Revamping the Delivery of Oral Health Care
When envisioning the future of the dental therapy profession, all of its moving parts need to be considered. Significant changes to the United States’ dental health care delivery system are on the horizon.
When envisioning the future of the dental therapy profession, all of its moving parts need to be considered. 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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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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Growth of Integration
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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Other models afford opportunities for dental therapy and could enable collaboration between dental hygienists and dental therapists. Permitted by practice acts in several states, dental hygienists work directly with physicians, without a dentist present. Colorado dental hygienists are collaborating interprofessionally with physicians at rural clinics and federally qualified health care facilities. Oregon’s dental practice act permits dental hygienists to deliver care in pediatric and obstetrics/gynecology medical practices. In each of these environments, dental therapists could work in tandem with dental hygienists and provide complementary dental services. For example, in a pediatric practice, dental hygienists could assess a patient’s hard tissue status and provide preventive education and prophylaxes while dental therapists could handle pediatric emergency needs on-site. Both providers could triage to help find dental homes for families and their children.
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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. For example, as expanded function dental assistants are delegated more responsibilities, the roles of dental therapists and dental hygienists will broaden.
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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. Some suggest that dental therapists should first be dental hygienists. The current Commission on Dental Accreditation guidelines for dental therapy provide advanced standing for dental hygienists. This framework naturally leads to a dual degree. Existing or planned programs specifically are designed to graduate dental therapists who are dental hygienists.
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Importance of Content
Regardless of the program’s duration or degree conferred, several content areas, in addition to clinical education, are needed. One is interprofessional education. 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. As hospital and long-term care facility directors begin to realize how costly poor oral health is to their patients’ well-being and to their institutions, dental therapists and dental hygienists may see more placement in these types of environments. Current research shows that long-term care facility directors recognize that oral health care is not being sufficiently provided to their residents and that staff lacks knowledge related to oral health. Other research examines how daily oral hygiene can enhance the well-being of patients vulnerable to ventilator-acquired pneumonia in intensive care units. In these studies, daily oral hygiene care increased benchmarks of systemic wellness.
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What the Future Holds
In summary, predicting the future of dental therapy is complex. Many variables whose impact is unknown at this time may factor into the equation. It is exciting to consider where dental therapy is headed. Given the evolution of health care delivery in the United States, the growth of dental therapy programs and current and future legislative changes that potentially can propel dental therapy forward, the future appears rosy. Certain trends are occurring that enable some reasoned speculation. However, only time will tell.