Public health association seeks to define the role of dental therapists

American Association of Public Health Dentistry establishes planning panel for dental therapist curriculum, hoping that two-year program fills gaps among underserved populations.

The American Association of Public Health Dentistry recently announced the creation of a panel comprised of Dental Deans and Dental Faculty to develop postsecondary curriculum and training for a mid-level dental provider model that is relatively new in the U.S. Known in other countries with advanced dental care systems similar to the U.S., dental therapists provide preventive and basic dental repair services, working under the general supervision of a dentist.

MPHD believes that new mid-level provider models added to the dental workforce can help meet the well-documented need for oral health care for underserved populations in the United States.

Within the next 12 months, the distinguished panel will establish goals for the model curriculum that could be adapted by university dental schools, community colleges or other institutions of higher learning in states licensing mid-level dental providers. Under the direction of Dr. Caswell Evans, Jr., the panel will begin work immediately. Dr. Evans also chairs the National Advisory Committee for the evaluation of Alaska's dental therapist
program.

The panel will establish general content and approach for: a two-year post secondary school curriculum; the educational setting for such training; and the type of curriculum advances required in the dental school program to prepare dentists to properly supervise and utilize the knowledge and skills of dental therapists. It will also develop a recommended career ladder for dental therapists and pathways for dental hygienists, dental assistants and community health aides to expand their training to add dental therapist duties; and will review program accreditation and licensure needs as they relate to current state practice acts.

According to Dr. Evans, "The dental therapist designation has been widely used in over 50 countries where various populations have limited access to health care. Notable among these is New Zealand, where dental therapists have been used extensively in a system of school-based care. Trained to provide a specified set of dental procedures such as simple extractions, basic restorative and preventive procedures, dental therapists have been successful over a period of years in lowering the rate of caries among school-age children in New Zealand."

In Alaska, dental therapists have been integrated into the Alaska Native Tribal Health Consortium to reach remote populations. The oral disease level is extremely high in Alaska where 68 percent of children between the ages of 2-5 years have untreated tooth decay in comparison to 19 percent of all children (1). Almost half of American Indian and Alaska Native children ages 6-14 have dental decay in primary and permanent teeth, compared to only
11 percent of all children.

The first dental therapists in Alaska were trained in New Zealand. Based on the success of the New Zealand training program, the W.K. Kellogg Foundation and three other foundations provided funding for the Alaska Native Tribal Health Consortium (ANTHC), in collaboration with the University of Washington, to train additional dental therapists in Alaska. Recently, the state of Minnesota passed legislation allowing dental therapists to be trained and practice in that state. Dental therapists are one of three mid-level dental
providers being trained and evaluated currently in the United States.

According to Dr. Evans, "AAPHD is bringing together a group of educators, including those with public health backgrounds, to develop a standardized model curriculum. Several states have indicated their interest in utilizing dental therapists as part of the delivery system."

Dr. Evans continues, "Given the backload of untreated disease in underserved communities and the access to care problem for their residents, it appears that dental therapists appropriately trained might be employed and provide services in public sector facilities and programs such as Federally Qualified Health Centers and other forms of 'community health center' facilities, state and local health departments, and other service systems that focus on providing access to care for underserved populations."

"We emphasize," continued Dr. Evans, "that dental therapists would be expected to provide care under general supervision and would be trained accordingly." The panel plans to create a curriculum utilizing the successes in other countries and Alaska. Another goal of the training is to incorporate a cultural awareness component into the curriculum.

The project is being funded by the W.K. Kellogg Foundation and the Josiah Macy, Jr. Foundation. The W.K. Kellogg Foundation, established in 1930, supports children, families and communities as they strengthen and create conditions that propel vulnerable children to achieve success as individuals and as contributors to the larger community and society. Grants are concentrated in the United States, southern Africa, Latin America and the
Caribbean.

The Josiah Macy, Jr. Foundation is a privately endowed philanthropy located in the borough of Manhattan, New York City. The Foundation supports programs designed to improve the education of health professionals in the interest of the health of the public.

AAPHD is the nation's largest organization dedicated to the vision of optimal oral health for all. Its members are dentists, dental hygienists, and other individuals committed to improving the oral health of the public. Founded in 1937, the AAPHD provides a focus for meeting the challenge to improve oral health. Public health dentistry is one of the nine Dental Specialties recognized by the American Dental Association.

1 An Oral Health Survey of American Indian and Alaska Native Dental Patients, Regional Differences and National Comparisons, published by the U. S. Department of Health and Human Services, Indian Health Service, Division of Dental Services, 1999.

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