MinnesotaMinnesota DentalDental TherapistTherapist JimJim NickmanNickman DDSDDS MinnesotaMinnesota’’ss RecentRecent ContributionsContributions MinnesotaMinnesota DentalDental TherapistTherapist
.. HistoryHistory ofof MNMN DentalDental TherapyTherapy LegislationLegislation .. FinalFinal LegislationLegislation .. CurrentCurrent ProgramsPrograms .. FutureFuture ImplementationImplementation IssuesIssues
MinnesotaMinnesota DentalDental TherapistTherapist BackgroundBackground andand LegislativeLegislative HistoryHistory
Sen Shelia Kiscaden
Safety Net Coalition
OHCPOHCP
There was successful passage of significant new funding for the (Maryland) Department of Health… after the death of Deamonte Driver in 2007, triggered a focused review of dental health services. $400,000 in operating revenue and $500,000 in capital revenue was appropriated …. Further, the legislation that expands the scope of practice for dental hygienists in certain settings was also enacted….Finally, $7 million was appropriated to increase dental reimbursement rates… MinnesotaMinnesota DentalDental TherapistTherapist
.. SpringSpring 20072007 .. SensingSensing thethe comingcoming storm,storm, thethe MDAMDA appliesapplies forfor andand receivesreceives helphelp fromfrom thethe ADAADA PublicPublic AffairsAffairs programprogram .. NewsNews lettersletters toto membersmembers detailingdetailing ADHPADHP proposalproposal .. MDAMDA coco--sponsorssponsors MinnesotaMinnesota AssociationAssociation ofof CommunityCommunity DentistryDentistry’’ss springspring meetingmeeting promotingpromoting ADAADA’’ss CDHCCDHC proposalproposal MinnesotaMinnesota DentalDental TherapistTherapist
.. SummerSummer 20072007 .. ADAADA PublicPublic AffairsAffairs programprogram conductsconducts focusfocus groupsgroups regardingregarding thethe ADHPADHP .. AlsoAlso examinedexamined whichwhich messagesmessages andand DentalDental AccessAccess proposalsproposals resonatedresonated withwith thethe publicpublic .. PresentedPresented toto thethe MDAMDA HouseHouse ofof DelegatesDelegates inin SeptemberSeptember 20072007 MinnesotaMinnesota DentalDental TherapistTherapist Sen Berglin Sen Marty Rep Thissen Sen Lynch
Recommendation 7.3: Develop a midlevel dental practitioner to work within a collaborative agreement with a licensed dentist.
A midlevel dental practitioner would be educated at the master’s degree‐level (over a two year course of study) to treat patients by providing diagnostic, preventive, therapeutic, and restorative dental services with a primary focus on the underserved. The midlevel dental practitioner would work under general supervision and under a collaborative agreement with a licensed dentist, similar to the arrangements that physicians assistants and advanced nurse practitioners have with physicians. SenSen AnnAnn LynchLynch
ADHPADHP RepRep CyCy ThaoThao MinnesotaMinnesota DentalDental TherapistTherapist
.. MinnesotaMinnesota DentalDental AssociationAssociation (MDA)(MDA) formsforms ““DentalDental AccessAccess CoalitionCoalition”” .. MembersMembers includeinclude ADA,ADA, AAPD,AAPD, MAPD,MAPD, AAEAAE amongamong othersothers .. EngagedEngaged aa locallocal PRPR firmfirm withwith connectionsconnections toto thethe DFLDFL majoritiesmajorities inin thethe LegislatureLegislature .. AdvisedAdvised onon ““grassgrass--rootsroots campaignscampaigns”” andand messagingmessaging .. FormsForms internalinternal ““OHPOHP tasktask forceforce””
DentalDental TherapistTherapist
DTDT MinnesotaMinnesota DentalDental TherapistTherapist
.. ADHPADHP proponentsproponents hadhad aa greatgreat gamegame planplan andand executedexecuted wellwell .. RelentlessRelentless LobbyingLobbying .. HearingsHearings withwith minimalminimal advanceadvance noticenotice .. LimitedLimited testimonytestimony .. ResponseResponse toto DDSDDS oppositionopposition ““turfturf battlebattle”” .. PressurePressure fromfrom dentaldental communitycommunity stallsstalls ADHPADHP progressprogress SenSen AnnAnn LynchLynch
OHP SenSen YvonneYvonne OHP PrettnerPrettner SolonSolon
DentalDental TherapistTherapist
DTDT Countries educating dental therapists Select countries utilizing dental therapists Australia Jordan Canada* Netherlands Great Britain* New Zealand* Hong Kong Singapore Ireland Switzerland
* Sites visited State of Minnesota Delegation
University of Minnesota (6) Minnesota State College and Universities (3) Central Administration Metropolitan State University Mankato State University Minnesota Dental Association (2) Minnesota Board of Dentistry (1)
Goals of site visits
Get “firsthand” knowledge of situation historical context is important published information often biased, inaccurate or dated programs rapidly changing
Query people at sites program directors and faculty dental professionals – community and academic students
