The Minnesota Advanced Dental Therapis

They were going out in the field, they were finding they could provide their preventative care, but they were seeing decay. They’d go back six months later, the hygienist, and they’d say it got worse – the abscess is still there, the decay is still there. Wouldn’t it be great if we could fill that cycle, at least close it a little bit, provide the care they need, and then refer to a dentist for other treatment. With the need for oral health care growing faster than the supply of dentists and with medical costs rising, millions of Americans – particularly children, the elderly, and the working poor – are not getting the dental care they need. This care shortage impacts not only individual health and productivity, but the cost effectiveness of the health care system. A 2007 study done in five Twin Cities hospitals showed that in one year, more than 10,000 ER visits were made for oral health care problems, at a cost of more than $4.7 million. As there are rarely dentists in an ER, the usual solution is to give an antibiotic, possibly pain medication, and tell the patient to try to find a dentist the next day. There’s a shortage of dentists – and there’s especially a shortage of dentists that are providing health care to people that are uninsured and don’t have the resources or access. This particular gap is becoming larger and larger, and so that need and that ability to be able to provide care is where our advanced dental therapist comes in. Recognizing the pressing need for increased effective access to dental care for underserved populations, in 2008 the Minnesota Legislature authorized two new dental practitioner roles: the dental therapist and advanced dental therapist. This groundbreaking statute requires that these new practitioners must agree to practice in settings serving low-income, uninsured, and underserved patients, or in a dental health professional shortage area. Prevention is needed if we’re going to get a handle on the disease that’s out there – but that also comes with the fact that when you’re out there in the community, you see the patients with their restorative or filling needs. The advanced dental therapist role was designed to be able to address these needs in the community. They are prepared at the Masters level, can work under general supervision, and their scope of practice includes the procedures most often required in underserved communities. They work collaboratively with a dentist, but the dentist doesn’t physically need to be on site. So they can go to different locations, you know, maybe it’s a school where they’re going to see patients or maybe it’s a worksite for adults with disabilities. Metropolitan State University developed the Master of Science Oral Health Care Practitioner program for baccalaureate-prepared dental hygienists to advance their education and expand their scope of practice to include the restorative procedures most commonly seen in underserved settings. This dual licensure uniquely prepares the students to provide both preventative and restorative care such as placing crowns, repairing dentures, and filling tooth decay – always consulting with a dentist and with the option of referring back to the dentist for more complicated procedures. What I would like to see is that the advanced dental therapists become an integrated part of the dental team. In order to meet the educational needs of our students and provide care to the community, Metropolitan State is building an educational dental clinic that will provide preventative and restorative procedures to the community at a reduced cost. This clinic is going to be located in a very diverse neighborhood on the northeast side of the city and it will provide access to patients who are underserved, provide a clinic where people who need dental care can go, and it will be a learning environment for our students. I actually worked in Australia and New Zealand about ten years ago and became acquainted with the concept of a mid-level provider who would work with a dentist and provide care for underserved populations. The role of the dental therapist is not a new one. Over 50 other countries have dental therapy practitioners or an equivalent – some for over 80 years. Studies have shown that the care outcomes of dental therapists are comparable to outcomes of a dentist. Our students begin as licensed dental hygienists; however, after program completion, they will be dually licensed practitioners, prepared in both preventative and restorative care and able to meet the broadest possible range of need. A well trained, educated dental hygienist is able to incorporate additional procedures safely for the public and to deliver really high quality care. We need to take care of our entire population – regardless of whether they’re on medical assistance or not. My vision is that we’re going to see a real change in accesses being addressed, that we see disease going down, that we see prevention going up. The role of the advanced dental therapist will be to fill a gap in oral health care that’s going to contribute greatly to meeting the need for those that are underserved, meeting the need for those that don’t have access, and providing low-cost care.

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