The American Dental Association celebrated the conclusion of its pilot projects for community dental health coordinators (CDHC) by releasing a paper reaffirming its “involvement and commitment” to the dental personnel who promote oral health in underserved areas.
As the last of the students in training programs graduate this fall, the dental association said it would “focus on evaluating the effectiveness and viability of the CDHC model and on providing technical assistance to other public and private entities who are interested in creating CDHC programs.”
The ADA projects that 34 community dental health coordinators will be working in their communities later this fall.
Dr. Robert Faiella, the president of the American Dental Association, said, "The Community Dental Health Coordinator model is designed to address barriers to oral health that go beyond poverty. People in inner cities, remote rural areas and Native American lands also face obstacles posed by education, language, culture, geography, and other factors. Community Dental Health Coordinators come from these same communities. They understand the problems and are uniquely equipped to provide solutions."
The ADA paper, titled “Breaking Down Barriers to Oral Health for All Americans,” (available at www.ada.org) described the progress made with CDHC pilot training programs since first implemented in 2006.
Since some pilot projects have already certified CDHCs, the paper includes statistics of the financial sustainability provided by the new dental workers. In examples provided by the ADA, billable services typically doubled in dental offices or clinics when the CDHC screened for oral health problems within a community.
The ADA continues to not define CDHCs as a midlevel oral health providers. The paper stated, for example: “CDHCs are not midlevel providers; they are not intended to take the place of dentists but, rather, to educate, prevent dental disease, and connect patients to dentists who will provide treatment.”
However, the legal language regarding the “competencies” of CDHCs continues to be challenged in some states. The CDHC is trained on a variety of skills during his or her 18-month training program, including sealant applications, coronal polishing, scaling for periodontal Type 1 patients, visual inspection of the oral cavity for carious lesions and other hard tissue anomalies, taking radiographs, visual soft tissue inspections, and hand instrumentation to prepare and place temporary restorations such as glass ionomers.
Some recent events include:
- Legislation in Vermont that is considering a CDHC program defines the CDHC as a dental assistant, dental hygienist, or “other trained dental professional.” The ADA built its access to care model based on community health workers (CHW) in other disciplines and encouraged CHWs to consider adding CDHC certification.
- New Mexico approved allowing dental assistants and dental hygienists to become certified as CDHCs. However, the state said services provided by dental hygienists would be limited to dental hygienists.
- Oklahoma, which is the base for one of the first CDHC pilot projects, witnessed the tweaking of the language regarding the CDHC competencies. The state wanted to prohibit the “clinical training of unlicensed persons not enrolled as dental or dental hygiene students.” The state’s dental board said clinical services would be limited to those provided by dental assistants.
The ADA’s CDHC pilot project is one of several "new" dental personnel models introduced in recent years to address access to care issues in the United States. Dental therapists in Alaska and the American Dental Hygienists’ Association’s advanced dental hygiene practitioner are other examples of professionals trained to provide care in underserved areas.