Goals of site visits
Inspect education facilities size, quality, use of advanced technology teaching and learning styles employed outreach programs – number, location, duration of experience Judge impact of health care systems on programming student expenses – tuition, fees, books, etc. job opportunities
Site visits to recognized dental therapist programs
First Nations University Prince Albert, Saskatchewan, Canada 32 years in operation University of Otago, School of Dentistry Dunedin, New Zealand 70+ years in operation University of Sheffield, Faculty of Dentistry Sheffield, England 25+ years in operation
Lesson learned from Canada visit
Without a dental school-based program the profession did not embrace dental therapists. Lesson learned from visit to New Zealand
Educating dental therapy students with dental students creates a professional partnership. Lesson learned from visit to Great Britain
Having the dentist “on site” builds patient confidence and trust in dental therapists. Brickle Loen Scandrett Amundson Tarren Reisdorf O H P
W Rau G Shragg Benavides Schoenbaum Gjerde
Sheppard Flynn Perpich Blue Lloyd Carroll
1)1)EducationalEducational requirementsrequirements andand competenciescompetencies 2)2)TrainingTraining programprogram accreditationaccreditation 3) Scope of Practice 4) Level of Supervision 5)5) MedicationsMedications thatthat maymay bebe prescribed,prescribed, administered,administered, andand dispenseddispensed
6)6) ExtractionsExtractions thatthat maymay bebe performedperformed 8)8) AnAn assessmentassessment ofof thethe economiceconomic impactimpact
7)7) CriteriaCriteria forfor determiningdetermining practicepractice settingssettings 10)10) LicensingLicensing andand regulatoryregulatory requirementsrequirements
9)9) AnAn evaluationevaluation processprocess thatthat includesincludes clearlyclearly defineddefined outcomesoutcomes
MDAMDA CoreCore PrinciplesPrinciples
.. TrainingTraining mustmust occuroccur inin aa facilityfacility withwith thethe experienceexperience andand curriculumcurriculum toto traintrain safelysafely .. TheThe OHPOHP belongsbelongs inin aa dentaldental homehome asas aa membermember ofof thethe existingexisting dentaldental teamteam .. Examination,Examination, diagnosis,diagnosis, andand treatmenttreatment planningplanning remainremain withinwithin thethe solesole possessionpossession ofof aa licensedlicensed dentistdentist MDAMDA CoreCore PrinciplesPrinciples
.. IrreversibleIrreversible proceduresprocedures shouldshould bebe performedperformed underunder thethe indirectindirect (on(on--site)site) supervisionsupervision ofof aa MinnesotaMinnesota LicensedLicensed DDSDDS .. CollaborativeCollaborative agreementsagreements shouldshould bebe reservedreserved toto provideprovide basicbasic preventativepreventative servicesservices inin thethe absenceabsence ofof anan onsiteonsite dentistdentist MDAMDA CoreCore PrinciplesPrinciples
.. ToTo meetmeet thethe legislativelegislative intentintent ofof increasedincreased access,access, .. thethe DTDT oror OHPOHP mustmust notnot bebe limitedlimited byby practicepractice settingsetting .. MoreMore thanthan 50%50% ofof thethe DTDT’’ss oror OHPOHP’’ss patientpatient populationpopulation mustmust bebe fromfrom underservedunderserved populationspopulations Shoenbaum Shragg
Berglin Marty Thissen Lynch
DaysDays atat thethe CapitolCapitol Feb.Feb. 2525thth
Feb.Feb. 1111thth SenSen AnnAnn LynchLynch
OHPOHP RepRep CyCy ThaoThao Sen Yvonne Prettner Solon
DTDT RepRep KimKim NortonNorton SenateSenate HealthHealth HousingHousing andand FamilyFamily SecuritySecurity
SenSen JohnJohn MartyMarty SenSen DavidDavid HannHann
HouseHouse HealthHealth CareCare && HumanHuman ServicesServices PolicyPolicy && OversightOversight LicensingLicensing DivisionDivision (( OHPOHP 4/3)4/3) (DT(DT 5/2)5/2)
RepRep CyCy ThaoThao RepRep KimKim NortonNorton
ConferenceConference CommitteeCommittee
SenatorSenator MargaretMargaret RepRep TomTom
AndersonAnderson KelliherKelliher RukavinaRukavina MinnesotaMinnesota DentalDental TherapistTherapist FinalFinal LegislationLegislation MinnesotaMinnesota DentalDental TherapistTherapist LawLaw ..EstablishesEstablishes aa newnew typetype ofof licensed,licensed, midlevelmidlevel dentaldental provider,provider, calledcalled aa dentaldental therapist,therapist, whowho willwill provideprovide basicbasic oraloral healthhealth andand dentaldental servicesservices toto underservedunderserved patientspatients andand communities.communities. DTDT Scope/Scope/ SupervisionSupervision
.. UnderUnder IndirectIndirect (On(On Site)Site) SupervisionSupervision . Emergency palliative treatment of dental pain. . The placement and removal of space maintainers.
