there is only one native reservation in Alaska. It is on Annette Island in the southeast panhandle. The remote villages are towns just like other small towns in America, the geography is just different.

 

[FLOSS UR TEETH]

Alaska is clearly an outlier - an outlier that merits unique needs. So you really hope to extend concerns surrounding nomadic, tribal societies in remote - borderline, inhospitable regions of the country to the rest of the nation? Yikes.

Obviously, it would be handled differently in the lower 48.

If you are dealing with a specific, minute facet of the country - i.e. a small tribal (key word tribal) village in Alaska with highly unique needs and highly limited solutions and the options are A. No oral healthcare or B. Mid-Level provider. What do you think is the better choice?

SeatleRDH, are you a nomad? Anyways, uva, what makes you think any other provider would want to live in a "small tribal nomad area" especially if the dentists dont want to live there?

Maybe we should focus on something a little more effective. Maybe something called prevention. Because I REALLY don't think these DT's want to live in these areas either.

 

[persenmi]

There is no way possible that a dental therapist straight out of high school and a few months of training could provide anything but the most basic dental care. Even then, they would absolutely need the supervision of a real, fully trained and vetted doctor who has a comprehensive knowledge of the human body and its inner workings. My guess would be that if anything, unsupervised dental therapists will generate more work for dentists. For instance, If a patient bypasses going to the doctor (the dentist) and a pathology of the parotid gland is overlooked and untreated, that patient will suffer continued caries due to impaired saliva production. Or, if a patient presents to a dental therapist with all the symptoms of diabetes melleitus (xerostomia, frequent urination, periodontal disease, etc.) a dentist will have the knowledge to diagnose the disease and perhaps curtail some of its negative effects by catching it early. Honestly, the only way this will work is if these therapists are carefully supervised by a real dentist. People who don't understand this are ignorant. I know lots of people who THINK dentists aren't donctors and we all laugh when its a joke. This is no joke. Dentists are doctors. You will understand this better when you get to dental school. Anybody who is crazy enough to go to a dental therapist for discount dentistry will get exactly what they pay for.

 

[uva09]

Bottom dollar was tongue and cheek for discount or inexpensive - I was not commenting on the quality of work. A mid-level provider would be able to provide work more inexpensively than a traditional dentist - hence bottom dollar work. But I appreciate the acerbic advice.

SeatleRDH, I am sure your eager charm and idealistic views enchanted your dental school interviews. Please send me a postcard from Alaska once you graduate and serve the people so nobly.

This is the real world.

I'm sure the ADA would love to send a few hundred Dentists out to Alaska to take care of the problem. But who? Where's the line? Alas, there is no market for this. If there were a financial incentive to serve many of these rural and underserved regions, we would not have the issues in the first place.

In Medicine, we face a shortage of primary care providers. Many medical students do not want to invest all that time and money to become a family practice physician. And the opportunity cost is growing. Physician Assistants help fill this gap in market demand with a comparably inexpensive service provider.

Mid-level providers arise out of a need to fill a market void that Dentists or Physicians are not willing to meet. And you can't force anyone to do anything or go anywhere - only incentivize.

 

[FLOSS UR TEETH]

stop fighting, its clear we have different opinions.

 

[SeattleRDH]

SeatleRDH, I am sure your eager charm and idealistic views enchanted your dental school interviews. Please send me a postcard from Alaska once you graduate and serve the people so nobly.

This is the real world.

In defense, I was born and raised in Alaska and my father is a former president of the Alaska State Dental Association. I know what I'm talking about. It may not be *your* world but my world is certainly real. Enjoy your Porche.

 

[uva09]

Then you should know that this discusion and my comments with regards to Alaska refer to the many unorganized boroughs (more than half of the state's land mass), without mainstream government influence or infrastructure - not large cities like Anchorage or Fairbanks.

 

[oreoson]

Thanks for sharing the video. Alaska looks like a place where I can blend in with the locals.
If they pay me enough to be able to pay back my student loan, I'll consider moving there.

Btw, there used to be a dental therapy school in Regina 🙂p don't laugh), Saskatchewan, but unfortunately the Canadian govt shut it down earlier this year possibly due to pressure from CDA.

Australia, on the other hand, is more innovative in their efforts to mitigate oral health disparity in rural areas. James cook University offers a 5 yr bachelor program specializing in tropical dentistry. CDN high school students who are interested in rural dentistry might wanna look into it.

 

[Nymphicus]

By the way you guys, it's not just Alaska...mid-levels spread quickly. Fast track to being a dentist/doctor? There are many financial, personal, economic, and political reasons for pushing these ideas forward.

http://www.newenglandruralhealth.org/activities/oralhealth.htm
Vermont bill H.398 authorizes and regulates the practice of dental therapy; it will be considered in 2012 legislative session.

http://www.dentistry.umn.edu/programs_admissions/DentalTherapyPrograms/home.html The University of Minnesota School of Dentistry offers two educational tracks for dental therapists.


There is no reason besides scope of practice arguments by the respective professional organizations as to why these types of (sub)mid-level providers should be geographically limited. The same incentives that exist for dentists and doctors and other professionals also exists exactly the same for mid-level providers.