Posts Tagged ‘dental therapists’

Sanders and Cummings Make the Case for a Comprehensive U.S. Dental System

Friday, June 8th, 2012

Yesterday, Senator Bernie Sanders (I-VT) and Rep. Elijah Cummings (D-Maryland) announced they are filing legislation to address a national crisis in dental care.

The legislation would expand comprehensive dental coverage to millions of Americans through Medicare, Medicaid, and the Veterans Administration; increase access to dental services at community health centers, school-based clinics and through mobile services; and address the underlying shortage of providers by expanding the National Health Services Corps scholarship program, among other measures.

Access to comprehensive oral health care is a dire need for more than 82 million Americans who struggle daily to access care.

In February, 2,300 Kansans lined up outside an old Wal-Mart at a makeshift dental clinic, the annual Kansas Mercy of Mission Free Dental Clinic, and were lucky enough to receive care. Thousands more were turned away. While the clinic provided some residents their first opportunity to see a dentist in years, or in some cases for the first time in their lives, it also illustrated that too many people go without regular oral health care. Missions of Mercy events and emergency rooms are too often the destination for Americans who lack access to dental care because the dental delivery system is not working.

In 2000, the first-ever Surgeon General’s report on oral health identified dental and oral disease as a “silent epidemic” that burdens some population groups throughout the country. Over the last decade, the problem has only worsened, unnecessarily claiming the life Deamonte Driver and others.

Earlier this year, Senator Bernard Sanders and the Senate Subcommittee on Primary Health and Aging issued a report, Dental Crisis in America; The Need to Expand Access, which showed:

•more than 47 million people live in places where it is difficult to access dental care
•more than 130 million Americans do not have dental insurance
•about 17 million low-income children see a dentist less than once a year
•only 45 percent of Americans age 2 and older saw a dental provider in the past 12 months

The legislation from Sen. Sanders and Rep. Cummings also contains important policies aimed to strengthen the oral health workforce. Nearly 50 million people in the United States live in dental professional shortage areas where they cannot gain easy access to a dentist. Therefore, it is exciting to see that the legislation’s included funding for the establishment of new demonstration programs within the Department of Veterans Affairs and Defense, the Federal Bureau of Prisons, and Indian Health Service for the training and employing alternative dental health care providers, known as dental therapists. Dental therapists and other mid-level providers offer the opportunity to reduce economic and geographic barriers to dental care throughout the country. By establishing and funding pilot programs, dental therapists will be able to provide routine and preventive care to underserved populations as well as demonstrate their ability to increase access to high quality, cost effective care. Already, dental therapists are increasing access to dental care in rural and underserved communities in Alaska and Minnesota.

Sen. Sanders and Rep. Cummings deserve credit for their vision to improve access to oral health care by investing in community-based dental services at community health centers and school based health centers, seeking to provide resources for coordinated care to keep patients out of costly emergency rooms, and strengthening the workforce by exploring proven models such as dental therapists who offer culturally competent care. Their efforts to invest in an oral health system that is equipped to provide coordinated, culturally competent care in community based settings is major progress and a seismic shift away from forcing millions of Americans to rely on makeshift dental clinics or a costly emergency rooms.

– David Jordan, Dental Access Project Director

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Posted in children's health, dental care, Health disparities, Uncategorized | No Comments »

Looking at the Whole Problem, Not Just the Mouth – The Need to Systematically Improve America’s Oral Health

Wednesday, April 11th, 2012

Often overlooked, untreated tooth decay and poor oral health have become an epidemic in the United States. In fact, tooth decay is the most common childhood disease, five times more common than asthma.

On March 6th, The New York Times reported that an alarming number of preschoolers were facing oral surgery due to untreated tooth decay. According to the CDC, for the first time in forty years there is an increase in the number of preschoolers with cavities.

While last month’s New York Times story captured the need for more awareness about the importance of oral health to overall health and the need for better diets to prevent tooth decay, it did not explore the fact that there are more than 83 million people who do not receive regular dental care because the existing system is not capable of serving them. An entire quarter of the population, these 83 million people do not receive dental care because they live in communities where there are not enough dentists to meet the need or because the dental care offered is unaffordable.

Without a delivery system in place that provides routine care and preventive services, the proportion of the population that this epidemic effects will persist and grow larger.

