Secular trends in dental services provided by dental therapists and dentists in Southwest Alaska

BackgroundThe goal of the study was to identify secular trends in dental service delivery between dental therapists and dentists in the Yukon-Kuskokwim Delta region of Southwest Alaska, the first area of the United States to authorize dental therapy practice.MethodsElectronic health record transactions from the Yukon-Kuskokwim Health Corporation from 2006 through 2015 (n = 27,459) were analyzed. Five types of dental services were identified using Current Dental Terminology procedure codes: diagnostic, preventive, restorative, endodontic, and oral surgery. Main outcomes were percentages of services provided by dental therapists compared with dentists and population-level preventive oral health care.ResultsThe overall number of diagnostic, preventive, and restorative services in the Yukon-Kuskokwim Delta increased. For diagnostic services, there was a 3.5% annual decrease observed for dentists and a 4.1% annual increase for dental therapists (P < .001). Similar trends were observed for restorative services. For preventive services, there was no change for dentists (P = .89) and a 4.8% annual increase for dental therapists (P < .001). Dental therapists were more likely than dentists to provide preventive care at the population level.ConclusionsDental therapists have made substantial contributions to the delivery of dental services in Alaska Native communities, particularly for population-based preventive care.Practical ImplicationsThe study’s findings indicate that there is a role for dental therapy practice in addressing poor access to oral health care in underserved communities.     

Job satisfaction among dental therapists in South Africa

Objectives: This article forms part of a larger research project on the dental therapy profession in South Africa. The objective of this study was to determine the level of job satisfaction among dental therapists trained at one South African university. Methods: This study was conducted using the qualitative research approach, where purposive and convenience sampling was used to select interviewees. They were asked a single question: “Do you think that dental therapists in South Africa are satisfied within their present careers?” The narrative data was interpreted using thematic analysis, and the data was validated by using the markers of trustworthiness. Results: All stakeholders believed that dental therapists trained at this university were not satisfied in the private and public sectors. In the private sector, they expressed frustration with their limited scope of practice. In the public service, lack of posts, poorly functioning dental facilities, and inadequate remuneration caused high levels of dissatisfaction. Many dental therapists chose this profession as a stepping stone to dentistry. Conclusions: The roles and scope of practice of all members of the oral health team needs to be redefined within the context of the primary health care approach. Universities need to recruit students appropriately to fulfill their role within this team. Dental services in the public sector need to be upgraded to meet the oral health needs of the country.     

The working practices and career satisfaction of dental therapists in New Zealand

OBJECTIVE: To describe the working practices and level of career satisfaction of dental therapists in New Zealand. DESIGN: Postal survey of dental therapists identified from the New Zealand Dental Council's dental therapy database. One mailing with one follow-up. PARTICIPANTS: Questionnaires were sent to 683 registered dental therapists. Replies were received from 566 (82.9%). OUTCOME MEASURES: Current working practice, career breaks, continuing education, career satisfaction. RESULTS: Respondents had a high career satisfaction, but were much less satisfied with their remuneration. After controlling for age and income satisfaction, therapists who felt that they were valued members of the dental community had over four times the odds of having higher overall job satisfaction. There were no differences in the mean career satisfaction scale score by age, but respondents aged 45 and over had a lower mean income satisfaction scale score than their younger counterparts (p<0.05). Older respondents were more likely to report regularly placing fissure sealants (p<0.05), participating in peer review (p<0.05), and playing a role in team management/coordination (p<0.05) than younger respondents. Most therapists (412; 82.2%) had taken at least one career break, usually for child rearing. A mean of 6.5 years (SD 5.9; range six weeks to 25 years) had been taken in career breaks. Younger therapists were more interested in moving into private practice than their older colleagues (p<0.05). More than half of respondents planned to retire from dental therapy within 10 years. CONCLUSION: Urgent action is required to improve the recruitment and retention of dental therapists in the New Zealand School Dental Service. Measures to reduce the time taken in career breaks could increase the productivity of this workforce. Remuneration and career progression are key issues; therapists need to feel that they are valued members of the dental profession.     

