US study calls for change to Dental therapists’ scope of practice

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A new US study has reignited the debate over which practitioners are qualified to provide dental care, especially to underserved populations in high-poverty areas. The study, financed by the W. K. Kellogg, Rasmuson and Bethel Community Services Foundations, examined the work of dental therapists in five rural Alaskan communities. It found that Alaska’s dental therapists provide “safe, competent, appropriate” care. (The therapists refer cases beyond their scope to supervising dentists.)

The report is entitled Alaska Dental Therapist Program: RTI Evaluation Report.

The positive results are consistent with findings from overseas, where dental therapy programs are well established, said Dr. Mary Williard, a dentist who directs the therapist training program for the nonprofit Alaska Native Tribal Health Consortium.

Alaska, the only state where nondentists may perform extractions and administer fillings. The state’s 14 therapists, who receive two years of training, help fill a vacuum: Alaska has long had trouble attracting and retaining licensed dentists. Sixty per cent of Alaska Native children ages two to five have untreated decay, and 20 percent of Native adults over 55 have no teeth at all.

Ten other US states, including Connecticut, are considering midlevel dental provider systems for underserved residents. These practitioners can be trained for relatively little money. However, the American Dental Association is not keen on the idea of drafting policy based on the Alaskan report.

“Alaska is unique among the states in the degree to which geography presents a profound barrier to care,” the ADA said in a statement. “It is not representative of the remaining 49 states in this great nation.”

The ADA statement added that the Alaskan report was based on a very small number of participants, and does not constitute the kind of empirical health outcomes data on which to base major health policy decisions. The organisation also told the New York Times it opposes the use of nondentists for “irreversible procedures” – including drilling and extraction – citing patient safety.

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