Through further examination of the dental delivery system, it is clear America’s oral health is suffering as a result of the systemic problem caused by too few dentists in underserved rural and urban communities. Nearly 50 million Americans live in communities without enough dentists to meet their needs. Compounding the dental shortage problem is that not enough providers accept Medicaid. In 2009, 56 percent of Medicaid-enrolled children did not receive dental care—not even a routine exam.

Last year a study in the American Journal of Pediatrics showed that Medicaid patients were 18 times more likely to be denied care than children with private insurance.

With no place to turn for affordable dental care in their community, patients turn to the emergency room at a high cost to the patients, the health care system and to taxpayers. Last year, the Washington Hospital Association reported that dental visits were the number one reason uninsured patients visited the emergency room and it was the sixth reason for Medicaid enrollees to visit the emergency room.

According to a report released last month by the Pew Center on the States nationally, more than 830,000 visits to emergency rooms nationwide in 2009 were for preventable dental problems, highlighting the substantial cost of ER care. For example, Florida saw dental-related, emergency hospital visits produced charges exceed$88 million in 2010.

Recognizing the need for a better way to address America’s unmet oral health needs, Dr. Louis Sullivan, former Secretary of the United States Department of Health and Human Services, offers a systematic approach on how to better deliver care in underserved communities in Monday’s New York Times.

Dr. Sullivan notes that, “A more immediate solution is to train dental therapists who can provide preventive care and routine procedures … outside the confines of a traditional dentist’s office. [They] are common worldwide, and yet in the United States they practice only in Alaska and Minnesota, where state law allows it. Legislation is pending in five more states.

The dental profession has resisted efforts to allow midlevel providers to deliver this kind of care, and the government has so far failed to push for the change. It must do so now. [They] could encourage states to pass laws allowing these providers to practice by calling for demonstration projects proving their worth.”

Dr. Sullivan is not alone in recognizing the need for a comprehensive approach to addressing our oral health needs. Recently Senator Bernard Sanders (I-Vermont) released a report, “Dental Crisis in America: The Need to Expand Access,” that details the problems Americans face in accessing care and potential solutions, including mid-level providers such as dental therapists.

Additionally, Dr. David Nash of the University Of Kentucky College Of Dentistry released a monograph on Tuesday detailing the history of dental therapy both internationally and in the United States. After rigorously reviewing more than 1,100 documents on the care provided by dental therapists worldwide, the authors concluded that these practitioners deliver safe, effective dental care in addition to improving access to care. Included as part of the oral health workforce, they have the potential to decrease the cost of care as well.

With more attention on the dental crisis and solutions, like adding a mid-level provider to improve access to care, we need to keep the momentum up by supporting efforts at the state and federal levels to improve access to care and how care is delivered.

 – David Jordan,  Dental Access Project Director

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Posted in children's health, dental care | 1 Comment »

Confronting Our Dirty Little Secret

Wednesday, February 29th, 2012

After a decade of reports and tragedy a lot of progress must be made to improve our oral health

A decade ago, the Surgeon General released a report on oral health that described unmet oral health needs as a “silent epidemic”. Five years ago, a 12 year old Maryland boy, Deamonte Driver, died due to an untreated molar infection which spread to his brain.

Like most dental disease, Deamonte’s cavity could have been treated. His death could have been prevented but he did not have access to care.

Despite a tragic death and a groundbreaking decade old report that chronicles the need for better access to dental care, too many Americans suffer silently and un-served.

Today, Senator Bernard Sanders (I-Vermont) and the Senate Subcommittee on Primary Health and Aging confronted America’s dental crisis with a hearing and report that shined a light on the need to expand access to care.

The report, Dental Crisis in America: The Need to Expand Access, found that:

  • • More than 47 million people live in places where it is difficult to access dental care.
  • • About 17 million low-income children received no dental care in 2009.
  • • One fourth of adults in the U.S. ages 65 and older have lost all of their teeth.
  • • Low-income adults are almost twice as likely as higher-income adults to have gone without a dental check up in the previous year.
  • • Bad dental health impacts overall health and increases the risk for diabetes, heart disease, and poor birth outcomes.
  • • Almost 60 percent of kids ages 5 to 17 have cavities – making tooth decay five times more common than asthma among children of this age.
  • • Nearly 9,500 new dental providers are needed to meet the country’s current oral health needs.
  • • However, there are more dentists retiring each year than there are dental school graduates to replace them.

