Dental Therapists ‘Safe’ Pulling American Teeth, Study Suggests

BY Betty Ann Bowser  April 10, 2012 at 8:00 AM EDT


Photo by Jeff J. Mitchell/Getty Images

If you’re like most Americans, you probably think getting a tooth filled is about as much fun as undergoing a colonoscopy.

But oral health is no less an important part of staying healthy. Untreated dental disease can lead to serious medical conditions and — in extremely rare cases — it can kill you.

In spite of that, more and more Americans have been experiencing trouble accessing a dentist in recent years. It’s not just the shortage of dentists that’s the problem. It’s also a reflection of how many people can’t afford the cost of care or who lack dental insurance.

Also exacerbating the problem is the fact that a lot of dentists won’t treat Medicaid patients. Reimbursement rates in the federal-state program are often notoriously low.

So in recent years, a debate has been growing over whether to introduce a new type of provider — dental therapists — to the scene. Dental therapists are limited practitioners who are trained to do “basic” dental work, including X-rays, preventative care, filings and extractions. In the countries where they practice today, most of them are carefully supervised by fully licensed and trained dentists.

Today, those who argue for the widespread use of dental therapists in the U.S. got some support in the form of a massive, worldwide study of dental therapists.

Sponsored and paid for by the W.K.Kellogg Foundation, the report found that dental therapists offer treatment that is “technically competent, safe and effective,” especially for children.

The study involved the review of more than 1,100 pages of documents on the history and practice of dental therapists in 54 countries.

The lead author of the study, Dr. David Nash, a pediatric dentist and the William R.Willard professor of dental education at the University of Kentucky College of Dentistry, said the study was “absolutely unprecedented” and should “put to rest once and for all” the controversy over whether dental therapists are a safe and effective way to provide basic dental care for people in areas where there is a shortage of dentists.

In the United States, dental therapists were first introduced in 2005 to Alaska Natives who live in isolated villages accessible only by air. Most of the communities have no dentist and — until dental therapists were brought into tribal communities — most of the people who live in these out-of-the-way places had no dental care at all (watch the NewsHour’s full report here).

The only other place dental therapists practice is in Minnesota, where a handful of people have been trained. The first group graduated last year and began treating people in under-served areas several months ago. Five other states are currently considering legislation to provide for dental therapists.

In recent years, studies conducted by the federal government and some private foundations have determined that nearly 40 percent of the American population doesn’t see a dentist at least once a year. And there are hundreds of pockets across the country where there aren’t enough dentists to serve the number of people who live there.

Ever since the introduction of dental therapists in Alaska seven years ago, a controversy has been growing over whether the rest of the states should be allowed to train dental therapists and allow them to practice.

The American Dental Association and other professional dental societies have opposed this idea and have vociferously protested any attempts to bring dental therapists to the lower 48. The ADA has consistently maintained that dental therapists are not adequately trained to perform irreversible surgeries — primarily extractions.

In a statement, the organization criticized the Kellogg study, saying it failed to “rise to the level of a systematic literature review, nor does it adequately address some of the key indicators of whether and to what extent the use of therapists improves pubic oral health.”

Training more people to X-ray, file, and pull teeth doesn’t cut to the heart of the issue, the ADA contends. America’s dental crisis will only be reversed through more structural changes, the statement said, including community water fluoridation; first dental visits by age 1; oral health education, assessments and sealant programs in schools; better integration with the medical community; and “realistic funding of care for those in greatest need.”

“The nation will never drill, fill and extract its way out of what amounts to a public health crisis among some populations,” the statement said. “Throwing more ‘treaters’ into the mix amounts to digging a hole in an ocean of disease. Instead, what is required is a fundamental shift in oral health from a model of surgical intervention to one of disease prevention, because virtually all dental disease is preventable.”

Read the full report here and the ADA’s response here. Then revisit the NewsHour’s two-part series on America’s dental crisis, including Betty Ann Bowser’s full report from Alaska on the dental therapist training program.