Will America See an Influx of Dental Therapists?

in the December edition of Health Affairs examines how the role of dental therapists might become more prominent in American dentistry as the American health care system continues to change.

Dental therapists, which are more prevalent in other countries, are able to drill and fill cavities, and perform other restorative surgical procedures “under the supervision of dentists,” the article says. In the US, dental therapists are currently only practicing in Alaska, Minnesota, Maine and Vermont. Their licensing and education requirements are determined on a state-by-state basis. According to the article, dental therapists are working in these states to provide care to rural or Native American communities.

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.”

However, the article says, dental regulatory groups, such as the American Dental Association’s Dental Quality Alliance (DQA), seems to be following suit. The DQA has developed its own set of quality metrics.

“Large dental practices and private insurers are making similar changes,” the authors write. “For example, Kaiser Permanente of the Northwest is tying dental payments to accessibility and consumer satisfaction benchmarks.”

It’s also reasonable to expect, the authors write, that more private health plans will incorporate dental coverage as research continues to show a link between oral health and overall health.

The expansion of dental therapy has been met with resistance from dental societies in the U.S., the authors note, with critics questioning their training. Critics have also suggested that there are more effective ways of addressing accessibility to care, such as using “outreach mechanisms” to fill empty chair time. They also argue that it would be better to direct efforts at “prevention instead of treatment.”

“Some oral health advocates have voiced a preference for the use of school-based prevention programs and telehealth technologies, in which remotely supervising dentists guide hygienists to treat early decay with noninvasive treatments,” the authors write.