WHERE ARE THE DENTAL THERAPISTS?
By Richard Davis
It was about 10 years ago when a group of Vermont health care activists started working on the creation of a new level of dental practitioner to fill in gaps in the provision of dental care. Bills passed the Vermont Senate in 2015 and the House in 2016 and S.20 was signed into law by Governor Peter Shumlin in June 2016.
An April 2016 story in VTDigger provides a description of what the bill does. “The profession would require more education than a dental hygienist but less education than a dentist.
A dental therapist would have a bachelor’s degree and be allowed to perform eight procedures more than a dental hygienist. The person would need to work under a contract with a supervising dentist, who has a doctorate. However, the dentist would not need to practice in the same building as the dental therapist.’
“The Vermont Technical College in Randolph has outlined sample curriculum for a four-year program to train dental therapists should S.20 become law. The person would learn the same three years’ worth of curriculum as a dental hygienist but spend an additional year in training.”
“Supporters of the bill to license dental therapists say S.20 creates jobs and makes it easier for Vermonters to get routine dental procedures. Opponents say the new profession would create a two-tiered system of dental care in which not all Vermonters can see a dentist.”
As we shepherded passage of the bill there was strong opposition from the Vermont Dental Society. They argued that dental therapists would lower the quality of dental care in Vermont. Supporters of the bill argued that access to care would increase and people would have a lower cost alternative to dental care. My sense was that the dentists felt threatened and that they did not want to give up their turf.
The battle followed a similar scenario when nurses first tried to create the role of nurse practitioner. Many medical societies fought hard against the move to create a mid-level practitioner. The first nurse practitioner training program was established in 1965. Nurse practitioners have not only established a solid reputation in the health care delivery system but they have also become an essential part of the system.
The hope was that dental therapists would become as essential as nurse practitioners. Dental therapists have been working in Alaska and Minnesota for a number of years and when we worked on the Vermont bill we used the worked done in those states to inform our actions here.
Thirteen states have dental therapy licensure but there are not many programs that train therapists. I spoke to an official in the admission’s department at Vermont Technical College and they told me that the school does have a dental therapist training program. I am still trying to find out how many therapists are being trained and where they are practicing.
Other than Minnesota and Alaska it does not appear from my research that there has been a lot of use of dental therapists across the country. According to the Vermont statute that licenses dental therapists they must work under the supervision of a licensed dentist and complete 1000 hours of direct patient care under that dentist.
The bill allows therapists to do a number of procedures that include extractions of primary teeth and many routine dental procedures. The hope has been that when these procedures are done by therapists they will cost less. In addition, adding more practitioners to the dental workforce would increase access. As things stand now in Vermont the waiting time to see a dentist is usually long and once a person sees a dentist the bill can be difficult to pay.
As more information emerges about the status of dental therapists in Vermont I will keep you posted.