Senator Sanders recently told The Nation, “We have a real crisis both in terms of access to affordable dental care—and not only for lower-income Americans but for many in the middle-class as well—and the consequences of a lack of treatment.”

The consequences of dental crisis was evident this week as the Pew Center on the States released a report that detailed that lack of access to regular dental care is resulting in costly visits to the emergency room for preventable dental problems.

To address the access problems and public health consequences of poor access to dental care, the report explores potential solutions such as:

  • • expanding the oral health workforce
  • • integrating dental services: federally qualified health centers and school-based health centers as models
  • • expanding coverage and increasing reimbursement rates
  • • focus on prevention and education

In order to ensure that dental access is no longer silently overlooked, Sanders called on community members to, “Go to our website, tell us your views and observations on dental care. And do whatever you can to rally your representatives in the House and the Senate to begin to address this crisis. I think we’ve got to raise the noise and the level of consciousness about the dental crisis, and when we do that we can get some serious Congressional response.”

Speak up, be heard and ensure unmet oral health needs are no longer a silent epidemic.

 – David Jordan, Dental Access Project Director

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Dental Access More Controversial Than Contraceptive Care?

Wednesday, February 22nd, 2012

Late last month as snow enveloped Olympia, Washington, state advocates braved the elements for hearings on two very important yet different issues – improving access to dental care and reproductive rights and contraception coverage. At one point a veteran advocate attending the same hearing for a bill on reproductive rights remarked to our partners at the Children’s Alliance, “When did access to dental care become more controversial than reproductive rights?”

While contraception coverage has been in the national spotlight recently, the debate over access to dental care continues to be just as heated in state capitals as community-driven efforts to add mid-level providers to the dental team are met with resistance from dental associations. Dental therapists, mid-level dental providers, are practicing in Minnesota, Alaska and more than 50 countries. In fact, WBUR explored how dental therapists offer a cost effective way to expand and preserve quality access to dental care for underserved populations during these difficult financial times. Most recently, proposals have been debated in Kansas and Washington. However, 15 other states including Vermont and New Hampshire are also exploring alternative workforce models as a way to extend care to underserved populations. Despite the fact that these new providers would be able to provide care in communities where there are not enough dentists and enhance the dentist-led team’s ability to provide routine and preventive care to vulnerable populations, community driven, multi-stakeholder and consumer efforts are still being met with opposition from dental groups.

This dynamic was on full display in Kansas last month at a House Health Care Committee Roundtable discussion that explored how adding a dental provider to the dental team will improve access to care. A broad coalition of community groups, children’s groups, supportive dentists, safety-net clinics and educators explained the clear need for better access to dental care, especially for children—27.6 percent of Kansas third graders have untreated tooth decay. This is due to the fact that 93 of the 105 counties in Kansas do not have enough dentists to serve their populations, 28 counties do not have a Medicaid dental provider, and only 25 percent of Kansas dentists accept Medicaid patients. Despite the broad-based support for a new way to deliver care, the dental association still opposed the measure.

Unfortunately, lawmakers continue to see the issue as a turf battle. As many know, scope of practice issues typically involve one trade association pitted against another trade association, which legislators do not like refereeing. But this issue is different because it is not about business or about dentists – it is about finding a way to treat untreated tooth decay and helping improve the oral health of underserved communities. As the issue evolves, it is critical to help policymakers and stakeholders elsewhere understand that limited access to dental care disrupts the lives of millions of kids throughout the country. In fact, according to the Pew Center on States state dental policies fail one in five children.

In Washington State, April Ritter’s daughter went without care. She was forced to endure pain and sleepless nights because Ritter could not find a dentist who accepted her Medicaid coverage. In addition to negatively impacting the health of children and adults, the lack of dentists in underserved communities or dentists who will only accept certain types of insurance is also leading to unnecessary costs. According to the Washington Hospital Association, severe toothaches are the number one reason people in Washington without insurance end up in the emergency room.