Impact of dental therapists on productivity and finances: I. Literature review

This study examined the financial impact of dental therapists on Federally Qualified Health Center dental clinics (treating children) and on private general dental practices (treating children and adults). This article, the first of four on this subject, reviews the dental therapy literature and the dental access problem for low-income children. Dental therapists now practice in many developed countries, tribal areas of Alaska, and Minnesota. These allied dental professionals vary in their training and required dentist supervision, but all provide routine restorative and other related services to children and adults. The limited literature on the impact of dental therapists suggests that they work mainly in school and community clinics and some private practices, are well accepted by patients, provide restorations that are comparable in quality to those of dentists, expand the supply of services, do not increase private practices' net revenues, and in school programs decrease the number of untreated decayed teeth. Of the approximately 33.8 million children enrolled in Medicaid and the Children's Health Insurance Program (CHIP), some 40 percent now receive at least one annual dental visit. To increase utilization for all children to 60 percent-the rate seen in children from upper-income families-another 6.7 million children need to receive care; dental therapists may help to accomplish that objective.     

Non-working dental therapists: opportunities to ameliorate workforce shortages

BACKGROUND: Workforce development is acritical factor allowing delivery on government health priorities. Against a backdrop of increasingdemand for dental therapists being significantly higher than the levels of recruitment, it is widely acknowledged that rural and remote areas (having greater recruitment and retention issues) will face significant shortfall in therapist numbers as the workforce shortages take hold in dentistry. This study analysed the reasons for dental therapists leaving the profession, and factors that would promote the recruitment and retention of dental therapists, especially in rural and remote areas. METHODS: A postal survey was undertaken amongst all registered dental therapists in Western Australia between the years 1999-2003. RESULTS: Of all respondents, 28 per cent indicated that they do not work as dental therapists anymore. A number of reasons for leaving the profession were highlighted, including family reasons, careerchange, poor salaries, relocation, illness and injury, and stress. To increase retention and recruitment of dental therapists to rural areas, a number of opportunities were highlighted by respondents, including increased salaries, living support, travel assistance, access to continuing education, recruitment of more rural students and more flexibility (including job sharing). CONCLUSION: This survey has highlighted various opportunities to recruit and retain dental therapists in their profession and to increase the numbers of rural dental therapists. A broad integrated rural retention strategy is necessary to address these issues among the dental therapy workforce.     

The international dental therapist: history and current status

Dental therapists provide preventive, restorative, and minor surgical treatment, mostly for children in government-sponsored health programs, in more than 53 countries. Their quality of care and acceptance by the public and dental profession has been well-documented. Since 2005, they have been effectively serving native Alaskans in remote communities. Not only do dental therapists provide basic dental care to underserved populations, they enable associated dentists to practice at a higher level of proficiency and efficiency.     

The virtual dental home: a critique

The Virtual Dental Home is a concept of the Pacific Center for Special Care of the Arthur A. Dugoni School of Dentistry in San Francisco. It is designed to improve access to dental care for underserved populations, specifically children and institutionalized adults. This article describes the development and implementation of the Virtual Dental Home, subsequently critiquing the concept. The criteria for a dental home are not met by the program. It is the equivalent of a traditional public oral health prevention and screening program, with the additional dimension of allowing dental hygienists and assistants to place interim glass ionomer restorations in dental cavities. The critique questions the need to insert a “cloud” dentist into the process. The routine utilization of radiographs is also challenged. The VDH not only lacks the attributes of a dental home, it has not been shown to be as efficient and effective as traditional programs staffed by dental hygienists and dental therapists. The article concludes by describing how programs utilizing dental therapists could address the deficiencies of the Virtual Dental Home, effectively improving access to oral health care for underserved populations.     