. Cavity preparation
. Restoration of primary and permanent teeth.
. Placement of temporary crowns.
. Preparation and placement of preformed crowns.
. Pulpotomies on primary teeth.
. Indirect and direct pulp capping of primary and permanent teeth.
. Stabilization of reimplanted teeth.
. Extractions of primary teeth.
. Suture removal.
. Brush biopsies.
. Repair of defective prosthetic appliances.
. Recementing of permanent crowns.
DTDT Scope/SupervisionScope/Supervision .. UnderUnder GeneralGeneral (Off(Off Site)Site) SupervisionSupervision . Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis . Preliminary charting of the oral cavity . Making radiographs
. Mechanical polishing
. Application of topical preventive or prophylactic agents, including fluoride varnishes and pit and fissure sealants. . Pulp vitality testing . Application of desensitizing medication or resin.
. Fabrication of athletic mouthguards.
. Placement of temporary restorations.
. Fabrication of soft occlusal guards.
. Tissue conditioning and soft reline.
. Atraumatic restorative therapy (ART).
. Dressing changes.
. Tooth reimplantation.
. Administration of local anesthetic; and nitrous oxide.
AdvancedAdvanced DentalDental TherapistTherapist ScopeScope .. AllAll servicesservices listedlisted forfor DentalDental TherapistTherapist .. PlusPlus ------
.. OralOral evaluationevaluation andand assessmentassessment ofof dentaldental diseasedisease andand thethe formulationformulation ofof anan individualizedindividualized treatmenttreatment planplan authorizedauthorized byby thethe collaboratingcollaborating dentistdentist .. NonsurgicalNonsurgical extractionsextractions ofof permanentpermanent teethteeth-- perioperio involved,involved, mobilitymobility ofof 33 oror 4,4, ifif authorizedauthorized byby DDSDDS
AllAll underunder GeneralGeneral SupervisionSupervision--i.ei.e..-- nono dentistdentist presentpresent AdvancedAdvanced DentalDental TherapistTherapist
.. InIn orderorder toto bebe CertifiedCertified byby thethe BoardBoard . Must complete a Dental therapy education program . Must pass an examination to demonstrate competency for the DT scope . Must be licensed as a Dental Therapist . Must complete 2000 hours of dental therapy clinical practice under direct or indirect supervision . Must graduate from a master’s advanced dental therapy program . Must pass a Board approved “certification” exam to demonstrate competency under the advanced scope of practice . Must submit an application for certification as prescribed by the Board
Settings/Settings/ PopulationsPopulations ServedServed
.. “A Dental Therapist … is limited to Primarily practicing in settings that serve low-income, uninsured, and underserved patients or in a dental health professional shortage area.” .. Medical facilities .. Assisted living facilities & nursing homes .. Federally qualified health centers .. Organization receiving Community clinic grants .. Military and veterans hospitals, clinics, and care settings .. A patient’s home .. Oral health educational institutions
Settings/PopulationsSettings/Populations ServedServed
.. AnyAny otherother clinicclinic oror practicepractice setting,setting, includingincluding mobilemobile dentaldental units,units, inin whichwhich atat leastleast 50%50% ofof thethe totaltotal patientpatient basebase consistsconsists of:of: .. Enrollees in a Minnesota health care program .. Patients with a medical disability or chronic condition that creates a significant barrier to receiving care .. Patients without dental coverage either public program or private insurance with an income less than 200% of federal poverty guidelines .. Dental health professional shortage area patients
CollaborativeCollaborative ManagementManagement AgreementAgreement (CMA)(CMA)
