US dentists block ‘midlevel dental providers’

The American Dental Association is opposed to therapists being trained to perform procedures.

The American Association of Public Health Dentistry (AAPHD) has announced the publication of a series of papers that highlight curriculum guidelines for the training of dental therapists. In response, the American Dental Association issued a statement saying that the ADA remains committed to its position that only dentists should perform irreversible/surgical procedures.

“AAPHD believes that adding dental therapists as members of the dental team may help meet growing U.S. oral health needs, particularly among underserved populations,” read a news release from AAPHD.

The proposed model curriculum is based on a two-year, post-secondary training program, and has been advised by an 11-person academic panel “selected for expertise, experience and in-depth knowledge of dental education.” One proposal involves models of ‘midlevel’ dental providers—non-dentists who would perform surgical/irreversible procedures.

“To date there has been no consensus on the specific prerequisites, scope or duration of educational program, or other critical attributes needed to define any academic model,” said the ADA. “While we appreciate the work that went into [the AAPHD papers], we disagree on a critical point: The ADA does not believe a non-dentist should perform surgical/irreversible procedures.”

The ADA further explained why it has taken an approach to workforce needs that emphasizes oral health care and prevention.

“The ADA supports innovations in the dental team that would improve oral health among people who lack adequate access to care, provided that those innovations do not compromise the very system they seek to extend. Our own Community Dental Health Coordinator pilot project seeks to do that by training community health workers who specialize in oral health education and disease prevention, factors that ultimately are the nation’s best hope of ending what we all agree are unacceptable levels of oral disease.”

The AAPHD papers cover principles upon which a dental therapy program should be based; recommended length of training; competencies required for graduates; and general curriculum content. The panel considered the course of study for dental therapists in programs already in the United States (Minnesota and the Alaska Native Tribal Health Consortium/University of Washington program) and throughout the world.

“The AAPHD brought together this panel of academicians and highly respected authorities in dental education to determine an appropriate course of study to be included in a two year education program,” said Dr. Caswell Evans Jr., associate dean for prevention and public health sciences at the University of Illinois at Chicago and convener of the panel.

“There has been a growing interest in adding a new oral health professional designation to the dental workforce by both state and federal legislatures,” said Dr. Evans. “The AAPHD and the panel it convened believe that such a designation could add value to the dental profession as a whole, and could assist the profession in its efforts to improve access to care for difficult-to-reach sectors of the population.”

“AAPHD took on the charge of developing a model curriculum because of the increasing interest in the states and the need to standardize training to assure accreditation of programs, as well as develop a career path for entering the profession to best serve the oral health needs of all populations,” said AAPHD President Diane Brunson, RDH. “We believe that the expert panel recommendations, used as a model to build on, will assure that curricula from school to school and state to state are consistent, of high quality and will pave the way for national accrediting.”

Despite the differences of opinion on the issue of midlevel providers, the ADA reiterated its support for AAPHD in its efforts to improve the nation’s health.

“The majority of dentists who belong to the American Association of Public Health Dentistry are also members of the ADA,” said the ADA in the statement. “They provide valued perspective and resources to our advocacy on behalf of the nation’s oral health. The ADA historically has been among their greatest supporters and advocates, and we will continue to be so. We will continue to work with the AAPHD and all interested stakeholders toward the goal we all share—a healthier more productive nation.

“But, in doing so, the Association will not erode its unequivocal opposition to nondentists performing surgical/irreversible procedures, or to other proposals that we believe run contrary to the public good.”


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