Dental therapists in general dental practices: an economic evaluation

Dental access disparities are well documented and have been recognized as a national problem. Their major cause is the lack of reasonable Medicaid reimbursement rates for the underserved. Specifically, Medicaid reimbursement rates for children average 40 percent below market rates. In addition, most state Medicaid programs do not cover adults. To address these issues, advocates of better oral health for the underserved are considering support for a new allied provider-a dental therapist- capable of providing services at a lower cost per service and in low-income and rural areas. Using a standard economic analysis, this study estimated the potential cost, price, utilization, and dentist's income effects of dental therapists employed in general dental practices. The analysis is based on national general dental practice data and the broadest scope of responsibility for dental therapists that their advocates have advanced, including the ability to provide restorations and extractions to adults and children, training for three years, and minimum supervision. Assuming dental therapists provide restorative, extraction, and pulpal services to patients of all ages and dental hygienists continue to deliver all hygiene services, the mean reduction in a general practice costs ranges between 1.57 and 2.36 percent. For dental therapists treating children only, the range is 0.31 to 0.47 percent. The effects on price and utilization are even smaller. In addition, the effects on most dentists' gross income, hours of work, and net income are negative. The estimated economic impact of dental therapists in the United States on private dental practice is very limited; therefore, the demand for dental therapists by private practices also would probably be very limited.     

The working practices and job satisfaction of dental therapists: findings of a national survey

OBJECTIVE: To describe the working practices and level of job satisfaction of dental therapists in the United Kingdom. DESIGN: Postal questionnaire survey of 380 dental therapists registered with the General Dental Council. RESULTS: Only 13% of dental therapists are also qualified as dental hygienists. Around 75% of those registered with the GDC are currently employed as dental therapists. Of those not currently working as dental therapists most were either working as hygienists or caring for their children at home. Over 90% of those working as therapists are employed within the Community Dental Service. About half work part-time. Part-time working is more common among respondents with childcare responsibilities. Most dental therapists are employed in clinical roles, and perform a limited range of treatments. A small proportion appear to have been asked to undertake duties which are not currently legal for them to perform. Three-quarters of those who were currently working as dental therapists had taken career breaks at some point, the most common reasons for such a break being a change in career and/or child rearing. The respondents expressed a high level of job satisfaction, particularly among older dental therapists. CONCLUSIONS: Dental therapy offers a potentially rewarding career in terms of job satisfaction. Any planned increase in the numbers of training places for dental therapists should their role be expanded, for example to include working in general dental practice, would need to take cognisance of the high rate of part-time working and the proportion who could be expected to take career breaks at some point in their working lives, as is the case with female dental practitioners.     

Dental Therapists in South Australia

A bstract — The development of the School of Dental Therapy in Adelaide, the education and employment of dental therapists in the School Dental Service section of the South Australian Department of Public Health has been described. The direction and supervision of dental therapists and the clinical duties which may be delegated to them have been reported.     

Dental hygiene and direct access to care: Past and present

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider–patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be ‘deployed’ outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care.     

Diagnosis, treatment planning and referral by school dental therapists

A bstract — -The capacity of 47 dental therapists to recognize carious lesions, poor oral hygiene and chronic marginal gingivitis and to plan treatment for caries in groups of 10 school children in the South Australian School Dental Service was assessed. In general, the therapists seemed competent to perform these duties.
Their ability to make appropriate referrals to dentists and to provide certain statistical data was also evaluated.
In South Australia, examinations made by therapists are checked periodically by their regional dentists.     

Beginning the socialization to a new workforce model: dental students' preliminary knowledge of and attitudes about the role of the dental therapist

The purpose of the study reported here was to assess first- and second-year dental students' knowledge of and attitudes about the role of the dental therapist in the oral health care delivery system. The results of this study are informing the continued development and implementation of a new dental workforce training model at the University of Minnesota. Dental students at the university (Classes of 2012 and 2013) were surveyed in 2009, with follow-up surveys planned for the subsequent five years. Multiple-choice questions and statements to be ranked using a Likert scale were used to determine what the students knew and thought about dental therapists' scope of practice, care delivery, work quality, cost-effectiveness, and role in reducing disparities in oral health care access. The results suggest that the students had generally neutral or uncertain attitudes about dental therapy, based on minimal knowledge about the role of dental therapists. In addition, we found little difference in attitudes between the two classes, the only exception being that the first-year students less often perceived the therapists as a solution to access problems. These baseline data are guiding the intraprofessional training of dental, dental hygiene, and dental therapy students toward the goal of positive socialization to a new workforce model and affirmation of the dental therapist as a member of the oral health care team.     

