A new report from the W.K. Kellogg Foundation attempts to make the case for expanding Alaska’s Dental Health Therapist model to other parts of the country. It looks at how the mid-level dental provider model is working in more than 50 countries around the world. But the American Dental Association has long been opposed to Dental Health Therapists in the United States. And the new report won’t reverse that opposition.
Dental therapists practice in places like New Zealand, Canada, Hong Kong and Thailand. They exist in developed and developing countries. In all, David Nash- the report’s author, found evidence for Dental Therapists in 54 countries. Nash reviewed more than 1,000 documents from as many countries as possible for the report. He found Dental Therapists typically practice in public clinics and mostly care for children.
“There is clear documentation that dental therapists provide quality care, safe care, efficient care and economical care. Much more economical than in the United States. And much more effective than in the United States,” Nash said.
Nash is a pediatric dentistry professor at the University of Kentucky and a long time advocate for Dental Therapists. He helped launch Alaska’s Dental Therapy program in 2005. Dental Therapists provide cleanings and preventive care and can do some fillings and extractions. In Alaska, they work in rural villages. Only one other state-Minnesota allows Dental Therapists to practice. Nash hopes his report for the Kellogg Foundation will help change that by providing evidence for best practices for the profession.
“So that our public policy leaders and our legislatures and so forth they know what exists, they know what the truth is,” Nash said.
But Nash does not believe the report is likely to change minds at the American Dental Association. The organization fought to stop Alaska’s Dental Therapist Program and is against any expansion to other states. The ADA calls the Kellogg report an “advocacy document intended to support a predetermined conclusion.”
“It is not a scientific, systematic study and that is what a science based organization like the ADA obviously would prefer,” Dr. Bill Calnon, president of the ADA, said.
The ADA doesn’t support Dental Therapists because they can extract teeth and fill cavities without the direct supervision of a dentist, a practice they call unsafe. The organization agrees with the Kellogg Foundation that the amount of tooth decay in underserved areas like rural Alaska is a public health crisis. But Calnon says Dental Therapists are only a short term fix to the problem. And he says the new report is short sighted.
“I think what it does is it misses the point the ADA has been trying to make around the country and that is the fact that workforce issues are really only one small piece of a much larger puzzle.”
The ADA is piloting a new provider called Community Dental Health Coordinator, to provide education and preventive services. But Dr. Mary Williard, who trains Alaska’s Dental Therapists says that’s exactly what Dental Therapists do. She says the bulk of their work involves cleanings, sealants and dental health education. She hopes the new report will help clear up some of the biggest misperceptions about the program.
“The fear that I see out there, the misunderstandings is in regards to, is this a safe practice? And can a therapist who’s trained in only two years post high school actually provide safe appropriate and competent care,” Williard said.
Dr. Williard says so far, there have been no complaints about the work of Alaska’s Dental Therapists. The state now has 25 certified Dental Therapists working in the tribal health care system in remote rural villages like Klawock and Aniak. Williard directs the Dental Therapist training school in Anchorage- a partnership with the University of Washington that started in 2007.
“In the few short years we’ve been around we’ve been able to increase the number of providers in Alaska quite significantly. They’re in a lot of the villages on the edges of the state where we’ve traditionally had difficulty finding consistent dental care from dentists,” Williard said.
Dr. Williard says the dental system in the U.S. works well for people who have money and insurance. But it’s failing the rest of the population. Her focus is on expanding the Dental Therapist program in Alaska. But she hopes to see Dental Therapists practicing soon in other undeserved areas of the U.S. as well.