After taking a closer look at their analysis of ER visits for the time period of January 2008 – June 2009, which found the total number of dental-related ER visits was 54,000, with total charges of $35 million, the Washington Hospital Association joined a community driven coalition organized by the Children’s Alliance, Washington CAN, the American Indian Health Commission, Northwest Portland Area Indian Health Board, the Washington State Dental Hygienists Association, community health centers and supportive dentists who are working to add a dental therapist to the dental team as a way to improve access to care, preserve services and reduce costs – particularly costs incurred through unnecessary ER visits.

Recognizing the benefits of adding a new provider to the dental team would help improve access to care and help control costs, the Washington State Senate Committee on Health and Long Term Care supported the bill and passed it favorably out of their committee on February 2. Despite the bill advancing through the key committee and support from an energetic sponsor, Sen. David Frockt, other legislators did not seize the opportunity this year. However, a great deal of progress was made as lawmakers heard from children and adults in their districts who had unmet oral health needs who came out in support of the Washington Dental Access Campaign.

Last week, the debate regarding access to dental care unfolded in New Hampshire in much the same way – children’s advocates supporting efforts to increase access to care were met with opposition from dentists.

Vermont may be the next state to examine access to dental care. Hopefully, policymakers understand the effort is about the estimated 24,000 children in Vermont enrolled in Medicaid who failed to get the dental care they urgently needed in 2009 or the 10,000 Vermont seniors and 62,000 adults under age 65 who went without care that year, rather than the interests of a trade association. The best solutions begin with listening to the people who need access to care not the businesses and groups who claim they speak for them.

 – David Jordan, Dental Access Project Director

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PBS NewsHour Explores The Growing Need for Better Access to Dental Care and Dental Therapist Solution

Tuesday, November 22nd, 2011

This week, PBS’ NewsHour highlighted that millions of Americans go without dental care and also profiled how alternative dental providers, known as dental therapists, have improved access to care in Alaska and have the potential to do the same in the lower 48.

The first report in the series highlights that millions of Americans go without regular dental care. According to the report, only one of every two Americans has dental insurance, which means cost is a barrier to getting care for too many Americans. The report also detailed that Americans, particularly those in rural or low-income communities, often have trouble finding dentists who will serve them – more than 50 million children and adults in the United States live in areas without enough dentists.

Unfortunately, not having dental care can have serious effects on your overall health. Due to poor access to dental care, tooth decay is the most common chronic childhood disease in the United States – five times more common than asthma. Left untreated, dental decay can set the stage for a lifetime of poor health. It is linked to such serious health problems as diabetes, stroke and heart disease.

In part two of the NewsHour series, the report highlighted how dental therapists are being used in Alaska to treat previously underserved Alaska Natives. The piece highlights how dental therapists are bringing care to 35,000 people who never had access to regular dental care before.

Dental therapists are effective in reaching previously underserved populations because they are able to deliver care in the community, which is more efficient and effective than relying on patients to travel far distances to see a dentist in a traditional dental home.

Also, dental therapists can provide preventive care and commonly needed services such as fillings and routine extractions. That way, dentists can see more patients, and midlevel providers can expand access further by practicing in remote areas where there are no dentists.

The dental therapist program in Alaska has worked so well that it is seen as an innovative way to better deliver care to the 83 million Americans going without regular dental care because there are not enough affordable providers in their community or there are no providers in their community to serve them.

In addition the dental therapists practicing in Alaska, dental therapists are already authorized and being trained in Minnesota. Alternative providers such as dental therapists are under consideration in 16 other states. Community Catalyst is working with the W. K. Kellogg Foundation to support the establishment of a new primary care dental provider in Kansas, New Mexico, Ohio, Vermont and Washington. The Pew Charitable Trusts is working on similar efforts in multiple states as well.

Momentum is growing based on the model’s history of success. Last month, the Kansas City Star endorsed the effort led by Kansas Action for Children, Kansas Association for the Medically Underserved and Kansas Health Consumer Coalition to establish a registered dental practitioner position. The registered dental practitioner would be able to provide routine and preventive care to underserved residents of the state – 93 of 105 Kansas counties do not have enough dentists and only 25 percent of Kansas dentists accept Medicaid patients. Registered dental practitioners could fill this void by helping dentists extend their reach into underserved communities and giving dentists who treat underserved populations an additional provider to help them see more patients.