General dental practitioners' knowledge of and attitudes towards the employment of dental therapists in general practice

OBJECTIVE: To investigate general dental practitioners' knowledge of and attitudes towards dental therapists, to ascertain the likelihood of their employment in general dental practice, what client groups they would be likely to treat, and to identify the main perceived barriers to their employment in general dental practice. METHOD: Postal questionnaire. SETTING: General dental practitioners in the county of West Sussex. SAMPLING: All dentists holding a contract to provide general dental services in West Sussex were contacted. Final sample size was 200. KEY FINDINGS: Thirty eight per cent of dentists said they would employ a therapist if legislation allowed. Main perceived barriers were cost, lack of knowledge and dentists' acceptance. CONCLUSIONS: In general dentists had a favourable attitude towards dental therapists, although there was a real lack of knowledge about their permitted duties. Most dentists felt therapists should treat children and people with special needs.     

The International Collaborative Oral Health Development Project

The Canadian Dental Therapy programme was developed to meet the dental needs of remote communities in the North West Territories. In collaboration with the Mozambique Government trainees from that country are now being admitted to a modification of the programme designed to meet the needs of Mozambique. The aim is to help the Mozambicans to establish a core of supervisors, educators and providers of dental care within their dental auxiliary programme. (Editor's summary.)     

Dental school faculty perceptions of and attitudes toward the new dental therapy model

The University of Minnesota School of Dentistry launched its new dental therapy program in September 2009 after the Minnesota state legislature had authorized the training and practice of a dental therapist in May of the same year. The creation of this mid-level dental provider is seen as a workforce solution to help address the problem of access to dental care experienced by some members of our society. However, there is a lack of consensus and even controversy in organized dentistry about dental therapy, one of the mid-level provider models. This study explored the attitudes and perceptions of dental school faculty members who have been tasked to prepare these new dental therapists to do their work. Focus groups were conducted with a randomly selected group of faculty members, the results of which were used to develop a survey of faculty members in all departments of the school. A total of 151 faculty members responded to the survey: 68 percent of these respondents were fifty-one years of age or older; 79 percent were male; and 39 percent were full-time and 61 percent part-time. Fifty-four percent were clinical faculty members, and the rest taught in the preclinical courses and basic sciences. The study found that these dental faculty members believe dentists have a personal responsibility in the care of the underserved but do not agree that the dental therapists are part of the solution to improve access. There was a clear divide between the part-time faculty members, who practice outside the institution, and the full-time educators with regard to the role of dental therapists. However, there was an overall consensus that dental faculty members have a commitment and responsibility to educate future dental therapists regardless of their personal position. This is encouraging to dental therapy students, who can be assured that they will receive the education they need to prepare them to practice.     

The role of dental therapists working in four personal dental service pilots: type of patients seen, work undertaken and cost-effectiveness within the context of the dental practice

OBJECTIVES: To describe the type of patients seen and work undertaken by dental therapists employed in four personal dental service practices and to report on their cost-effectiveness within the context of the dental practice. METHOD: All members of the dental team used a standard day sheet to record all patient contacts and procedures undertaken in that session. Dental therapists recorded data for 30 consecutive sessions and dentists recorded information for 20 sessions. Items were recorded in sufficient detail to allow later matching with the GDS statement of remuneration and a calculation of the average gross fees and patient charges per session. RESULTS: The role of the dental therapist varied between the practices studied. In two practices the therapist saw a high proportion of child patients, and in one of these this was combined with providing care for a high number of adult patients who were exempt from patient charges. In the two practices where the dental team did not include a dental hygienist, the dental therapist had a relatively high workload providing dental hygiene care for adult patients. It appears that the gross fees and patient charges generated by the dental therapist in all four PDS practices fail to cover the cost of the salary of the dental therapist, dental nurse and associated overheads borne by the practice.