What type of people become dental therapists?

[TJNova2011]

Out of curiosity, what type of people become therapists? And why would someone choose this profession that seems so hopeless?

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[ortho lurker]

Out of curiosity, what type of people become therapists? And why would someone choose this profession that seems so hopeless?

Probably foreign-trained dentists who can't get accepted into an international program in the U.S. (just look at foreign medical doctors who become nurses in this country). For some of them, the dental therapist salary will be higher than what they make as a doctor in their own country. Here is the future of dental therapy in the U.S., street-side!

http://www.youtube.com/watch?v=WR8tIjTykbE

As a licensed dentist, even that was hard for me to watch. You should read the comment below by Kako Shirazi to see what the public is already thinking. Before you bash me for being close-minded, these immigrants have every right to do what the U.S. laws allow. Blame the system, not the people.

 

[TJNova2011]

Probably foreign-trained dentists who can't get accepted into an international program in the U.S. (just look at foreign medical doctors who become nurses in this country). For some of them, the dental therapist salary will be higher than what they make as a doctor in their own country. Here is the future of dental therapy in the U.S., street-side!

http://www.youtube.com/watch?v=WR8tIjTykbE

As a licensed dentist, even that was hard for me to watch. You should read the comment below by Kako Shirazi to see what the public is already thinking. Before you bash me for being close-minded, these immigrants have every right to do what the U.S. laws allow. Blame the system, not the people.

They want their treatment to cost less than a haircut....

 

[Bobby Fischer]

http://www.youtube.com/watch?v=WR8tIjTykbE

As a licensed dentist, even that was hard for me to watch...

At the rate N. America has fallen to Brazilian style socioeconomics, I can see how the next step is to fall to Indian style.

Hey, at least the music rocked!

 

[suarez 7]

U of Minn featured a panel of dental therapy students at one of their presentations (you can actually watch this video at their website), and when each (3 or 4 of them) was asked why they chose to be a therapist they admitted that they were unable to get accepted to dental school and so once they found out about this program they applied to it and got accepted.

In other words, dental therapists are dental school rejects. Why on earth should the government trust them with high-speeds...

 

[ortho lurker]

In other words, dental therapists are dental school rejects. Why on earth should the government trust them with high-speeds...

If you didn't read my other post, it's all about $$$ (just like the expansion of dental schools and class sizes). Greedy chain owners team up and bribe lawmakers to create laws that will benefit them. In truth, the client base that these dental therapists will see probably aren't the type of patients that you would want in your private practice--based solely on price. However, it may make interesting conversations when your private practice patients ask you how some places can do it for so cheap and then you have to explain about the education requirements and so forth.

 

[peterngu]

Out of curiosity, what type of people become therapists? And why would someone choose this profession that seems so hopeless?

Why does this profession seem so hopeless? In the medical field, mid-level practitioners like Nurse practitioners only go to school for two years and make almost as much as family doctors. A friend of mine that is now an NP is my point of reference.

Unfortunately if this mid-level takes off and breaks out of practice restrictions within low access-to-care areas, then I could see GPs getting in trouble just like family doctors, where compensation received isn't justified by the amount of education required.

 

[jeffity]

Why does this profession seem so hopeless? In the medical field, mid-level practitioners like Nurse practitioners only go to school for two years and make almost as much as family doctors. A friend of mine that is now an NP is my point of reference.

Unfortunately if this mid-level takes off and breaks out of practice restrictions within low access-to-care areas, then I could see GPs getting in trouble just like family doctors, where compensation received isn't justified by the amount of education required.

Maybe. Only time will tell. Keep in mind, however, that this isn't quite the same as nurse vs. physician. This involves a surgical component. Consumers might take into consideration just who this is slicing open their mouth or drilling away, even if for a brief moment. That extra training and experience under supervision and exposure to unique cases could really play a role in this. But I am aware for some, the almighty dollar will govern their decision.

 

[HopeforDMD]

Maybe. Only time will tell. Keep in mind, however, that this isn't quite the same as nurse vs. physician. This involves a surgical component. Consumers might take into consideration just who this is slicing open their mouth or drilling away, even if for a brief moment. That extra training and experience under supervision and exposure to unique cases could really play a role in this. But I am aware for some, the almighty dollar will govern their decision.

