The Solution

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These problems didn’t appear out of nowhere. In November 2014, the UND Center for Rural Health released a study that identified North Dakota’s oral health needs and the top five recommendations for increasing dental access across the state.
 
One of the most favored recommendations was to expand what dental hygienists can do so they can provide preventive and restorative services in community settings such as schools and nursing homes. Another was to replicate two nonprofit programs in Minnesota that deliver services in those community settings using dental therapists, who are similar to physician assistants in the medical field and can provide preventive and routine care such as filling cavities. 
 
Dental Therapists Help Dentists Extend Care To More People
 
Like many countries, Minnesota and Alaska now have dental therapists who are similar to physician assistants in the medical field and can provide preventive and routine treatment such as fillings.  Dental therapists work under the supervision of a dentist and help them extend routine care to people who currently don’t have access, such as the young, the poor and the elderly.
 
Dental therapists have been shown to help dentists see more patients, decrease travel and appointment wait times, increase productivity, increase patient satisfaction and lower “no-shows.” They are highly educated and trained professionals—and like dental hygienists, dentists must hire and supervise them and can restrict their procedures. Dental therapy would also be a way for hygienists to do more.
 
In North Dakota, dental therapists could work in various settings. Private practice dentists, especially in rural areas, could hire them to expand care to more people. They could also work in community health centers or mobile programs, serving kids in schools and seniors in nursing homes and assisted living centers. With a dental therapist providing more routine care, a dentist would have greater availability for more complex cases. 
 
Evidence Supports Dental Therapy

  • More than 1,100 studies show dental therapists provide high quality care.[i]
  • ​The Journal of the American Dental Association published a study in 2011 stating that dental therapists provided high quality care comparable to dentists for procedures both can do.[ii]
  • The Journal of the American Dental Association published a study in 2011 stating that dental therapists provided high quality care comparable to dentists for procedures both can do.x
  • Dental teams employing dental therapists reduce untreated tooth decay more than dentist-only teams.[iii]
  • Patients in MN said 76% of appointments were for preventive check-ups or routine treatment like fillings.[iv]
  • A rural private practice employing a dental therapist in MN increased Medicaid patients and profits despite a far lower reimbursement rate there.[v]
  • Support among MN dentists for dental therapists is growing, as “most or all have jobs lined up prior to graduation.” 95% are employed (about half in private practice) and the number graduating is increasing.[vi]
  • Experience in 50+ countries, AK and MN shows allowing dentists to hire them can extend care to more rural, low-income, and uninsured patients—including in schools and nursing homes.

 
In North Dakota

  • Dental therapists will work within a narrow scope of practice to allow dentists to extend needed routine and preventive care to underserved North Dakotans, as well as focus on more complicated needs and higher-revenue work.
  • ​There will be 94 procedures in a dental therapist’s scope of practice compared to nearly 400 for a general dentist.[vii]
  • A dentist will supervise each licensed dental therapist, affirm their abilities and set their scope of practice through a written management agreement.
  • To become licensed, dental therapists will need to go through the ND Board of Dental Examiners process similar to dentists and other dental providers.  
  • The national accrediting commission for schools educating dentists and other dental providers has approved standards for dental therapy.[viii]

   
Next Steps:

North Dakotans for Dental Access is working with stakeholders across the state to allow dentists to add dental therapists to the dental team in North Dakota.
 
Here is how you can help us improve dental access across the state:

​      1. Sign up for our e-newsletter to stay informed. 
      2. Email info@nddentalaccess.com if you’re interested in joining coalition.
      3. Contact your legislators to tell them you support allowing dentists to hire dental therapists.
      4. Write letters to the editor of your local newspaper to help spread the word. 


North Dakotans for Dental Access Coalition Members

  • AARP North Dakota
  • Alliance for Health Care Access (Grand Forks)
  • Community Action Partnership of ND
  • Family Voices of ND
  • Fargo-Moorhead Coalition for Homeless Persons
  • North Dakota Chapter of the American Academy of Pediatrics
  • North Dakota Dental Hygienists' Association
  • North Dakota Nurses Association
  • North Dakota Nurse Practitioners Association
  • North Dakota Protection and Advocacy Project
  • North Dakota Public Health Association
  • North Dakota Rural Health Association
  • North Dakota Women’s Network   
  • Northland Health Centers
  • Third Street Clinic
  • Americans for Prosperity
  • Americans for Tax Reform

  


[i] Nash D et al., “A Review of the Global Literature on Dental Therapists,” Community Dentistry and Oral Epidemiology (2013).

[ii] Bader JD et al. Clinical technical performance of dental therapists in AK. JADA 2011;142(3):322-326.

[iii] Wright JT et al. A systematic review of oral health outcomes produced by dental teams incorporating midlevel providers. JADA. 2013;144(1):75–91.

[iv] MN Department of Health and MN Board of Dentistry, “Early Impacts of Dental Therapists in MN” (February 2014).

[v] Expanding the Dental Team: Studies of Two Private Practices, Pew Charitable Trusts, 2014.

[vi] Presentation by Dr. Karl Self, Director, Division of Dental Therapy, University of MN, at the National Oral Health Conference, April 20, 2016; Email communication from Dr. Jayne Cernohous, Director of Dental Therapy, Metropolitan State University, to The Pew Charitable Trusts, December 7, 2016.

[vii] The Pew Charitable Trusts. Analysis using 2013 American Dental Association Codes on Dental Procedures and Nomenclature, ADA Commission on Dental Accreditation 2015 Accreditation Standards for Dental Therapy Programs, and ND Admin. Code 20-01 through 20-05 (via the ND Board of Dental Examiners) current as of April 1, 2015.

[viii] American Dental Association, Commission on Dental Accreditation. Accreditation Standards for Dental Therapy Education Programs. August 2015

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