Mid-Level Providers in Dentistry, how much can they do without dentists' presence?

[DentistScientist]

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I developed some interest about mid level providers in dentistry and what they can do to help dentists and what they can do without dentists' presence. I am starting this thread because I would like to learn more about mid level providers and what could they do in the future as well.

First of all,
I learned that there are two mid level programs in dentistry.
(1) Master of Dental Therapy (DT)
(2) Master of Science in Advanced Dental Therapy (ADT)

Similar to mid-level providers in medicine, nurse practitioners (NPs) and physician assistants (PAs), these programs were originally founded to address the dental needs of patients living in underserved areas. And just like NPs and PAs, dental therapists (DTs) and advanced dental therapists (ADTs) are currently able to perform several procedures without the presence of dentists. (DMD or DDS)


Here are the four different levels of dentist' supervision in the state of Minnesota.

Subp. 21. Supervision. “Supervision” means one of the following levels of supervision, in descending order of restriction.

1. “Personal supervision” means the dentist is personally operating on a patient and authorizes the allied dental personnel to aid in treatment by concurrently performing supportive procedures.
2. “Direct supervision” means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and before dismissal of the patient, evaluates the performance of the allied dental personnel.
3. “Indirect supervision” means the dentist is in the office, authorizes the procedures, and remains in the office while the procedures are being performed by the allied dental personnel.
4. “General supervision” means the supervision of tasks or procedures that do not require the presence of the dentist in the office or on the premises at the time the tasks or procedures are being performed but require the tasks be performed with the prior knowledge and consent of the dentist

Source: https://www.mchoralhealth.org/mn/dental-therapy/scope.html



Here is the list of procedures that DTs and ADTs can do without the presence of dentists.

Source: http://mn.gov/boards/assets/DT Chart BA_tcm21-262696.pdf


Please feel free to share your knowledge about mid-level providers. And your future predictions as well.

Thank you.

 

[DentistScientist]

Nurse Practitioners and Physician Assistants are now able to diagnose and treat patients and prescribe medications independently and do not need physician supervision.
They published many research papers supporting their competency in primary care settings and lobbied to change the laws and regulations.

I would like to learn more about the future relationship between Dental Therapists and Advanced Dental Therapists and Dentists.
Source: https://onlinenursing.simmons.edu/nursing-blog/nurse-practitioners-scope-of-practice-map/

 

[DaddioDan]

I did some research on this topic a few years back. It makes sense in the areas they're trying to attract providers. I want to say the number was 2000 extra visits per year per DT. Like I said it makes sense for the rural communities of Alaska and Kansas where they were implementing it, but what I found very concerning was Alaska having these DT get an education right out of high school. With the tuition increases and poor Medicaid reimbursement, it's going to be hard to attract competent providers to underserved areas. I also think there will be a lot of opposition from established dentists as it relates to the "power" they currently have.

 

[DentistScientist]

I see.

In addition to Alaska and Kansas, in the state of Minnesota, Dental Therapists can do these procedures without the presence of dentists. Similar things are happening in Vermont and Maine as well.


General Supervision (i.e. dentist may or may not be present)

1. Oral health instruction and disease prevention education, including nutritional counseling and dary analysis
2. Preliminary charting of the oral cavity
3. Making radiographs
4. Mechanical polishing;
5. Application of topical preventive or prophylactic agents, including fluoride varnishes and pit and fure sealants
6. Pulp vitality testing
7. Application of desensitizing medication or resin
8. Fabrication of athletic mouthguards
9. Placement of temporary restorations
10. Fabrication of soft occlusal guards
11. Tissue conditioning and soft reline
12. Atraumatic restorative therapy;
13. Dressing changes
14. Tooth reimplantation
15. Administration of local anesthetic
16. Administration of nitrous oxide

In addition to these, both dental therapists can do these with the presence of dentists.