I don't know... Would the average joe really place dentistry higher than medicine when it comes to the rigor needed in their educational requirements? Does the average american put dental procedures (especially fillings / crowns) in the same category as surgeries outside the mouth? And after all, the therapist will have "supervision" by a dentist.

Hope you're right though. I would like to think that I'll be more useful than a tech when I graduate.

 

[UCSFx2017]

Out of curiosity, what type of people become therapists? And why would someone choose this profession that seems so hopeless?

http://www.ykhc.org/2012/08/14/new-dhat-students/

http://www.ykhc.org/wp-content/uploads/2013/01/DHAT-Patton-8.5-x-11.pdf

http://depts.washington.edu/dentexak/news/who-we-serve/

http://depts.washington.edu/dentexak/who-we-are/mission/

Corina Cadzow from Yukon, AK says,

"I am from Fort Yukon, Alaska. My goal was to start a career that was always different and challenging. I got an education as a Dental Health Aide Therapist so I could return to my hometown and work with the people of my community. I try to make the people confortable, and educate them on how to keep from getting cavities. I have a lot of friends here and like to help in anyway I can. I like to go camping, hunting, and fishing. I also like to bead and play basketball."

Shawn Martin from Bethel, AK says,

"I am from the community of Bethel, the place where I was born and raised. I want to give my dental knowledge to the community. Some families can't travel to Bethel to see a dentist due to insufficient money or time. That's where I will come in and bring oral care to remote patients. Teach patients how to brush and floss. Tell them the importance of applying fluoride to their teeth. Teach children about cavity bugs and why they have to brush them off or have holes in their teeth. I will become a Dental Health Aide Therapist to provide preventive and routine dental care to my people."

Stephanie Woods from Kotzeube, AK says,

"I am a certified Dental Health Aide Therapist (DHAT) that trained in New Zealand in 2003-2004, working for the Maniilaq Association since January of 2005. After doing a six-month preceptorship in Kotzebue, I moved to the village of Shungnak, where my husband is from, and practiced dentistry in the local clinic as well as frequent travel to other villages. In January 2009 I became the dental director for the department and moved to the region's headquarters in Kotzeube. I currently work in the clinic 1-2 days a week and travel to one of the outlying villages for one week every other month to provide dental services. I have spoken in numerous states around the country including twice in Washington DC promoting the DHAT program. For the past eight years I've been on the Dental Academic Review Committee (DARC) that reviews the DHAT curriculum."

Phylicia Whilde from Toksook Bay says,

"I have the experience of traveling to a faraway place in order to get dental treatment. As a child every time I had a toothache or cavity I had to travel to Bethel, just like everyone in my village. In Elementary School I went to Bethel many times in order to get my cavities and fillings done. One of the things most needed in the villages is a Dental Health Aide Therapist. When I was six I got as toy dentist kit for Christmas. I went to everyone in the house pretending to fix their teeth. After one year in training in Anchorage, and year 2 in Bethel, I now work as a Dental Health Aide Therapist for the Yukon-Kuskokwim Health Corporation in Bethel."

Ben Steward from Tok says,

"It has been nearly three years since I graduated the DENTEX program. T.C.C. hired me and moved me to Tok, which is a perfect fit for my family and lifestyle. It is a small town on the road system, a great mix of the things I love about the bush yet still accessible to the comforts the city has to offer. Work as a DHAT remains as fun and exciting as I had felt it would. Every day is different; I never know what kind of work I will be doing till it's done. The people that work in the clinic with me are amazingly fun to work with. On top of that the people of the community are just as fun and interesting to get to know."

Conan Murat from Aniak, AK says,

"I was born and in Bethel, AK, graduated from Bethel Regional High School in 2000. I left for New Zealand in 2003 to attend the University of Otago and graduated in 2004. Ever since I started working for YKHC I have been dedicated to caring for the people of the YK delta. I have been working and living in Aniak ,AK since 2006 and have been providing care 12 surrounding villages. It has been quite an adventure since I have been practicing as a DHAT, traveling every other week to a different village to keep up with the amount of care needed in my area. I totally love what I do for a living and I can't imagine doing anything else."

