The forest for the trees

In a perfect world, oral health professionals would welcome new providers who could assist us in transforming the desolate oral health status of this country.

By JoAnn R. Gurenlian, RDH, PhD

Discussions about dental therapists seem to generate some excitement. Recent legislation has been introduced to allow this new midlevel provider to function in states where the oral health needs of many residents are either unserved or underserved. These oral health-care providers are working in health centers, helping to provide much needed oral care at an affordable rate.

The education of dental therapists has been reviewed recently by organizations such as the Commission on Dental Accreditation, American Academy of Public Health Dentistry, American Dental Hygienists' Association (ADHA), and even the Federal Trade Commission (FTC). While some advocate for dental therapists to be educated at the baccalaureate level, advanced dental therapists receive their education at the graduate level. The FTC criticized proposed accreditation standards for being limiting, due to the inclusion of unnecessary statements on supervision, evaluation, and treatment planning. The FTC noted that the proposed standards limit competitiveness and hamper efforts to expand access to dental services in areas where dentists are either scarce or unavailable.

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The discussions of dental therapists concern me. First, there are some who lobby strongly that these individuals are not needed. Others feel that it is imperative to control the education of therapists by limiting their scope of practice and keeping their education grounded at the baccalaureate level. Their negative influence is profound.

Currently, there are only a small number of dental therapists (approximately 28) in the United States. It must be hard for the dental therapists to be educated to provide a service that others are trying to limit and control. Sound familiar? Dental hygiene has experienced the same issues for most of the life of the profession. Maybe there is something we can do to help these midlevel providers avoid the pitfalls we face.

What can we do? Let's start by showing more than a passing glance at what is occurring. Since dental hygienists can become dental therapists too, our colleagues may be encountering the same frustrations we experience when we are not permitted to provide services we were educated to perform, when we are not adequately reimbursed for services rendered, and when another group imposes limits on our scope of practice.

In addition, we should be demanding that those who wish to control midlevel providers provide evidence that therapists are ineffective, incapable, and unsafe. Despite the information that exists to the contrary, these opponents back their claims with significant money to influence public legislators. It is time for those who lobby against midlevel oral health providers to be held accountable. The facts speak otherwise. The public and state legislators need a reality check, and that leads to another suggestion. It is time that the facts were made more readily available and discussed among those in need so they can demand the availability of the oral care they deserve.

Further, it is time to consider expanding the ADHA to embrace these dental therapists. It is hard for 28 individuals to create their own professional organization and have adequate representation. If the ADHA became the American Dental Hygienists and Therapists Association (ADHTA), there might be greater strength in numbers and influence.

Lastly, there is a reason dental therapists are being educated at the graduate level. Let's work toward achieving advanced education as the national standard for this midlevel provider. The additional knowledge and clinical expertise will serve the public well and help to limit the controlling efforts of those who can't see the forest for the trees in terms of alternative workforce models that meet the oral health needs of the public.

In a perfect world, oral health professionals would welcome new providers who could assist us in transforming the desolate oral health status of this country. In a perfect world, we would recognize that there is room for all of us as the need is so great. In a perfect world, less control by one group may translate to improved oral health outcomes. Let's strive for that!

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and president of the International Federation of Dental Hygienists.

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