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Kellogg moves ahead on dental therapist project

Battle Creek, Mich.—The W.K. Kellogg Foundation Nov. 17 announced that it will invest more than $16 million by 2014 in its Dental Therapist Project, focusing on efforts in Kansas, New Mexico, Ohio, Vermont and Washington.

ADA President Raymond Gist, though welcoming the Kellogg Foundation “to the fight to improve the oral health of the millions who suffer from its lack,” noted that the foundation’s recent efforts to address this complex issue focus exclusively on expanding a single provider model, based on the controversial Alaska Dental Health Aide Therapist.

The limited research evaluation conducted by Kellogg did not provide the robust examination or projectable metrics on which to base such important policy and public health decisions, he said. In addition, there is no comprehensive model or report with an economic analysis from a cost benefit perspective for this new dental workforce model.

“No matter where you stand on the issue of nondentists performing dental surgery—and we stand firmly against it—limiting the approach to overcoming the many access barriers to promoting this one workforce model ignores numerous, and we believe much greater, barriers to care,” said Dr. Gist. “Frankly, these energies and resources would be better directed toward fixing existing programs.”

Barriers that need to be removed, he added, include lack of adequate funding for public assistance dental programs and geographic and other practical barriers like transportation, securing time off from work, translation services, health literacy levels and child care.

“Prevention is the ultimate solution to the epidemic of untreated oral disease,” said Dr. Gist. “The nation will never drill and fill its way out of this health crisis. Yes, we must bring millions more into the system to receive comprehensive and coordinated care overseen by dentists. But almost all of this disease is entirely preventable.

“The ADA supports workforce innovations that address prevention and providing care to those with the most urgent needs, without putting the patient at risk,” Dr. Gist added. “In 2009, the Association launched the Community Dental Health Coordinator pilot project. The CDHC model is based on community health workers, who have proven extraordinarily successful on the medical side. The CDHC focuses primarily on prevention, through oral health education, and the application of preventive measures like sealants and fluoride varnishes. The CDHC enables the patient to overcome several of the more practical barriers to care—cultural, language, scheduling coordination—and helps the community members navigate these obstacles successfully. The majority of the first class of CDHCs completed its training this fall. They now are working in clinics and other public health settings.” (See related story http://www.ada.org/news/5064.aspx).

The ADA’s statement in response to the Kellogg initiative is posted online at http://www.ada.org/5065.aspx.

The Kellogg Foundation said it will work in the five states with its national lead grantee Community Catalyst, a nonprofit health care advocacy organization. The project will support what it describes as “community-led efforts” in those five states to establish dental therapist programs as a way to expand access to oral health care, said the Kellogg Foundation in a press release.

Last month, Kellogg issued a report on the Alaska Dental Health Aide Therapist program. The October study by RTI International of Research Triangle Park, N.C., concluded that dental therapists practicing in Alaska provide safe, competent and appropriate dental care. The study evaluated five therapists and 300 patients.

In December 2009, Kellogg released a report that advocated midlevel dental providers who would perform some surgical procedures as a solution to the nation's oral health care access crisis.

State dental society officials would first like to solve the more mundane barriers to accessing routine comprehensive care and lack of money dedicated to dental care for low-income residents before adding another member of the dental team. Dentistry already includes several team members, including dental hygienists, dental assistants and expanded function dental assistants whose capacity to support increasing access to comprehensive care is currently underleveraged within the existing dental delivery system.

“Clearly we don’t think this is necessary in the state of Kansas. If a problem exists in a maldistribution of dentists in our state, we think the best approach is to put our heads together and do a better job to provide incentives to put dentists in those areas that are needed,” said Dr. Dave Hamel, president of the Kansas Dental Association.

Dr. Hamel said the KDA has approached the state legislature about providing incentives for dentists to practice in rural areas and is finalizing a good oral health package to present in the next legislative session. Funding for Kansas’ Donated Dental Services program has been cut and needs to be restored; the state doesn’t have an adult Medicaid program; and there need to be revisions made in the existing Medicaid program that could incite dentists to participate.

The Vermont State Dental Society has not taken a position on Kellogg’s plan, instead focusing on solving the root problems driving the issue.

“We believe that it is a broader issue that must be considered: Who are the people without access to care and what are the reasons they are without access? We definitely know that resources and financing are a critical component. We will be continuing our efforts to expand the Vermont Medicaid program for those clearly identified in financial need to better access oral health services,” said Peter Taylor, executive director.

“It concerns us that the dental therapist model is being proposed as the solution when we realize there are many facets to these problems,” he said. “While that effort is going on, we will be working with our Vermont Department of Health and other advocacy groups to look at the big picture of oral health in Vermont.”

The New Mexico Dental Association does not believe access-to-care barriers in its state are related to scope of practice and would have liked to see coalitions work to eliminate a tax on dental care instead, said Mark Moores, NMDA executive director.

“We have a huge social justice issue in New Mexico,” Mr. Moores said. “There is a sales tax on dental care in our state of 7 or 8 percent. This is an unfair tax on the working poor. We would have loved to work with Kellogg to eliminate this unjust tax policy and eliminate this huge barrier that the working poor have in accessing quality oral health care. The New Mexico Dental Association was displeased that Kellogg didn’t reach out to the largest and most respected dental organization in the state to work together to improve oral health care for all New Mexicans.”

The Washington State Dental Association’s charitable foundation, the Washington Oral Health Foundation, has school programs in place to address prevention, which Washington dental leaders believe is the ultimate solution.

“I think it’s a very complex problem. Kellogg is looking at a very narrow part of that problem. We’re looking at a much broader scope of the issue that’s before us,” said Dr. Doug Walsh, president of the WSDA.

Dr. Walsh said the WSDA is more concerned with losing funding for adult Medicaid, which will occur beginning Jan. 1, and about the lack of fluoridation throughout the state. Both are issues he wishes Kellogg would pay attention to.

The Kellogg news release is available online at www.wkkf.org.