Eric J. Linduska from King Cove, Alaska says,

"Growing up in an active rural community has allowed me to recognize qualities that make a strong community grow emotionally and physically—qualities such as teamwork, friendship, patience, hard work and honesty. My goal has been to live in the Aleutians and provide DHAT services to the people there. Knowing firsthand how poor oral healthcare is in the Aleutians, I could not have set a more challenging, inspirational and worthy goal for myself. I became a Dental Health Aide Therapist to implement preventive measures for bad oral health through education and general clinical practice. The sites that I serve are Adak, Akutan, Cold Bay, False Pass, King Cove, Nelson Lagoon, Sand Point and Whittier."

Melanie Harris from Hooper Bay, AK says,

"I was born and raised in a small country town in Pennsylvania where I grew to love hunting and all the activities the outdoors provide. When I was given a chance to work in Alaska over a year ago I let nothing get in the way. I simply love the way of life here. I moved to Hooper Bay, Alaska to work in their dental clinic looking for a new experience after 11 plus years in the field. I understand almost all aspects of dentistry. It is a privilege to treat our patients with the care they need and deserve. This is my dream come true."

Mind you that most of the people who I quoted were Caucasians and not Internationally-trained dentists.

Why do you think it's so hopeless?

 

[UCSFx2017]

For the time being you should take a look at the CDA's discussion of dental therapists and the like. Even Dean Featherstone, who grew up in New Zealand where DT's function in school clinics, pitches his opinion on what should happen to address the access-to-care issue.

http://www.cda.org/Portals/0/journal/journal_072011.pdf

The access-to-care issue is hotly debated as to whether it exists or not but it is undisputed that there is an unequal distribution of dentists and that both low-income and diverse populations are high-risk groups for caries. You could also argue how much training is enough training to perform some of these procedures. Could dentists be overqualified for some basic procedures? Where can you set that boundary? Are dental therapists the creation of lobbyists or of clinicians who are evidence-based driven?

 

[yappy]

The conversation seems to have drifted into discussing strictly procedures. That's great; but, what I thought seemed difficult when I shadowed a dentist was comprehensive treatment planning.

Using the mid-level example - at the hospital I work at a NP or PA, working under the direction of their cardiothoracic surgeon attending, may do things as invasive as central lines, chest tubes, okay extending strong RX like heprin, and sometimes even open / close. However, they NEVER direct the care for that patient. They only perform these procedures when their attending has told them.

In dentistry, when there are a lot of dental health issues issues, I've noticed some dentists will think hard about how to best tackle the problem and come up with a well thought out treatment plan for the patient. This is especially important for the types of patients a therapist would see in a community clinic setting. So - how good are DT at coming up with comprehensive care plans when their education & SOP is piecemeal itself? More importantly, isn't there an external legal-malpractice element that will expose this? If the treatment plan itself is incorrect wont that leave the DT liable for not providing care that was up to par with a fully lic dentist?

 

[gryffindor]

Why does this profession seem so hopeless? In the medical field, mid-level practitioners like Nurse practitioners only go to school for two years and make almost as much as family doctors. A friend of mine that is now an NP is my point of reference.

Unfortunately if this mid-level takes off and breaks out of practice restrictions within low access-to-care areas, then I could see GPs getting in trouble just like family doctors, where compensation received isn't justified by the amount of education required.

In dentistry, there are high materials costs, especially in GP offices. It is going to cost the same to buy amalgam from the supply house whether you are a GP or a DT. Dental procedures are done most efficiently with an assistant which is another high cost in salar.. In medicine, many patient problems can be resolved with a prescription pad and maybe a pair of gloves. Overhead in a visit like that is like 35 cents so there is more room to bring down costs by using a lower cost practitioner. It doesn't work like that in dentistry.

