What mid-level dental providers do and why you should know about it

In America, dental health is perceived as junior to overall health and not given the attention and urgency it deserves. Research studies support that overall general health and well-being are directly correlated with the oral cavity and oral health. Research has also concluded that the divide in oral health between low-income communities and higher-income communities continues to grow and is consistently worse for lower income communities.

Steven Comas

In America, dental health is perceived as junior to overall health and not given the attention and urgency it deserves. Research studies support that overall general health and well-being are directly correlated with the oral cavity and oral health. Research has also concluded that the divide in oral health between low-income communities and higher-income communities continues to grow and is consistently worse for lower income communities. Dental care has largely been perceived as a luxury and dental insurance from employers is highly coveted amongst many potential employees. How often have we heard friends and others ask when considering an employment opportunity, “Do they offer dental?”

So this crisis in oral health implores stakeholders to ask what can be done to reach underserved populations. Health Insurance companies have expanded dental coverage to some extent, but many restrictions are placed on the coverage and often times 100% of the cost of treatment is not covered. Another barrier is the reality that many dentists do not accept Medicaid (usually the primary type of insurance in these lower income communities) as a source of payment for their services. There is also a shortage of dentists in these lower income communities. Despite these obstacles, creative new ways of administering dental care to these underserved populations are emerging.

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There are two main strategies that have received the most attention and are currently being developed or have been implemented in some states: one is placing existing providers, such as dental hygienists in community settings like nursing homes, senior centers, and public schools in a collaborative or tele-health type of set up. In this type of arrangement, the dental hygienist offers oral screenings, while preventive care and referrals are made to the dentist, who is off site, when advanced procedures are needed.

Another tactic currently being utilized effectively and successfully in more than 50 nations as well as in three states in the U.S. is the midlevel dental provider. These midlevel providers are often called dental therapists, though different areas may have slightly different titles for them. The dental therapists not only provide the quality specialized preventive dental care they have been rigorously trained for, but are also trained to perform restorative care such as placing fillings and minor extractions. It has been found that dental therapists perform fewer procedures and require less training while commanding a lower salary than dentists. Research has confirmed dental therapists also provide high quality care that is very cost effective, and the availability of having dental therapists work in the underserved communities remedies the scarcity of dentists, as well as dentist’s refusal to accept Medicaid. These findings are very promising to delivering care to underserved populations. Minnesota and Maine currently have practicing dental therapists and legislation has been recently passed to authorize a midlevel dental provider in Maine. Fifteen additional states are considering licensing for midlevel dental providers.

The Pew Charitable Trusts is a global research and public policy organization dedicated to serving the public. It is independent, nonprofit, and nongovernmental. They researched and examined the issue of dental care in underserved communities in a reportthat was released in June 2014. What they were primarily researching was whether this issue could be effectively and cost efficiently addressed by using a midlevel type of provider in various settings. They addressed how the midlevel provider is integrated into practice settings, how they expand care to previously underserved populations, what the economic value is of a midlevel provider, and if employing them make fiscal sense. They conducted this study with a federally qualified health center, a clinic with multiple sites, and a telehealth project.

Underserved populations clearly displayed an increased access to care and non-profit practices were shown to be able to utilize existing finances to serve more of the population by using midlevel providers. Some examples of the results include how two dental therapists provided care for 1,352 patients over the course of one year, many of whom were seen for the first time ever for dental care. In another case, one dental therapist was able to care for 1,756 patients, all at reduced costs versus conventional methods of care, and all while increasing access to care. In addition, many patients who had never been able to receive any type of dental care received care for the first time in these settings by these midlevel providers.

Every member of the dental team has a role to fill. Clearly, an approach that addresses every need is what is best for the patient. While dentists are a critical component to dental health, dental hygienists play just as an important role if not a more impactful one in these types of situations. The rigorous, intensive, hands-on training that dental hygienists receive equips us to best handle preventive care as well as some restorative care. We are best equipped to be able to provide greater access to care with our knowledge on prevention and maintaining oral health. The role of the dental hygienist as originally envisioned at its core was for exactly these type of scenarios. We can most effectively provide the care necessary to make a change in this nation’s oral and general health.

If you are interested in finding out more about mid level providers, visit the ADHA website, using your SADHA credentials.

Steven Comas graduated with an AAS in Dental Hygiene from Hostos Community College in 2014. He recently became licensed in New York to practice dental hygiene. Inspired by what he has learned and cognizant of the needs surrounding the dental hygiene profession, he has decided to continue his education and pursue a bachelor’s degree. He lives in New York City with his wife and daughter.

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