Minnesota Dental Therapist Evidence to Date is Underwhelming

COMMENTARY by Director Paul S. Casamassimo, DDS, MS
October 2014
Earlier this year the Minnesota State Dental Board and the Minnesota Department of Health released a report entitled "Early Impacts of Dental Therapists in Minnesota." 
The legislation authorizing a new workforce model in the State of Minnesota required a five-year assessment of the effect of this workforce change. The initial report was issued in February, 2014 based on a study of the dental therapists working in Minnesota to date. The American Academy of Pediatric Dentistry (AAPD) is in agreement with the authors of the report that results "cannot be generalized and applied" because of the formative nature of the study, the very small number of therapists in practice at the time of the study, and numerous methodological problems with the study design. Any conclusions about the impact of therapists on access to care, clinical outcomes, and the effect of dental therapy on the overall oral health care system would be premature and not in the best interests of children’s oral health. The AAPD encourages further study, over a longer time period, with attention to rigorous study design, especially in assessing health outcomes and the economic impact of dental therapy.
The study population in this five-year retrospective study was 32 dental therapists licensed in Minnesota (six of whom also held certifications as advanced dental therapists) since the legislation authorized the two programs. In aggregate, the workforce contribution for this study was determined from approximately seven full-time equivalents. The report, done over a period of two years (2011-2013), indicated that therapists had seen 6338 patients. This would suggest that a therapist saw only about 4 patients per week on average. The significant methodological problems of this study preclude an accurate assessment of the meaning of these numbers. As such, readers should be cautious about making conclusions about the impact of therapy on access to care.  It should also be noted that, on average, a pediatric dentist cares for about 115 patients per week (including hygiene visits).  See:  http://www.aapd.org/assets/1/7/SurveyofDentalPracticeReport.pdf.
At this time, the AAPD maintains its position that evidence is lacking to show that dental therapy positively influences access to care. The AAPD remains committed to viewing objectively any emerging studies that might shed light on the issues related to dental therapy and its contribution to access to care and children’s oral health.  However, the AAPD also remains concerned that simply passing legislation relative to new workforce models does not equate to improved access to care and may result in complacency about addressing the complex factors affecting access. The economic and health literacy challenges contributing to inadequate utilization of care by children in some segments of society must be addressed to see real improvement. The AAPD will continue to work at the state and national level to seek safe, economically feasible, and effective solutions to lack of access to oral health care for children.  Our members, as the professionals who provide the most care for the children at highest risk for dental decay (over 70 percent provide care to publically insured children), will continue to provide a safety net for these children. The AAPD also believes that optimal care for children involves the establishment of a dental home by age 1 for every child.  See: http://www.aapd.org/media/Policies_Guidelines/P_WorkforceIssues.pdf.

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