OPINION: Dentists should welcome, not scorn, dental midlevels
Post Date: Oct 15 2015

By Allen Hindin, D.D.S. - Printed in the Grand Forks Herald
October 15, 2015
In dental school, I was taught that solo dental practice was the highest achievement a dentist could aspire to, and that all other aspects of dentistry were for those of us who could not make it in solo private. Autonomy was valued highly.
Then as a U.S. Army dentist, I learned that teams can accomplish far more than individuals. This was back when many dentists practiced without even one dental assistant and expanded functions were generally prohibited, "in the interests of protecting the public."
Quite a few states still do not allow expanded functions, despite overwhelming evidence of safety and good quality outcomes.
Dental therapists have delivered safe, appropriate and effective care for almost 95 years. They competently perform basic dental procedures, while costing about 10 percent of what it costs to produce a dental school graduate.
They do not make dentists irrelevant. Instead, they let dentists increase their potential by freeing the dentists from having to perform at the bottom of their competencies.
The past 10 years in Alaska and five in Minnesota have been uneventful for "red flag" events and positive as far as public acceptance and quality of care are concerned. Still, organized dentistry continues its longstanding claim that therapists are unnecessary and a threat to the public.
As far back as 1975, for example, dentists at Boston's Forsyth Institute were experimenting with using "added skills dental hygienists" to drill and fill teeth. While the experiment was successful, it was shut down by the Massachusetts Board of Dentistry, its chairman saying in The Boston Globe, "Dentists are not busy. We do not need this kind of research."
In 1979, I met Dr. Michael Lewis, director of Saskatchewan's Wascanna Institute, where he was training dental assistants and others to be "dental nurses" in two years. They served in public schools, where they provided free clinical dental care in a manner similar to the current practice in the Alaska Native Tribal Health Consortium.
And in 2008, I visited the elegantly simple dental health-aide therapist training program in Anchorage, Alaska, a collaborative effort between the Alaska consortium and the University of Washington.
I met a former airport line man who had become an enthusiastic and highly sought-after dental therapist after spending two years training in New Zealand.
No supporters of therapists have claimed that therapists are The Answer to the problem of access to dental care for poor and near poor. But they are an important part of improving access—especially therapists who require only two to three years of training, rather than having to be dental hygienists first.
And what is abundantly clear is that since the late 1800s, dentistry has been woefully unable to provide care for the poor and near poor of America. Volunteerism and other acts of charity, while well intended, are incapable of meeting the long-term needs.
The traditional private-practice, dentist-centric model of delivery works for those who have the education, money and mobility to use it. For the remainder—about 30 percent of Americans—there has to be another way.
Dental therapists will be an important part of reaching that population with desperately needed and affordable services.
There is a dentist in private practice in western Minnesota who has employed a dental therapist for some time. He loves working with her and has a healthier bottom line as well, while serving many Medicaid-insured patients.
I wonder if Dr. Brent Holman of the North Dakota Dental Association ever contacted him, before claiming with such certitude that the dental therapist "experiment" is a failure? And if they are failures, why have no employed therapists anywhere in Minnesota been let go?
My home state of Connecticut, by the way, was where Dr. Alfred Fones in 1906 trained his assistant to clean teeth, thus creating the world's first dental hygienist. Though hygienists initially were licensed in 1913, it was not until 1958—45 years later—that all states accepted them.
We in dentistry are slow to accept change.
But today, if evidence triumphs over emotion and open-minded dentists are given the chance to show what dental therapists can do, then organized dentistry will come to celebrate therapists the way my hospital medical staff recently celebrated the anniversaries of physician assistants and nurse midwives.
Dr. Hindin, a dentist in private practice, also serves as dental director for United Cerebral Palsy of the Hudson Valley in New York.

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