As the Kansas City Star noted, Kansas has a chance to get out in front of a healthy trend. Lawmakers should get to work on a sound bill that enables well-trained clinicians to serve the basic dental needs of Kansas citizens.

There is significant research supporting the efficacy of dental therapists in increasing access to care and delivering quality care. Still, the ADA and organized dentistry, such as the Kansas Dental Association oppose this proven model despite admitting they have no evidence to support their position. In the Kansas City Star, Kevin Robertson, the Kansas Dental Association’s executive director, acknowledged that no research backs up the association’s contention that dental practitioners could compromise patient safety. The ADA’s President, Dr. William Calnon, made similar statements in the NewsHour report.

As one in five children suffer because they are unable to access regular dental care, we must move beyond turf fights and advocate for policies and providers such as dental therapists that can help improve access to care and the health of patients and communities. We have a real opportunity to place providers in communities where no one is available to offer care, which means less decay, fewer health problems, and lower health care costs. As you watch the NewsHour piece, envision how dental therapists could help better deliver care to your community, and please use Community Catalyst as a resource.

— David Jordan, Dental Access Project Director

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New Oral Health Study Reveals The Good, The Bad, and The Ugly Truth When It Comes To Dental Care

Thursday, October 6th, 2011

Oral health advocates are trained to reinforce that oral health is essential to overall health. The good news is that a poll released today by the W.K. Kellogg Foundation (conducted by Lake Research) found that 79 percent of survey respondents say that receiving regular dental care is very or somewhat important.

The bad news is that 41 percent of respondents report that they or someone in their household have put off dental care in the last twelve month due to costs. Respondents recognized that too many Americans cannot regularly access preventive and routine dental care and, as a result, 78 percent of respondents said they would support training new providers to offer routine dental care.

The survey indicated that cost and availability of providers are the major barriers to care:

  • – 84 percent of respondents believe that the number of people who cannot afford dental care is a problem
  • – 82 percent of respondents believe that it is hard for people to get free or low-cost dental care in the communities where they live
  • – Nearly one third of respondents (30 percent) say they do not have access to a place where they get regular dental care

The survey highlights the fact that millions of Americans go without routine oral health care because of problems with access or cost. Simply put, there are not enough affordable options for oral health care, and there is a severe shortage of dentists in low-income, rural and underserved communities.

Recognizing the struggle Americans face in accessing care, the survey also asked about a new approach to providing dental care – the use of mid-level providers known as dental therapists. Respondents recognized the potential of dental therapists to improve care. As noted above, 78 percent of respondents say they would support the training of “licensed dental practitioners” to provide preventive and routine care.

Dental therapists are well-trained dental providers who provide routine care in communities where there are not enough dentists. They are filling a void in Alaska through providing care in Alaska Native communities. As a result, dental therapists will soon practice in Minnesota in underserved communities throughout the state.

As we look at innovative ways to improve access to oral health care and how care is delivered, these findings indicate that the public supports training dental therapists as a way to do both. The truth is mid-level providers have helped improve the medical team’s ability provide care to the American public.

Experiences in Alaska, Minnesota and 54 other countries show dental therapists enhance the ability of the dental team to deliver care to underserved populations as documented in a recent GAO report.

On the ground, our state partners in five states – Kansas, Ohio, New Mexico, Vermont and Washington – are leading efforts to increase access to dental care by adding alternative providers to the team. Oregon passed a bill to establish an alternative provider pilot program, and Maine passed legislation to study the issue. Last year, Congress included language authorizing alternative dental provider pilot programs in the Affordable Care Act. There is growing momentum for this approach from the public and policymakers.

This study validates the thousands of personal stories our partners and other state advocates have collected from members of the community who go without care because they cannot afford it or there is no provider in their community.

Despite study after study, support from Congress for the establishment of the Alternative Dental Provider Program in the Affordable Care Act, the critical need for better access to care, and a model of successful deployment of dental therapists for over 90 years, organized dentistry remains opposed to the model and has no evidence to support its position. The ugly truth is that in the last year, organized dentistry, has vigorously opposed funding the alternative provider pilot program and has opposed dental therapists as a way to increase access to care.

