The Missing Link in Dental Care? Meet the Dental Therapist

For the past 16 years, I have worked as a registered dental assistant in an underserved community in northern Michigan, addressing oral health care disparities that seem to have no end in sight. During this time, I have assisted in the extraction and restoration of hundreds of thousands of teeth in a public health dental clinic. In my community, rampant dental caries and chronic periodontal diseases are daily realities. Unfortunately, the resources to treat these patients promptly are severely lacking. Many individuals are forced to wait over a year before they can be seen, leaving them untreated and in pain. Public oral healthcare is in a crisis, and we are failing to meet the needs of our patients. I believe the integration of dental therapists into underserved communities, where individuals are at a higher risk for dental disease, can help close the gap in access to care by providing a cost-effective solution that maintains high-quality dental services.

Dental therapists are midlevel practitioners who, under a collaborative practice agreement with a supervising dentist, can offer care within their scope of practice, similar to the role of a nurse practitioner in relation to a physician. They provide comprehensive and preventive care, including restorations and nonsurgical extractions. This allows dentists to focus on more complex procedures such as root canals and crowns. In addition to clinical care, dental therapists are trained to offer oral health education and culturally competent care, often spending more time with patients than a dentist typically can. As many dental therapists are locals within their community, they already have established trust and rapport with their patient population, which leads to better patient compliance. A study “Dental Therapists: A Solution to a Shortage of Dentists in Underserved Communities,” published in Public Health Reports, found that the introduction of dental therapists led to “increased access to dental care, declining rates of dental disease, and decreased costs associated with dental care.”¹ By working alongside existing oral health professionals, dental therapists can provide routine care, which increases accessibility, especially in underserved areas.

Underserved communities are often characterized by higher levels of poverty and lower levels of education, contributing to an increased incidence of dental caries and periodontal diseases. Poor diet, higher sugar consumption, tobacco use, and limited access to oral hygiene education and dental care coverage exacerbate these issues. Even when individuals qualify for state insurance, they may be required to travel long distances to find a participating dentist, further limiting access to care. This lack of access to both care and education places vulnerable populations in even more dire circumstances. For example, research shows that more than 40% of individuals in low-income groups have untreated carious lesions, compared to only 9% in higher-income populations.² This disparity could be significantly reduced with improved access to care, particularly in low-income and underserved areas.

Midlevel practitioners, such as dental therapists, can offer an equitable solution to this problem. Dental therapists are cost-effective because they undergo less advanced education than dentists, leading to lower tuition costs and reduced educational debt. This makes them more affordable to employ while still providing high-quality care. Due to their narrower scope of practice, dental therapists can perform procedures, such as restorations and extractions, with a level of quality comparable to that of a dentist. A 2013 systematic review conducted by the American Dental Association found that patients who received restorative treatment from dental therapists experienced a decrease in untreated caries over time, with no significant difference in treatment quality compared to those treated by dentists.³ Dental therapists are an essential part of the dental team, complementing dentists and allied professionals, particularly in underserved communities where oral health disparities persist and continue to grow.

I firmly believe that anyone willing to make a difference can contribute to addressing these disparities in oral health care. As a dental assistant, my passion lies in helping patients, but my ability to do so is limited. This, along with my love for dentistry and restorative care, inspired me to pursue a career as a dental therapist. Becoming a dental therapist will broaden my scope of practice, allowing me to provide more comprehensive care and relieve some of the burdens on dentists, ultimately enabling us to treat more patients collectively. Additionally, it will allow me to continue doing what I love: providing patient-focused care while restoring smiles.

The pathway to becoming a dental therapist is often misunderstood, with many believing that a dental hygiene background or dual licensure is required. However, in Michigan and many other states, licensure does not depend on prior dental hygiene education. Some educational programs offer dual enrollment options, while others provide a direct pathway, allowing anyone to apply if they meet the necessary requirements. This provides an opportunity for dental auxiliaries and others interested in dental careers to pursue this path. Registered dental assistants or expanded function assistants are well-suited to become dental therapists, given their existing procedural knowledge and skill set in restorative care. However, some states may require dual licensure as both a dental hygienist and a dental therapist, so it is important to check state licensing rules before choosing the appropriate educational route.

Together with dentists, dental therapists, dental hygienists, and dental assistants, I believe the collective dental team can extend care to more patients than ever before, working collaboratively to provide equitable oral health care for all. Achieving this is within our reach. Our patients deserve high-quality, comprehensive care, regardless of their socioeconomic status, race, culture, or the underserved community in which they live. I envision a future where this becomes the reality in all underserved communities nationwide. This is why I am pursuing a career in dental therapy: to be part of the movement working toward equitable oral health care for all.

References

1. Fellows JL, Atchison KA, Chaffin J, Chávez EM, Tinanoff N. Oral health in America: implications for dental practice. J Am Dent Assoc. 2022;153:601-609.
2. Yang YT, Chen B, Wanchek T. Dental therapists: a solution to a shortage of dentists in underserved communities? Public Health Reports. 2017;132:285-288.
3. Wright JT, Graham F, Hayes C, et al. A systematic review of oral health outcomes produced by dental teams incorporating midlevel providers. J Am Dent Assoc. 2013;144:75-91.