.. WrittenWritten agreementagreement withwith supervisingsupervising dentistdentist .. MustMust bebe MinnesotaMinnesota licensedlicensed andand practicingpracticing dentistdentist .. DentistDentist mustmust acceptaccept responsibilityresponsibility forfor allall servicesservices providedprovided byby DTDT .. MustMust bebe updated,updated, renewed,renewed, andand submittedsubmitted toto thethe BoardBoard ofof DentistryDentistry annually.annually. MinnesotaMinnesota DentalDental TherapistTherapist CurrentCurrent ProgramsPrograms DentalDental TherapistTherapist
DTDT UU ofof MNMN DTDT ProgramProgram
.. EnrollmentEnrollment .. 20112011 –– 88 MSMS andand 11 BSBS .. 20132013 –– 66 MSMS andand 44 BSBS .. LengthLength 2828 monthsmonths (+(+ 11 yearyear forfor BS)BS) .. CostCost approximatelyapproximately $65K$65K forfor BS/MSBS/MS .. TrainedTrained inin CODACODA accreditedaccredited dentaldental clinicsclinics .. TrainedTrained alongsidealongside DDSDDS andand DHDH studentsstudents
Bachelor in Dental Therapy: Curriculum Map
Yr1 Yr2 SYrS 3 S Y4
Liberal education requirements
Dental courses
Pre-clinical courses
Clinical courses – Moos Tower
Outreach experiences Master in Dental Therapy: Curriculum Map
Yr1 S Yr2 SYrS 3
Prerequisite courses
Dental courses
Pre-clinical courses
Clinical courses– Moos Tower
Outreach experiences Programs in Dental Therapy
Prerequisites or part of program Compositional Writing – 4 credits General Biology – 4 credits Principles of General Chemistry – 4 credits Human Physiology – 4 credits Biochemistry – 3 credits Statistics – 4 credits Psychology – 4 credits Intensive Writing – 4 credits Human Anatomy – 3 credits Microbiology – 3 credits
DT Program Curriculum
Fall 2009 Head and Neck Anatomy (DT, DH) DT Care Process: Clinical Application I (DT, DH) Oral Anatomy Lecture and Lab (DT, DDS) Introduction to Psychomotor Skills (DT, DDS) Liberal Ed courses or Prerequisite courses in:
Education
Public Health
Leadership
DT Program Curriculum
Spring 2010 Local Anesthesia and Pain Management (DT, DDS) Oral and Maxillofacial Radiology (DT, DDS, DH) Oral Histology and Embryology (DT, DDS, DH) Provider – Patient Relationship (DT, DH) Cariology and Applied Nutrition in Dental Therapy Care (DT, DH) Pathology for Allied Health Students (DT)
DT Program Curriculum
Summer 2010 Periodontology I (DT, DDS) Preclinical Pediatric Dentistry (DT, DDS, DH) Pharmacology (DT, DH) Oral and Maxillofacial Radiology Lab (DT, DDS, DH) Applied Biomaterials (DT, DDS) Operative I Lecture & Lab (DT, DDS) FIPCC – Foundations of Interprofessional Communication & Collaboration (DT, DDS, DH) DT Program Curriculum
Fall 2010 Preventive Pediatric Dentistry Clinic (DT) Oral and Maxillofacial Radiology II (DT, DDS, DH) Dental Public Health and Academic Service Learning I (DT, DH) DT Care Process: Clinical Application II (DT, DH) Ethics and Jurisprudence for the Dental Therapist (DT, DH) Operative Dentistry I, II & III (DT, DDS)
DT Program Curriculum
Spring 2011 Management and Supervision of a Dental Practice (DT, DDS, DH) Dental Public Health and Academic Service Learning II (DT, DH) Research Methods (DT, DH) Clinical Pediatric Dentistry (DT, DDS) Oral Radiology Clinic (DT, DDS, DH) Comprehensive Care Clinic (DT, DDS) Operative Clinic (DT,DDS)
DT Program Curriculum
Summer 2011 Team Building Course (DT, DDS, DH) Essentials of Clinical Care (DT,DDS) [Comprehensive Care Clinic, Operative, Radiology, Pediatric Clinics] Outreach Experiences (DT, DDS, DH) Fall 2011 Comprehensive Care Clinic (DT, DDS) Operative/Radiology/Pediatric Clinics (DT, DDS) Outreach Experiences (DT, DDS, DH) Graduation December 2011
OHCPOHCP MetropolitanMetropolitan StateState UniversityUniversity // NormandaleNormandale CommunityCommunity CollegeCollege .. CurriculumCurriculum designeddesigned basedbased onon thethe ADHPADHP modelmodel .. CareerCareer LadderLadder forfor practicingpracticing DHDH’’ss .. MadeMade thethe strategicstrategic decisiondecision toto traintrain forfor thethe AdvancedAdvanced DentalDental TherapistTherapist .. SequentialSequential versusversus ConcurrentConcurrent hourshours