 

[Duriel]

In dentistry, there are high materials costs, especially in GP offices. It is going to cost the same to buy amalgam from the supply house whether you are a GP or a DT. Dental procedures are done most efficiently with an assistant which is another high cost in salar.. In medicine, many patient problems can be resolved with a prescription pad and maybe a pair of gloves. Overhead in a visit like that is like 35 cents so there is more room to bring down costs by using a lower cost practitioner. It doesn't work like that in dentistry.

Makes you wonder if these offices are going to be subsidized

 

[peterngu]

In dentistry, there are high materials costs, especially in GP offices. It is going to cost the same to buy amalgam from the supply house whether you are a GP or a DT. Dental procedures are done most efficiently with an assistant which is another high cost in salar.. In medicine, many patient problems can be resolved with a prescription pad and maybe a pair of gloves. Overhead in a visit like that is like 35 cents so there is more room to bring down costs by using a lower cost practitioner. It doesn't work like that in dentistry.

That's a great argument. Don't get me wrong, I don't want to see this take off in any way that harms patients. However, if you want to talk costs, I could argue a scenario where DTs take over the roles of GPs in a corporate setting. The decrease in salary would be huge savings. Corporate dentistry has already demonstrated the ability to do unethical things for the sake of saving money.

Also, charging less than private offices and seeing more Medicaid/lower income patients is one way to boost daily production and make up the difference. I could see DTs providing complex amalgam/composite restoration for patients that can't afford crowns, especially since I've done it myself as a student (external rotations at http://midental.org/about-us/). Referrals for Medicaid-covered prostheses could be written to GPs.

 

[mike3kgt]

Melanie Harris from Hooper Bay, AK says,
Quote:
"I was born and raised in a small country town in Pennsylvania where I grew to love hunting and all the activities the outdoors provide. When I was given a chance to work in Alaska over a year ago I let nothing get in the way. I simply love the way of life here. I moved to Hooper Bay, Alaska to work in their dental clinic looking for a new experience after 11 plus years in the field. I understand almost all aspects of dentistry. It is a privilege to treat our patients with the care they need and deserve. This is my dream come true."

I find this statement very hard to believe. I know many board certified prosthodontists who don't claim the know "almost all aspects" of dentistry.

Typical you know only what you think you know when in reality...you don't know as much as what you really know.

 

[gryffindor]

Also, charging less than private offices and seeing more Medicaid/lower income patients is one way to boost daily production and make up the difference. I could see DTs providing complex amalgam/composite restoration for patients that can't afford crowns, especially since I've done it myself as a student (external rotations at http://midental.org/about-us/). Referrals for Medicaid-covered prostheses could be written to GPs.

If the tooth has reached the point where one has to do a MODBFL amalgam or composite to rebuild it, it needs a crown. All the DT's "complex amalgam" is doing is buying a very short amount of time. To do a MODBFL amalgam well requires time, something that Medicaid offices with low reimbursements don't have. When the MODBFL fractures in 3 month, is Medicaid going to pay again to patch it? I bet they'll just pay to extract it. Which is fine, sometimes extraction is the solution for a patient and their wallet. But we don't need a DT to know that.

 

[ortho lurker]

If the tooth has reached the point where one has to do a MODBFL amalgam or composite to rebuild it, it needs a crown. All the DT's "complex amalgam" is doing is buying a very short amount of time. To do a MODBFL amalgam well requires time, something that Medicaid offices with low reimbursements don't have. When the MODBFL fractures in 3 month, is Medicaid going to pay again to patch it? I bet they'll just pay to extract it. Which is fine, sometimes extraction is the solution for a patient and their wallet. But we don't need a DT to know that.

Again, these are not the type of patients that you would want to see in your own private practice. Should people take more responsibility to save up for what's best for their healthcare rather than spending $ they don't have on fancy gadgets such as iPads, expensive iPhone monthly cell phone plans, cable/satellite channels they don't use, cigarettes, etc.? People in this country take no personal accountability and view healthcare as a right handed to them. The public views dental work as overpriced and would rather go on vacation than to save a tooth. Outsiders don't understand (or give a flying crap) that dental schools have the highest tuition amongst all the professional schools, and that dental offices cost the most to set up compared to other types of healthcare offices.