Indirect Supervision (i.e. dentist onsite)

1. Emergency palliative treatment of dental pain
2. The placement and removal of space maintainers
3. Cavity preparation
4. Restoration of primary and permanent teeth
5. Placement of temporary crowns
6. Preparation and placement of preformed crowns
7. Pulpotemies on primary teeth
8. Indirect and direct pulp capping on primary and permanent teeth
9. Stabilization of reimplanted teeth
10. Extractions of primary teeth
11. Suture removal
12. Brush biopsies
13. Repair of defective prosthetic devices
14. Recementing of permanent crowns

Source: https://www.mchoralhealth.org/mn/dental-therapy/scope.html

 

[DentistScientist]

About future,


"In the U.S., two factors are at play that might lead to more dental therapists working in the industry, the article authors write. The first, they say, is the transition to corporate dentistry. As dental practices begin to move from privately owned to group practices, the demand for higher patient volume to turn a profit increases. “An increase in the number of these large group practices could drive demand for midlevel providers such as dental therapist” to address higher patient volume, the authors write. "

"The second factor, the authors say, is the Affordable Care Act (ACA). The authors note that while the general health care system has been subject to new regulations under ACA, “dentistry has been largely unaffected by these changes.” Traditionally, they say, dental practices have not been a part of larger health care systems and therefore are “not subject to the same stringent demands for quality and accountability as medical is, and largely isolated form the care delivery efficiencies enjoyed by large group practices.”

Source: http://www.dmdtoday.com/news/the-battle-over-dental-therapist-role-heats-up

See more at: http://www.dmdtoday.com/news/will-america-see-an-influx-of-dental-therapists#sthash.wn1NNAmL.dpuf

 

[shotanacrp30]

I did some research on this topic a few years back. It makes sense in the areas they're trying to attract providers. I want to say the number was 2000 extra visits per year per DT. Like I said it makes sense for the rural communities of Alaska and Kansas where they were implementing it, but what I found very concerning was Alaska having these DT get an education right out of high school. With the tuition increases and poor Medicaid reimbursement, it's going to be hard to attract competent providers to underserved areas. I also think there will be a lot of opposition from established dentists as it relates to the "power" they currently have.

Dental therapists has been, and will continue to be targeted by the established dental organizations (i.e.- ADA).
While I believe dental therapy is part of a solution to provide care to those in underserved populations or populations under Medicaid, it is not the sole solution.
It is quite a sensitive topic to most dentists, and so many of them oppose these providers despite the truth of how they benefit people with oral health diseases.
The fact that providers argue who gets to provide what to patients is alarming.
Rather, the conversation should be what can we do for the people to have a healthy mouth, which leads to a healthy body.
ADA, ADHA, deans of dental schools, dental hygiene schools, and other stakeholders must work together to understand what they can do to provide quality, person-centered care to all people.
Until that happens, we have a long way to go....

Here is an article/blog from Community Catalyst, titled "Dental Therapists at Work: The Economic Benefits of Dental Therapy" http://www.communitycatalyst.org/bl...nomic-benefits-of-dental-therapy#.WLdFT4-cGUk.
In addition, here is a video that shows a bit of dental therapy in Minnesota. It was featured on NBC Nightly News, hosted by Lester Holt.
http://www.nbcnews.com/nightly-news/video/the-debate-to-legalize-dental-therapists-881217603775

 

[DentistScientist]

Dental therapists has been, and will continue to be targeted by the established dental organizations (i.e.- ADA).
While I believe dental therapy is part of a solution to provide care to those in underserved populations or populations under Medicaid, it is not the sole solution.
It is quite a sensitive topic to most dentists, and so many of them oppose these providers despite the truth of how they benefit people with oral health diseases.
The fact that providers argue who gets to provide what to patients is alarming.
Rather, the conversation should be what can we do for the people to have a healthy mouth, which leads to a healthy body.
ADA, ADHA, deans of dental schools, dental hygiene schools, and other stakeholders must work together to understand what they can do to provide quality, person-centered care to all people.
Until that happens, we have a long way to go....

