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‘Mutual, overarching goal should eclipse our differences’

The Association offered a “dramatically different view” of improving access to care than offered April 9-10 by professional and philanthropic advocates of dental therapists in the oral health workforce.

Former Health and Human Services Secretary Louis W. Sullivan, M.D., called for Alaska-style dental therapists as a solution to widespread dental-care access disparities in an opinion piece published April 9 in The New York Times. The W.K. Kellogg Foundation April 10 released “A Review of the Global Literature on Dental Therapists” subtitled “In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States” and suggesting a greater role for midlevel dental providers.

“The ADA will submit a letter to the editor offering dentistry’s dramatically different view on how to help millions of underserved and un-served Americans attain good oral health,” said an Association all-member e-mail about Dr. Sullivan’s “Dental Insurance, but No Dentists” article. Dr. Sullivan, HHS Secretary under President George H.W. Bush, said in the article, “The federal government could encourage states to pass laws allowing these providers to practice by calling for demonstration projects proving their worth.”

In response to the literature review, the Association offered “a respectful but firm refutation of a report that claims to demonstrate the viability of one solution to a complex set of problems that impede too many Americans from attaining good oral health. The ADA’s firm stance against non-dentists performing surgical/irreversible procedures is well known.

“That said, the Association believes that all of the individuals and organizations involved in this discussion, whether regarding this paper specifically or the larger, ongoing discourse, want the same thing: a nation in which everyone who seeks it enjoys good oral health and the overall health to which it contributes. This mutual, overarching goal should eclipse our differences.” The Association comment is posted at ada.org.

The global literature “indicates that dental therapists included in the oral health workforce have the potential to decrease the cost of care, specifically for children,” the 456-page Kellogg monograph said. The research reviews the history and practice of dental therapists in 54 countries and territories since the use of therapists began in New Zealand in 1921. Therapists practice in Alaska and Minnesota.

“There is no question that dental therapists provide care for children that is high quality and safe,” said Dr. David Nash, the report’s principal author. “None of the 1,100 documents reviewed found any evidence of compromises to children’s safety or quality of care. Given these findings, the profession of dentistry should support adding dental therapists to the oral health care team.”

Dr. Nash is the William R. Willard Professor of Dental Education and professor of pediatric dentistry at the College of Dentistry at the University of Kentucky. He is a member of the American Dental Association and the American Academy of Pediatric Dentistry.

The report positions philanthropic foundations as taking a lead in the United States on access to health care. “With respect to oral health issues, these foundations have recognized that dental therapists in the oral health workforce can assist in addressing the problems of access and disparities,” the report said. “They have provided funds for research, advocacy and implementation of oral health care programs. Among them are the Josiah Macy Jr., Pew, Rasmuson, Robert Wood Johnson and W.K. Kellogg foundations.”

The report is described as “essentially an annotation of the global literature, with minimal discussion” and “not an evidence-based systematic review of the literature. Rather, it is intended to identify the literature and annotate relevant documents that assist in characterizing the use of dental therapists worldwide.” It includes extensive professional dialogue and 1938-2012 U.S. literature relevant to dental therapists and attempts to characterize professional and public perspectives toward therapists.

“A comprehensive range of views is evident, but in general these views polarize into opponents and proponents,” the report said. “In some cases, the intellectual quality and tone of the debate has reflected poorly on the dental profession.”

The public perception in the United States is measured by a 2011 W.K. Kellogg Foundation national survey on access to dental care, according to the report’s executive summary. “More than three-quarters of respondents (78%) support an effort to train a new dental provider—a licensed dental practitioner—to work under the supervision of a dentist to provide preventive, routine care to people without regular access to care.” Globally, “no evidence could be found to indicate that the public perspective of dental therapists in any country was other than positive.”

The report described a dental therapist as “a limited practitioner who can provide basic dental care in the same manner as a dentist. Historically, the focus of a dental therapist has been on the prevention and treatment of dental disease in children.”