Expanding the Oral Healthcare Workforce

Oral diseases are highly prevalent—even though they are largely preventable—and are indicative of the social and economic inequalities present in the United States. According to Peres et al,¹ the most prevalent oral diseases are dental caries, tooth loss, periodontal diseases, and oral cancer. While significant efforts have been made to reduce disparities and improve access to oral healthcare, the dental needs of vulnerable populations often remain unmet.

Children living in poverty, socially marginalized groups, and older adults are most commonly affected by untreated oral diseases.¹ Members of ethnic, religious, or linguistic minorities; children; older adults; individuals of low socioeconomic status; those who are underinsured; and individuals with certain medical conditions are at increased risk of receiving inequitable healthcare.²

The current dental delivery model must change in order to meet the needs of vulnerable populations. A shortage of dentists exists in both urban and rural areas, demonstrating the need for more providers.³ In 2020, nearly 60 million US residents lived in areas with dental health professional shortages, indicating a severe maldistribution of the dental workforce.³

Dental therapy provides a way to improve access for vulnerable populations. Minnesota passed legislation creating two levels of dental therapy practice: dental therapist (DT) and advanced dental therapist (ADT). These providers are required to primarily serve low-income, uninsured, and underserved patients, or practice in dental health professional shortage areas.²

A CLOSER LOOK AT THE ADVANCED DENTAL THERAPIST

Dental therapists practice in 54 countries around the globe. In the US, 12 states have authorized ADTs and an additional eight states are pursuing legislation to add dental therapists to their oral healthcare teams.⁴

Minnesota became the first state to license dental therapists in 2009. Minnesota’s dental therapy model includes DTs and ADTs working under collaborative agreements with dentists.

DTs work under the supervising dentist with the dentist physically present in the same clinic. After reaching 2,000 hours of patient care, DTs can seek an ADT license from the state Board of Dentistry. This advanced licensing allows DTs to provide patient care without the need for their collaborative dentist to be physically present where the services are rendered.

Extractions of primary teeth, pulpal therapy on primary teeth, preparation and placement of preformed crowns, cavity preparations and restorations, placement of temporary crowns, and recementing of permanent crowns are just some of the services ADTs can do without the presence of their collaborative dentist. DTs can perform these same procedures but their collaborative dentist must be physically present in the same building while the work is taking place.

The ADT and the supervising dentist (who must be licensed in Minnesota) are required to work under a written contract called a “Collaborative Management Agreement.” This establishes the practice guidelines and outlines how the ADT and supervising dentist will work together.
The “Collaborative Management Agreement “ establishes and limits the ADT’s scope of practice and the level of dentist supervision required.⁵

This allows ADTs to provide dental services in locations such as senior living facilities and schools. With oral health services provided by both levels of dental therapists, the needs of vulnerable populations are met in a more timely manner. Data show that the addition of ADTs to the dental team increases the number of dental visits among low-income and Medicaid-eligible adults.³

INCREASING ACCESS TO CARE FOR VULNERABLE POPULATIONS

The cost of oral healthcare is a significant barrier to underserved populations.⁴ ADTs play an important role by providing services at a reasonable cost. Both ADTs and DTs can help improve oral health literacy, provide school-based services, and expand the scope of practice for oral health providers in order to improve access to all populations.

In Minnesota, ADTs can work in traditional dental offices and clinics, or in community settings, such as schools, nursing homes, faith-based organizations, community health centers, federally qualified health centers, and academic institutions.⁵

However, improving access to care is more complex than adding more providers to the system. Alternative models of dental care are under consideration in many states to help combat this issue.

Everyone should receive the same high-quality, affordable oral healthcare regardless of socioeconomic status, ethnicity, education, or ability to pay. ADTs are a strong, evidence-based solution to help address access to care for Americans who do not regularly receive dental care.

CONCLUSION

Oral health is integral to whole-body health. ADTs can help make dental care more accessible to those who need it most.

Dental therapists are evidence-based and safe additions to the oral healthcare team, and more states should consider legislation to incorporate them into their dental delivery models.

References

1. Peres M, Macpherson L, Weyant R, et al. Oral diseases: a global public health challenge. Lancet. 2019;394:249–260.
2. FDI World Dental Federation. Access to Oral Healthcare for Vulnerable and Underserved. Available at:fdiworldental.org/access-oral-healthcare-vulnerable-and-underserved. Accessed February 10, 2023.
3. Elani H, Mertz E, Kawachi I. Comparison of dental care visits before and after adoption of a policy to expand the dental workforce in Minnesota. JAMA Health Forum. 2022;3:e220158.
4. Catalanotto F, Hill L. Dental therapists’ impact on access to care and oral health equity. Compend Contin Educ Dent. 2021;42:256–257.
5. Office of Rural Health and Primary Care. Minnesota’s Dental Therapist Workforce. Available at:health.state.mn.us/data/workforce/oral/docs/dt.pdf. Accessed February 10, 2023.

From Dimensions of Dental Hygiene. March 2023; 21(3)10-11.