Here is an article/blog from Community Catalyst, titled "Dental Therapists at Work: The Economic Benefits of Dental Therapy" http://www.communitycatalyst.org/bl...nomic-benefits-of-dental-therapy#.WLdFT4-cGUk.
In addition, here is a video that shows a bit of dental therapy in Minnesota. It was featured on NBC Nightly News, hosted by Lester Holt.
http://www.nbcnews.com/nightly-news/video/the-debate-to-legalize-dental-therapists-881217603775

I am also concerned about mid-level providers growing in numbers and trying to expand their scope of care just like what nurse practitioners did. Could they lobby to make this happen and could they create doctor of dental therapy programs and compete with dds and dmds?
In my personal view, midlevel providers' independence could be dangerous for patients too.


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[shotanacrp30]

I am also concerned about mid-level providers growing in numbers and trying to expand their scope of care just like what nurse practitioners did. Could they lobby to make this happen and could they create doctor of dental therapy programs and compete with dds and dmds?
In my personal view, midlevel providers' independence could be dangerous for patients too.


Sent from my iPhone using SDN mobile

This is the exact same concerns that the dental association has, as they fear that the dental therapists will be "taking their patients away", which is in fact false.
Dental therapists in Minnesota primarily serve in rural and/or underserved areas. I doubt many dentists serve in those areas, unless they are passionate in serving those in need of oral health care.
At this point, I do not think dental therapists have the power to lobby and compete against dentists.
I do agree, however, that if dental therapists become too independent, as in, no actual supervision, it will be a concern.
That is why I believe that all dental stakeholders need to work together to determine the best approaches to provide quality oral health care to all. Dental therapists are A solution, but not THE solution.
There are multiple factors to discuss, which include dental insurance companies, dental school costs, the burden that dental students will have with their loans, the current political climate, reimbursement rates, and many other factors.

 

[Gulliverus]

Good afternoon. This is a fascinating topic. I searched various forums for the information you are interested in. On one of the platforms, smiledoctors.com, I read that there are two intermediate-level programs in dentistry: the Master of Dental Therapy.

 

[New_Vegas]

This is the exact same concerns that the dental association has, as they fear that the dental therapists will be "taking their patients away", which is in fact false.

No, it's actually true. Of course they are going to take patients away from dentists.

Dental therapists in Minnesota primarily serve in rural and/or underserved areas. I doubt many dentists serve in those areas, unless they are passionate in serving those in need of oral health care.

Lol, you are really drinking the Kool-Aid on this one. This is in fact, totally untrue. Most dental therapists in Minnesota are working in St. Paul/Minneapolis.
This is according to the Department of health of Minnesota: https://www.health.state.mn.us/data/workforce/oral/docs/2019dt.pdf

At this point, I do not think dental therapists have the power to lobby and compete against dentists.
I do agree, however, that if dental therapists become too independent, as in, no actual supervision, it will be a concern.
That is why I believe that all dental stakeholders need to work together to determine the best approaches to provide quality oral health care to all. Dental therapists are A solution, but not THE solution.
There are multiple factors to discuss, which include dental insurance companies, dental school costs, the burden that dental students will have with their loans, the current political climate, reimbursement rates, and many other factors.

Dental therapy is a terrible idea. These people aren't working in rural locations, they are working in cities. Why would they not? Are there even any incentives for them to work in rural areas? They are taking an already saturated field with too many providers (dentistry) and making the problem even worse. Dental therapists aren't a solution. They are dangerous for patients.

 

[2TH MVR]

I've never met or heard of a dental therapist in my area. Not saying they don't exist.
I work for a DSO that sees mostly lower income patients. Seems like these types of DSOs would be all over the idea of having cheaper labor.

 

[somefuturedoc]

My school preaches about how dental therapists and other off-brand midlevels are "essential for increased access to care"

It is satisfying to see the majority of my class disregard this BS and agree never to hire or support one of these people lol