There are too many tragic stories in policymakers’ own communities throughout the country for organized dentistry to ignore the fact that accessing dental care is a problem, and there is ample evidence that dental therapists can make a positive impact in addressing the unmet oral health needs in our country. Our job is clear – keep working to elevate awareness of how important oral health is to overall health and continue to demonstrate how dental therapists can benefit the millions of Americans who cannot get care or put it off.

— David Jordan, Director Dental Access Project

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Dental Therapists: A community solution to the oral health care crisis

Wednesday, November 17th, 2010

In one of the most memorable scenes in Cast Away, Tom Hanks, who is stranded on a deserted island and has a toothache, gruesomely removes his tooth with a figure skate because he can no longer live with the pain.

Even though they are not stranded on a deserted island, more than 80 million Americans suffer in pain because they cannot access regular dental care. While unserved and underserved Americans may not rely on a figure skate to deal with their untreated oral health pain, they are forced to take drastic measures due to dentist shortages and lack of affordable dental care.

Congressman Elijah Cummings (D-MD) regularly describes how his family dealt with untreated dental disease and pain — with a toothpick, turpentine, cotton balls and Orajel.  Congressman Cummings reminds us these tools are not uncommon, but rather the norm, in medicine cabinets throughout the country.

Fortunately, we can all agree figure skates, toothpicks, turpentine, cotton balls and Orajel are not the solution to our nation’s unmet oral health needs. We need to work together to extend dental care to the 49 million Americans who live in dental professional shortage areas and communities without enough dentists to serve them.

One promising solution to our severe dental professional shortage is to expand the reach of dental professionals into underserved communities by adding dental therapists to the dental team. Internationally, dental therapists have helped extend the reach of dental professionals into underserved and rural communities for more than 90 years.

Dental therapists are well established professionals who work as part of the dental team. Dental therapists receive two years of intensive training — more than 3,000 hours — to provide preventive oral health care and commonly needed services such as fillings and uncomplicated extractions. They work under the general supervision of an offsite dentist who preapproves the procedures they perform and reviews their work via phone, fax, and the Internet. In this way, dental therapists can provide more routine oral health care services while referring more complex services to their supervising dentists, thus extending the reach of the entire dental care team.

Community Catalyst, with generous support from the W.K. Kellogg Foundation, has partnered with advocacy organizations to launch campaigns in five states — Kansas, New Mexico, Ohio, Vermont, and Washington. The campaigns will build awareness of how dental therapists can meet unmet oral health needs and educate policymakers about how the addition of dental therapists can extend the reach of the dental team into underserved communities. Our partners will work at the state level to engage consumers, policymakers, dental professionals and stakeholders in discussions on improving oral health care delivery.

Historically, countries looking to increase access to care have looked to dental therapists. Most recently, Alaska Natives looked to dental therapists as a solution to dentist shortages and lack of affordable dental care. In fact, dental therapists have provided quality dental care to Alaska Natives since 2006. Recently, an independent evaluation conducted by RTI International found dental therapists in Alaska provide safe, competent and appropriate care. This study reaffirms multiple studies’ findings on dental therapists and over 90 years of experience that dental therapists provide quality, affordable dental care.

As we struggle to meet our nation’s unmet oral health needs and look for solutions to bolster our health care workforce, dental therapists offer a tangible and proven way to deliver affordable care.

Congressman Cummings also likes to remind his audience that “People don’t know what people don’t know.” The Dental Therapist Project enables us to inform consumers about how important their oral health is to their overall health. Our work will help consumers understand that quality affordable dental care is not a privilege but a right. After this Project, they’ll know their voice is the most important voice in shaping how their dental care is provided.

As we implement health reform, the Dental Therapist Project allows us to let policymakers know that too many Americans live without dental care because of a shortage of nearly 10,000 dentists. They’ll know how important alternative providers are to ensuring dental care can be available to their constituents who live in the 4,000 dental professional shortage areas. They’ll also see the facts overwhelmingly show dental therapists provide high quality, safe care and other workforce models that require non-dentists to practice under direct supervision of an on-site dentist cannot expand access to care to places that don’t have enough dentists. Only the dental therapist working under general supervision adds the opportunity for patients to get care in communities without a professional to treat them.

We will also work to let dentists know that millions of Americans face barriers to getting dental care. We will work with dentists so they understand that every day millions of Americans live without dental care because they can not afford it or because a dentist is not available in their community. We will help them understand that driving hours to see a dentist should not be acceptable. Most importantly, we will work with dentists to show that dental therapists, as part of a dentists led dental team, can extend the reach of the dental team into underserved communities.