MetropolitanMetropolitan StateState UniversityUniversity // NormandaleNormandale CommunityCommunity CollegeCollege .. EnrollmentEnrollment .. 20112011 –– 77 ADTADT studentsstudents .. 20132013 –– 66--77 ADTADT studentsstudents .. LengthLength ofof ProgramProgram .. 2626 MonthsMonths .. ProgramProgram CostCost .. ApproximatelyApproximately $30K$30K
MetropolitanMetropolitan StateState UniversityUniversity // NormandaleNormandale CommunityCommunity CollegeCollege .. AdmissionAdmission RequirementsRequirements .. LicensedLicensed DentalDental HygienistHygienist .. 1,0001,000 hourshours ofof clinicalclinical practicepractice asas DHDH .. CompletionCompletion ofof BSBS DHDH programprogram andand .. Collaborative and Advance DH practice .. Management of Oral Health Care Delivery .. Restorative Functions Theory and Lab
MetropolitanMetropolitan StateState UniversityUniversity // NormandaleNormandale CommunityCommunity CollegeCollege .. ClinicClinic SettingsSettings .. NormandaleNormandale CCCC DHDH ClinicClinic .. HennepinHennepin CountyCounty MedicalMedical CenterCenter .. FutureFuture northnorth MetroMetro locationlocation .. FacultyFaculty .. DentalDental trainingtraining managedmanaged byby locallocal dentistsdentists
MetropolitanMetropolitan StateState UniversityUniversity // NormandaleNormandale CommunityCommunity CollegeCollege MetropolitanMetropolitan StateState UniversityUniversity // NormandaleNormandale CommunityCommunity CollegeCollege MetropolitanMetropolitan StateState UniversityUniversity // NormandaleNormandale CommunityCommunity CollegeCollege MetropolitanMetropolitan StateState UniversityUniversity // NormandaleNormandale CommunityCommunity CollegeCollege .. OnlyOnly DentalDental HygieneHygiene andand DentalDental AssistingAssisting programsprograms areare accreditedaccredited byby CODACODA .. DentalDental TherapyTherapy programprogram monitoredmonitored byby MinnesotaMinnesota BoardBoard ofof DentistryDentistry MinnesotaMinnesota DentalDental TherapistTherapist FutureFuture ImplementationImplementation IssuesIssues FutureFuture IssuesIssues
.. AccreditationAccreditation .. CurrentlyCurrently reviewedreviewed byby thethe MinnesotaMinnesota BoardBoard ofof DentistryDentistry .. Provisional approval granted to both DT programs on August 13, 2010
.. WorkingWorking withwith thethe ADAADA CouncilCouncil onon DentalDental AccreditationAccreditation forfor reviewreview ofof dentaldental therapytherapy programsprograms FutureFuture IssuesIssues
.. AdvancedAdvanced DentalDental TherapistTherapist .. CurriculumCurriculum .. SequentialSequential versusversus ConcurrentConcurrent HoursHours
FutureFuture IssuesIssues
.. LicensureLicensure TestingTesting
FutureFuture IssuesIssues
.. EmploymentEmployment .. MetroMetro AreaArea likelylikely toto workwork forfor largelarge dentaldental groups,groups, communitycommunity clinicsclinics andand FQHCFQHC’’ss .. OutOut--StateState .. Some interest by private practitioners
.. SalariesSalaries .. LiabilityLiability .. EvaluationEvaluation processprocess ofof DTDT impactimpact
LessonsLessons LearnedLearned
.. StayStay involvedinvolved andand upup--toto--datedate onon pendingpending legislationlegislation thatthat maymay affectaffect thethe professionprofession .. ShareShare youryour effortsefforts toto helphelp thethe underservedunderserved withwith youryour legislatorslegislators andand thethe publicpublic ThankThank YouYou
.. SpecialSpecial acknowledgementacknowledgement forfor thethe useuse ofof theirtheir materialsmaterials .. Dr.Dr. ChrisChris CarrollCarroll .. DeanDean PatrickPatrick LloydLloyd