Non-Dental Provider Issues

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The AAPD has long focused its attention, resources and advocacy efforts on improving the oral health and access to quality dental services within the context of a Dental Home for those children who have the highest risk of developing dental decay. A major component of AAPD’s advocacy is focused on the development of oral health policies and evidence-based clinical practice guidelines that promote access to and the delivery of safe, comprehensive oral health care within a Dental Home. The Dental Home model is based on dentist-directed care, which means the dental team works under the direct supervision of a pediatric dentist to increase the dental office’s capacity to serve more children while preserving quality of care. 

 


Sample Legislative Testimony on the Minnesota Dental Therapy Model presented in Bismarck, North Dakota, 2016.

Dr. Anthony J. Hilleren, a solo practitioner in West Central Minnesota, presented clear and compelling Legislative Testimony on the Minnesota Dental Therapy Model to the state-level Health Services Committee in Bismarck, North Dakota, on September 21, 2016. Dr. Hilleren discussed his personal experiences in working with a dental therapist and presented a straightforward evaluation of the effect of dental therapy on increasing access to quality oral health care for the underserved populations in Minnesota.

Click here to read the full testimony


A Review of the Minnesota Dental Therapist Model, AGD Impact, May 2016

This article from the Academy of General Dentistry (AGD) discusses how the Minnesota dental therapist model has impacted access to dental care since its passage in the legislature in May 2009. The authors report no evidence that the emergence of dental therapists has resulted in cost savings to the state, more equitable distribution of dental health professionals, or improved access to care for low-income, uninsured, and underserved populations in Minnesota.

AGD Impact 5 2016 Midlevel Provider PDF

AGD Midlevel Legislation Map PDF 

Minnesota Midlevel Provider Map PDF


Some Care Versus No Care: An Ethical Analysis. Pediatric Dentistry, May/June 2014 

When examining solutions to mitigate dental disease and the crisis of access to care, a question is frequently raised: "Is some care better than no care?" The purpose of this article by Jessica De Bord, DDS, MSD, MA, was to examine whether the premise of some care being better than no care is ethically justifiable, and how the pediatric dental profession can balance the need for access and the need to provide appropriate, quality care.

Click here to read the full article.

 


Do Mid-Level Providers Improve the Population’s Oral Health? Journal of the American Dental Association, January 2013 

In this special commentary, Dr. J. Timothy Wright addresses the systematic review requested by the ADA’s House of Delegates to assess whether mid-level providers can provide dental services in a cost-effective manner, and whether their introduction into the dental workforce will improve oral health. Several important conclusions were drawn from the systematic review of mid-level providers. For example, the cost effectiveness of different workforce models has been analyzed hypothetically, but there are few actual data to support or refute cost differentials among different workforce models. In addition, comparison of outcomes in populations treated within the different workforce models suggested that dental therapists do not lower the population’s dental caries rates.

Read the article.

 


Dental Therapists in General Dental Practices: An Economic Evaluation. Journal of Dental Education, August 2012

This study evaluates the potential economic effects of employing dental therapists in general practices, such as whether substituting dental therapists for dentists in the U.S. dental care delivery system would lower the cost of delivering dental services and address access disparities to patients of all ages, including children. The economic analysis suggests that the potential impact of dental therapists in private general practices would be negligible. 

This article appears on the AAPD website with the permission of author Dr. Tryfon Beazoglou and the Journal of Dental Education.

Read the article.

 


Dental School Faculty Perceptions of and Attitudes toward the New Dental Therapy Model. Journal of Dental Education, April 2012

This study explores the attitudes and perceptions of dental school faculty members who have the responsibility to prepare new dental therapists to practice. The research found that dental faculty members participating in the study believe dentists have a personal responsibility in the care of the underserved, but do not agree that the dental therapists are part of the solution to improve access. There was a clear divide between part-time faculty and full-time educators with regard to the role of dental therapists. However, there was an overall consensus that dental faculty members have a commitment and obligation to educate future dental therapists regardless of their personal position.

This article appears on the AAPD website with the permission of author Dr. Naty Lopez and the Journal of Dental Education.  

Read the article.

 


A Two-Tier Standard: Do the Youngest Citizens of the United States of America Deserve a Two-Tier Standard of Dental Care? dentaltown.com, September 2011

In this Second Opinion article, Rhea M. Haugseth, D.M.D., presents a strong case that a two-tiered standard of care should not exist for our nation’s most vulnerable children. Services to this high-risk group should not be provided independently by non-dentists with less education and experience, especially when evidence-based research to support the safety, efficiency, effectiveness and sustainability of such delivery models is not available. 

Read the article.

 


An Economic Study of Expanded Duties of Dental Auxiliaries in Colorado. Dental Health Policy Analysis Series, American Dental Association, 2009

This study examined the relationship between delegation patterns and productivity, efficiency and practice income to identify the most effective patterns of delegation. The study found that delegation in general, as well as delegation of specific procedures/activities to dental hygienists and assistants, had an important effect on gross billings and patient visits. Similarly, delegating specific procedures/activities to dental hygienists and assistants had an important effect on the clinical efficiency of a general dental practice based on gross billings. One of the most powerful effects of delegation was in practice net income with an average difference of over $100,000.

Download the full report.

Download the report summary.

 


New Zealand Government Reports

New Zealand is often touted as an example of how alternative dental providers may impact access to dental services and, ultimately the oral health of children at higher risk of dental disease. The POHRPC has compiled reports published or commissioned by the government of New Zealand that summarize the findings of a national review of the system, detailed information about child oral health inequalities, factors that contribute to these inequalities and recommendations to alleviate these inequalities, and discuss challenges and costs of such a system.

DHBNZ National School Dental Service Review Final Report.

District Health Boards NZ - prepared under contract to the New Zealand Ministry of Health. December, 2004.

Peer-reviewed: No
Includes original research: Yes
Includes advocacy-related information: No

This review summarizes the findings of a required national review of school dental services facilitated by all District Health Boards. School dental services face a number of challenges which are outlined in the paper. Suggestions for reconfiguration and for overcoming current structural issues and inequalities are outlined and discussed. Research surveys and data analysis (carried out by DHBs during this review) to assist with the identification of inequalities within each DHB, included the deprivation status, decile, significant ethnicities, and decay rate of all clinics in the DHB.

Download the full article.

 

Improving Child Oral Health and Reducing Child Oral Health Inequalities
Report to the Minister of Health from the Public Health Advisory Committee
May 2003

Peer-reviewed: No
Includes original research: Yes
Includes advocacy-related information: No

This report was developed in response to a PHAC commissioned background paper on child oral health and inequalities in NZ from a team at the University of Otago. The paper provides detailed information about child oral health inequalities, factors that contribute to these inequalities and recommendations to alleviate these inequalities.

Download the full article.

 

Frequently Asked Questions: Oral Health in New Zealand

Peer-reviewed: No
Includes original research: No
Includes advocacy-related information: No

Contains information and charts related to the oral health status of New Zealand, what data is collected and how services are delivered (data from 2004). The document provides an overview of the current delivery system and costs as well as the changes that will take place in an attempt to improve the oral health status of New Zealand children by mid-2007. Information based on the report: Good Oral Health for All, for Life: The Strategic Vision for Oral Health in New Zealand.

Download the full article.