Our work is clear, we need to help people know what they don’t know about oral health — that it is important and should not be out of reach for anyone in any community. We will work to expand care to every community by engaging the community in how to best to deliver quality, affordable care. For too long, many communities have faced both financial and geographic barriers to dental care. Their voices have not been heard in the oral health policy debate, almost as if they were on a deserted island. The Dental Therapist Project will add the community’s voice to the oral health policy discussion.

– David Jordan, Director, Dental Access Project

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Village lessons on the dental access crisis: Alaska’s program a potential model for the lower 48

Tuesday, October 26th, 2010

In late August, I found myself in a small conference room in a sub-regional clinic (SRC) in St. Mary’s, Alaska, a village of 549 Yup’ik residents, listening to Bernadette Charles describe how she is working to meet the village’s oral health needs. Not only was her passion for preventing disease and serving her community admirable, her presence in this small village offers policy professionals a promising approach on how to expand dental care to rural and underserved communities.

Oral health is essential to overall health, yet nearly 50 million Americans lack access to a dentist for routine oral health care. There are 4,000 federally designated dental professional shortage areas in the U.S. Nearly 9,700 new dental practitioners are needed to overcome our nation’s dental care shortage. Therefore many communities around the country struggle to attract and retain dental providers. However, St. Mary’s and other Alaska Native communities are leading the way in developing a robust workforce by training providers from their own communities – a potential model for communities across the country that are grappling with a shortage of dental care.

Charles, an Alaska Native who is St. Mary’s first full-time dental provider in almost a decade, is not a dentist but rather a dental therapist, an alternative provider who extends the reach of dentists by providing basic preventive and restorative care under the general supervision of dentists in locations where dentists are not located.

Dental therapists, first deployed in New Zealand in the 1920s, have a long history of providing dental care in community-based settings in 54 countries throughout the world. However, Charles is one of only thirteen dental therapists practicing in the United States.

Charles was trained as part of a program established by the Alaska Native Tribal Health Consortium (ANTHC) to address the longstanding challenges of maintaining an adequate dentist workforce in harsh, rural Alaska.

The impact Charles and her colleagues are making in reducing barriers to care in underserved Alaska is undeniable – dental therapists are now serving nearly 20,000 people in communities that previously did not have dental care providers.

While the success of the practice of dental therapy was evident during my recent trip and is well-established internationally, concerns about the quality of care have been repeatedly raised by those opposing this model. As their major argument against the dental therapist model, organized dentistry claims dental therapists provide lower-quality care, and have expressed safety concerns.

To address any questions regarding the quality of care provided by dental therapists and to document the model’s potential, RTI International of Research Triangle Park, NC conducted an independent evaluation of the Alaskan dental therapy program. W.K. Kellogg Foundation, the Rasmuson Foundation and the Bethel Community Services Foundation funded the evaluation.

The RTI evaluation released today found that dental therapists with two years of intensive training provide safe, competent, appropriate dental care. Other findings include:

– Dental therapists are technically competent to perform the procedures within their scope of work and are doing so safely and appropriately.

– They are consistently working under the general supervision of dentists (at remote locations).

– They are successfully treating cavities and helping to relieve pain for people who often had to wait months or travel hours to seek treatment.

– Patients were very satisfied with the care they received.

– They are well-accepted in tribal villages.

The study of the Alaska program adds to research of programs that have been in place for decades that shows preventive and basic dental repair services provided by dental therapists are safe, high quality, acceptable to the public, and cost-effective.

While the study provides evidence of the efficacy of dental therapists in Alaska, I saw firsthand the impact Bernadette Charles had on her village. She brought regular dental care to St. Mary’s as well as three other villages — Mountain Village (where she grew up), Pilot Station, and Pitka’s Point — all areas in remote Alaska that previously had no care. Before dental therapists like Charles were able to work with their supervising dentists to extend care to remote, rural communities, residents depended on an annual visit from a dentist and irregular itinerant care, or they had to round up residents to fly hundreds of miles to the nearest dental care facility.

