Concern is rising about the shortage of health care workers in the U.S. As Senator Bernie Sanders told the media, “We don’t have enough doctors. We don’t have enough nurses. We don’t have enough psychologists or counselors for addiction. We don’t have enough pharmacists.”
He should have added, “We don’t have enough dental health workers.” Because study after study shows that oral health is integral to overall health. Research links poor oral health with heart disease, diabetes, pregnancy complications, pneumonia, etc.
However, dental health has long been treated as a luxury. For instance, some 76.5 million Americans have no dental insurance. Even those with insurance may not have access to oral health care, as evidenced by 70 million Americans who live in oral health professional deserts, with no nearby dental providers and services. In times of economic downturns, states often cut Medicaid dental health benefits for adults. But dental health is not a luxury: It is a basic health need, associated with positive health outcomes. And American oral health could easily be improved effectively and affordably: more dental therapists.
Dental therapists, similar to physician assistants in medicine, provide patients with preventive and routine care, like cavity fillings, tooth removal, and oral health education. There is variation in training for dental therapists due to different training requirements in states, but for certain areas of practice where the scope overlaps with dentists, dental therapists must demonstrate similar competencies as dentists.
First introduced in New Zealand about a century ago, dental therapists now practice in more than 50 countries. The Alaska Native Tribal Health Consortium introduced dental therapists to Alaska’s tribal communities in 2004 to address chronic dentist shortages. The results were so impressive that the program quickly expanded. Now, more than 40,000 Alaska Native people living in rural communities have much-needed access to dental care. As of March 2023, more than a dozen states had passed legislation allowing some form of dental therapy practice statewide or within Native communities.
One study noted that while dentistry’s workforce is overwhelmingly white and affluent, dental therapists often come from the underrepresented communities they serve, making dental therapy a compelling strategy for addressing structural racism. This tremendous potential for diversity creates the opportunity for dental therapists to offer culturally competent care. In addition, dental therapists expand access to care. For instance, in Alaska’s Yukon-Kuskokwim Delta, dental therapists were associated with providing more preventive care and fewer extractions. Reports by the Minnesota Board of Dentistry attest that dental therapists shorten wait times for patients and travel time for appointments. Research also shows that dental therapists have and continue to improve access to care. Dental therapists are a relatively cost-effective alternative, especially for providing care for low-income and Medicaid-enrolled patients.
Dental therapy offers a simple, affordable solution to a serious oral health crisis. However, in the early years after dental therapists were first introduced in the U.S., organized dentistry resisted this new type of provider. In more recent years, attitudes of dentists seem to be changing as dentists become more familiar of this emerging workforce model, and more dentists are making dental therapists a part of the care team. There are several reasons why more providers like including dental therapists in their care team. First, many dental therapists work primarily in rural settings and other areas with a shortage of dentists, supporting the desperate need for better oral health care access. Indeed, some states limit dental therapists to practice in underserved areas. Further, dental therapists can support dentists, not undermine them: one safety-net organization in Minnesota with dental therapists on their dental team, found that patients reported shorter wait times, allowed patients to have more of their oral health needs met in a single visit, and improved patients sense of having a regular dental provider. Dentists not only accepted the role of dental therapists, but in fact, found dental therapists provided high-quality work, allowing dentists to work more effectively.
Moreover, dental therapy offers an affordable, proven model to promote health equity, by providing greater access to oral health. Dental therapists have been able to collaborate closely with dentists and dental hygienists and have become integral parts of a system of care. In addition to the safety net, dental therapists can also work in private practices. One Minnesota study found that after dental therapists joined the practices, dentists performed fewer basic restorative and preventive procedures which freed them up to take on more complex dental procedures. Furthermore, there is substantial overlap in the tasks performed by dental therapists and dental hygienists, creating opportunities for movement between roles: from a dental hygienist to a dental therapist. Several states, including New York, Massachusetts, New Jersey, and Florida, have either adopted or are considering legislation to authorize or expand dental therapy. But we need much more.
Dental therapists are an emerging profession and research has shown, and continues to show, that they can positively impact access to care. Federal, state, and community stakeholders need to recognize dental therapists’ significant contribution to improving access to oral health care and increasing health equity. Statewide oral health coalitions should explore introducing dental therapists in their state to improve access to care. Policymakers need to introduce and pass legislation to allow dental therapists to operate wherever access to oral health services is limited. Adopting and expanding dental therapy is an evidence-based solution that can improve health equity while boosting our nation’s overall health—because oral health is an integral part of overall health.
Theekshana Fernando is a research scientist.