 

[goffdent]

Again, these are not the type of patients that you would want to see in your own private practice. Should people take more responsibility to save up for what's best for their healthcare rather than spending $ they don't have on fancy gadgets such as iPads, expensive iPhone monthly cell phone plans, cable/satellite channels they don't use, cigarettes, etc.? People in this country take no personal accountability and view healthcare as a right handed to them. The public views dental work as overpriced and would rather go on vacation than to save a tooth. Outsiders don't understand (or give a flying crap) that dental schools have the highest tuition amongst all the professional schools, and that dental offices cost the most to set up compared to other types of healthcare offices.

While I do agree with most of what you say... I just want to point out a generalization that many people make, including fellow classmates. Many say for example, they see all these medicaid children coming in with brand new clothes, shoes, watches, iphones, ipads, etc.. and their parents can't afford to pay their own $3 deductible etc. etc.. I am in the same clinic as these classmates and can say that 95% of the kids DO NOT have shiny new clothes, shoes, ipads, and iphones.. There are definitely people with no self accountability who milk the system, but there are ALOT in an unfortunate situation who are being criticized for no reason too..

In addition, people who say dentistry is expensive are obviously ignorant and lack any dental IQ, or common sense for that matter. With ambulance chasers a dime a dozen, and the economy, of course people want to make a quick buck.

Think about it, how much does a dentist do to actually "fix" a tooth, and then what does he charge you? 150-300 dollars lets say, after he takes BP, heart rate, makes radiographs, injects local anesthesia, takes a drill, preps a tooth and restores it. . Now go see a family medicine doctor and have him listen to you breath, look in your nose and ears, take your blood pressure, then tell you you have a virus and to wait it out and drink lots of fluids.. in 15 minutes and charge you $150 for that office visit. Who did more extensive and risky work and is worthy of charging more money? I would say the one doing a surgical procedure, injecting epi into your body, etc.

Also, if anyone should complain about dental work prices, just use the analogy that you're rotating the tires, changing the oil, and flushing the transmission. Because we all know the prices at the body shop justifies mechanic's $250,000 education..

 

[gryffindor]

The public views dental work as overpriced and would rather go on vacation than to save a tooth.

Then we should extract the tooth. Extractions are one of the lowest overhead procedures out there. 1 film (PA or Pan), Lidocaine, needle, syringe, elevator + forceps, and gauze. Suction and assistant and sutures are only necessary if it's going to get messy in which case a DT probably shouldn't be doing the procedure and the dentist should charge more for it. It probably takes more time to sign the legal mumbo jumbo saying you reviewed all risks of the procedures and presented alternative to treatment than to actually extract the tooth. Which brings me to my next point. Unhappy patients can sue their dentist and add a lot of stress to a small practice. Can an unhappy patient sue a dental therapist?

 

[goffdent]

Then we should extract the tooth. Extractions are one of the lowest overhead procedures out there. 1 film (PA or Pan), Lidocaine, needle, syringe, elevator + forceps, and gauze. Suction and assistant and sutures are only necessary if it's going to get messy in which case a DT probably shouldn't be doing the procedure and the dentist should charge more for it. It probably takes more time to sign the legal mumbo jumbo saying you reviewed all risks of the procedures and presented alternative to treatment than to actually extract the tooth. Which brings me to my next point. Unhappy patients can sue their dentist and add a lot of stress to a small practice. Can an unhappy patient sue a dental therapist?

Would they be suing the dentist under which they work?

I enjoy the 30minutes of paperwork for a 5 minute extraction...

 

[TJNova2011]

Then we should extract the tooth. Extractions are one of the lowest overhead procedures out there. 1 film (PA or Pan), Lidocaine, needle, syringe, elevator + forceps, and gauze. Suction and assistant and sutures are only necessary if it's going to get messy in which case a DT probably shouldn't be doing the procedure and the dentist should charge more for it. It probably takes more time to sign the legal mumbo jumbo saying you reviewed all risks of the procedures and presented alternative to treatment than to actually extract the tooth. Which brings me to my next point. Unhappy patients can sue their dentist and add a lot of stress to a small practice. Can an unhappy patient sue a dental therapist?

The dentist is ultimately responsible- (same as a dentist who employees a hygienist).