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Letters to the Editor

Dental therapists

Every week I read something about dental therapists and how states around the country are considering these new providers as a way to expand access to dental care, especially in underserved communities. What I have not seen is any real information regarding the training required for dental therapists. I took it upon myself to find out more, and this is information I would like to share with my fellow dentists.

The University of Washington provides curriculum development and administrative oversight for the dental therapist program in Alaska. The students spend their first year (39 weeks, five days/week) training at a center in Anchorage. The second year (40 weeks, five days/week) is spent at a clinic in Bethel, Alaska, where students work in pairs with a supervising dentist and see patients every day.

Upon completion of these two years, each dental therapist participates in a mini-residency of three months and 400 hours where he/she works under the direct supervision of a dentist. At the end of this period, the dentist determines a standing order of practice, i.e., a list of what procedures this particular dental therapist shows the competency to be allowed to perform under general supervision. This dentist has a clear understanding of the skill level of the dental therapist, ensuring that care is provided safely and competently.

Once in the field, the dental therapist is assigned to a satellite clinic in an underserved community and works under the general supervision of this same dentist. They generally communicate every day by phone, reviewing the dental therapist’s work orders and exchanging X-rays via the Internet. They are essentially consulting in real time with ready access for discussion and advice.

In Alaska, dental therapists are also required to demonstrate competency on a regular basis. Every two years throughout their career, they must be re-certified, demonstrating for a dentist each of the procedures in their individual scope of practice. This enables the dentist supervisor to continually assess that the dental therapist has maintained his/her competencies.

Thus, we should all realize that these practitioners receive extensive training for specific procedures, work under the direct supervision of a practicing dentist for months, and then, once their skill levels have been certified, practice under the general supervision of the same dentist. Every step of this training is to try to ensure safe, quality and appropriate care.

The ADA should consider starting its own pilot programs to further assess the value and possibilities associated with bringing a dental therapist onto the dental team. After all, pilot projects exemplify American creativity at its best, and who better than dentists to weigh in on the training, credentialing and evaluation of these new providers?

Edwin S. Mehlman, D.D.S.
Warren, R.I.
ADA Past Vice President (1994-95)
ADA Past Trustee (1999-2003)

Editor’s note: As Dr. Mehlman explains, dental therapists work under direct on-site supervision of a dentist “for months” while in training, then under “general supervision” of the same dentist. This approach is counter to current ADA policy (passed by the House of Delegates in 2010), which emphasizes the dentist’s role as the leader of the dental team who performs examinations, diagnoses, treatment planning and surgical/irreversible procedures that are defined as the cutting or removal of hard or soft tissue.

There are ways to support access needs and foster patient safety, as pointed out in the ADA’s 2011 statement, Breaking Down Barriers to Oral Health for All Americans: The Role of Workforce ( Changes to the dental workforce are only one factor when it comes to extending access to oral health for underserved populations.

It’s also worth noting that Dr. Mehlman describes workforce models that differ somewhat from two educational programs approved by the Minnesota Board of Dentistry, dental therapy and advanced dental therapy. Currently, there is no accreditation process that ensures quality review of any of these programs.