Before dental therapists, dental care for Alaskan natives was inefficient and costly. The addition of dental therapists to the dental team meant professionals who received rigorous training in providing a specific set of preventive and basic services, including cleaning, filling and routine extractions could work in the community to prevent disease and treat patients to the highest level of their training. Dental therapists allowed dentists like Dr.Dezbaa Damon, who supervises Bernadette Charles, to maximize their training and treat only the highest need patients, thereby extending their reach and improving access to care for thousands of Alaska Natives.

In Alaska, the addition of dental therapists to the dental team has improved the state’s ability to deliver quality, coordinated, and cost-effective care. As we struggle to address dental workforce shortages and improve the delivery of care in the lower 48, we could learn a lot from Alaska.

– David Jordan, Director of the Dental Access Project

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Dental care for every community

Tuesday, December 8th, 2009

Last week, the New York Times reported on the dire need to improve health care on Native American Tribal Lands. Unfortunately, one of the major components of overall health and the health care system was overlooked as part of the article – oral health and access to dental care.

Today, Native American Indian children and adults are suffering disproportionally because of lack of access to dental care. Untreated dental decay is two to three times higher among Native Americans than in the general population.

For example, at the Pine Ridge Clinic in South Dakota, children ages three and four attending a Head Start program were recently given screening exams by a dentist near the village of Wounded Knee.  Of twenty kids who were screened, 18 of them were found to have severe dental problems that could only be treated in an operating room due to the extent of their dental problems. That means the children had severe decay deep into their teeth that was causing pain, multiple infections and made eating difficult. More than half of each of these children’s teeth were severely decayed because of lack of access to dental professionals and services.

The Indian Health Service dental clinic in Pine Ridge is understaffed, making it impossible to provide care to all the children on the reservation suffering from tooth decay.  In short, if children are able to get to the clinic, which is 17 miles away, dentists are so overwhelmed by the demand to provide more serious treatment that they are unable to provide preventive care or treat cavities or decay.

While a shortage of dental professionals is a major problem throughout the country, it is worse on tribal lands. The Indian Health Service (IHS) has a 34 percent vacancy rate for clinical dentists; in some areas, the vacancy rate is 50 percent. In fact, there is only one dentist per 4000 Indians, compared to one dentist per 1700 in the general population.

Fortunately, Alaska has found a solution to this critical need for dental professionals to serve Native American Indians and the general population, who lack access to quality, affordable dental care. There, the Alaska Native Tribal Health Consortium (ANTHC) has added a dental therapist to the dental team to increase access to care.

Dental therapists are home-grown health professionals who serve their own communities. They fill a critical role in the dental partnership by providing complementary services to those dental hygienists and supporting the work of dentists. For nearly 100 years, dental therapists have been providing cleanings, sealants, fillings, and simple extractions to underserved urban and rural populations in countries with advanced dental care systems similar to the U.S., such as Canada, England, and New Zealand.

Before the program was implemented, some residents had access to dentists who only visited once a year. With the support of philanthropic organizations, dental therapists were trained, first in New Zealand and now by the University of Washington’s Medical School, and have returned to provide critical care to Alaskan natives.  Now, 11 dental therapists are providing care in nine dental shortage areas to more than 7,000 previously underserved Alaska Natives.  By 2012, there will be 32 dental therapists living in and providing culturally competent, high, quality dental care in dental professional shortage areas.

The quality of care offered by the dental therapists is well documented. Research and evidence from other countries where dental therapists have been part of the dental team since the 1920s shows that the preventive and basic dental repair services provided by dental therapists are safe, high quality, acceptable to the public and cost-effective.

Despite the successful use of dental therapists as part of the dental team,  the American Dental Association is trying to prevent dental therapists from joining dental teams on tribal lands in the lower 49. Thursday afternoon, ADA President Ron Tankersley testified that Native American Indian people should not receive care from dental therapists.

With 83 million Americans lacking access to dental care, now more than ever, we need to look at ways to improve the system. Dental therapists can benefit everyone, including dentists because they can provide critically important basic treatments to patients and allow dentists to focus on more serious services and surgeries.  We need to work together to provide all residents with access to quality, affordable, dental care – the dental therapist model is a proven solution for bringing care to every community.

–David Jordan, Dental Access Project director

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Posted in dental care, Health disparities, national health reform | 2 Comments »