CHICAGO — Today, the W.K. Kellogg Foundation released its report, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." True to its title, the report is presented in the context of a political movement, and not in the context of what is in the best interest of the American people and their oral health.
“Members of the public may not be aware of all the dangers to their long-term health that can result from being treated by lesser-educated health-care workers,” says AGD president Howard Gamble, DMD, FAGD. “Dental therapists are nondentists and can have as little as two years of post-high school education before going on to perform clinical dental procedures that may be irreversible, operating high-speed drills and pulling teeth, without the direct supervision of a dentist.”
“What the review fails to report,” said W. Carter Brown, DMD, FAGD, of the Academy of General Dentistry’s (AGD) Professional Relations Committee, “is any direct link between the introduction in the United States of dental therapists performing irreversible procedures without the direct supervision of dentists, and improved overall oral health outcomes.”
The W.K. Kellogg Foundation admits that its report “is not an evidence-based systematic review of the literature. Rather, it is intended to identify the literature and annotate relevant documents that assist in characterizing the use of dental therapists worldwide.” (Report, p.13)
In 2010, Dr. David Nash, an author of the W.K. Kellogg Foundation’s report, spoke out against the competency of dental therapists to provide care to underserved adults. “Adult dental care is complex in ways in which care for children is not,” claimed Dr. Nash. “In safety net settings, where many advocate that dental therapists practice, patients will likely present with mutilated dentitions and significant periodontal disease. Dental therapists should not be asked to address such complex conditions with their circumscribed training.” (Report, p. 50)
“It is appalling that a charitable organization would suggest that a provider who may be undereducated to provide care to adults be then relegated to provide care to our children,” states Dr. Gamble.
“Our current safety net in the United States has holes,” acknowledges Joseph Battaglia, DMD, FAGD, MS, AGD Dental Practice Council chair. “But the holes are not the quality of care provided by the current dental team. The holes are in the shortcomings in HHS's treatment of oral health and in the low rates of utilization of benefits, stemming from a lack of public understanding about the importance of oral health. The W.K. Kellogg Foundation seeks to stretch the safety net but leaves behind the holes."
“All of us have a shared responsibility to ensure that the public understands the importance of their oral health,” Dr. Battaglia adds. “We must focus at the state level, community by community, addressing providing proven, sustainable solutions to promote prevention and the accessing of available care.”
For years, the AGD has advocated for proven solutions that are safer for all populations. In its "White Paper on Increasing Access to and Utilization of Oral Health Care Services," the AGD called upon the states to “provide exams for 1-year-old children as part of the recommendations for new mothers to facilitate early screening,” and “provide oral health care, education, and preventive programs in schools,” among many other solutions.
If Kellogg and Pew would fund prevention programs in the schools, dentistry has plenty of people in their workforce to take care of this need. The safe and proven solutions are readily available and right at the fingertips of the dental profession; however, finances and support provided by foundations like Kellogg are necessary to implement them. Proven solutions include student loan repayment programs targeted at serving the underserved; utilization of recent graduates to provide care in underserved communities; simple improvements to Medicaid to enable greater Medicaid participation; and a stronger public health infrastructure that focuses on establishing “dental homes” under the supervision of licensed dentists.
“It is unethical and unfair for the underprivileged to be relegated to lesser educated professionals than the rest of the American population,” says Dr. Gamble. “When it comes to patient health, organizations should work together to create workable and proven solutions needed to improve the health of our fellow Americans.”
The Academy of General Dentistry (AGD) is a professional association of more than 37,000 general dentists dedicated to providing quality dental care and oral health education to the public. AGD members stay up-to-date in their profession through a commitment to continuing education. Founded in 1952, the AGD is the second largest dental association in the United States, and it is the only association that exclusively represents the needs and interests of general dentists. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management, and overall coordination of services related to patients’ oral health needs. For more information about the AGD, visit www.agd.org.
