Evolving Role of the Dental Therapist
Significant changes to the United States’ dental health care delivery system are on the horizon.
Significant changes to the United States’ dental health care delivery system are on the horizon. The role of the dental therapist likely will be integrated into a variety of dynamic and fluid delivery systems. To assess how dental therapy will evolve, several factors merit attention: the directions in which health care and oral health care delivery systems will be moving; delivery models that will be prevalent in the future; how dental therapists may contribute to cost-effective delivery systems; health care providers with whom dental therapists will interact interprofessionally and intraprofessionally; influence of legislative change on the profession; and various types of educational models for dental therapists and the elements of curricular content that will be essential.
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Changes in Delivery Systems
Solo or small group practices are being replaced by more nontraditional models. Dental service organizations (DSOs), integrated medical/dental models, federally qualified health care facilities, and community-based delivery systems are examples of novel practice sites—environments that could offer employment for dental therapists. Trends indicate that the transition to the aforementioned nontraditional delivery systems will not be short-lived. These alternative models may even become more prevalent as more states move to managed care, and patients covered by Medicaid are required to seek care at practices that assume more financial risk.
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The mentality that oral and systemic health are married, and that a health home is all-inclusive, will drive an increase in integrated medical/dental models. Integrated medical/dental models, such as Health Partners, provide a cooperative arrangement where capitation fees are based on risk ratios. Utilizing dental therapists rather than dentists to provide routine dental care is more cost effective for this type of large, integrated group practice. Another model of import is the community-based delivery system. Oregon’s Advantage Dental Services is a large group practice company that provides care in schools and other community sites. Dental therapists could deliver low-cost accessible dental care to underserved children in this type of setting.
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The changing health care landscape will have legislative ramifications. Nondental organizations and nonprofit groups will advocate for more direct delivery models of care that provide cost-effective quality services. Leaders of DSOs and other progressive models may be the strongest voices in state capitals to advocate for more liberal state practice acts for dental therapy and for practice ownership by nondentists. DSOs and other nontraditional models will recognize the benefits of allowing nondentist oral health providers to work to the fullest extent of their scopes of practice and have the potential to be powerful allies in moving dental therapy forward. This advocacy bodes well for increased utilization of all nondental oral health care providers.
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A continuing debate relates to the level of education that a dental therapist should obtain. Some argue that no maximum level is necessary, as 2 years of education have been shown effective. Others argue that dental therapists are providing irreversible dental procedures that demand more than technical expertise but require elevated clinical judgment, a strong grasp of the oral/systemic link, broad knowledge of the dental and medical sciences, and high-level learning and skill sets that 2 years of education may not provide. The University of Minnesota and the Metropolitan College/Normandale partnership in Minnesota, both offer dental therapy master’s level education. As with the dental health aide therapist, Minnesota’s dental therapists and advanced dental therapists have received positive evaluations. High ratings for both models indicate that each has a place in the dental therapy profession.
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If the future of health care moves toward integrated medical-dental models, dental therapists will collaborate with medical professionals. They will need to know how to communicate with nurses and physicians, and have a firm grasp of systemic health. Another important curricular area for dental therapy is intraprofessional education. Given the newness of dental therapy, dentists may need to learn more about the profession and ways that dental therapists can successfully be integrated into clinical practice. Dental therapy programs could enhance intraprofessional education by building community externships or dental school rotations into their curricula. Dental therapy program graduates in the Normandale/Metropolitan model must practice a specified number of hours to fulfill their requirements to become advanced dental therapists. Advanced dental therapists then have additional time to focus on developing sound clinical judgment and competent clinical practice skills.