FAQs

What is a Dental Therapist? Dental therapists are midlevel oral health care professionals trained to provide preventative and basic restorative dental care, including some procedures that are beyond the scope of a dental hygienist. They are proven, cost-effective providers that can help dental practices run more efficient operations, boost revenue and meet more of the oral health needs of the underserved.

What Do Dental Therapists Do? Dental therapists deliver basic but critically necessary dental services, including filling cavities, placing temporary crowns, and extracting diseased baby teeth and very loose permanent teeth. Many consequences of dental disease – pain, missed school and work, unnecessary visits to the emergency department – are the result of untreated decay.[13] However, in Maryland, only are authorized by law to drill and fill decayed teeth.

Where Do Dental Therapists Practice? Dental therapists can practice in both private dental offices and public clinics. They can also bring care directly to populations who face travel or mobility challenges in locations such as schools, nursing homes, veterans facilities and rural or geographically remote settings. Are Dental Therapists Supervised by a ? In Maryland, dental therapists will operate under the general supervision of a licensed dentist. This means that a supervising dentist may authorize a dental therapist to provide specific services off-site to patients not previously examined as long as the dentist is available for consultation and supervision.

What are the National Standards for Dental Therapy Training Programs? Programs in Maryland will need to meet standards defined by the Commission on Dental Accreditation (CODA), the national accrediting body recognized by the U.S. Department of Education that sets training standards for dental hygiene and training programs. CODA’s standards call for a minimum of three academic years of training for dental therapy. In Maryland, dental therapists will also be required to complete a minimum of 500 hours of training under the direct supervision of a dentist before applying for state licensure.

Is it Safe to be Treated by a Dental Therapist? More than 1,000 studies show that dental therapists deliver care of the same quality as dentists for the procedures they are trained to perform.[14] An analysis conducted by the American Dental Association Council on Scientific Affairs stated the following, “A variety of studies indicate that appropriately trained midlevel providers are capable of providing high-quality services, including irreversible procedures such as restorative care and dental extractions.”[15]

How will Dental Therapy Impact a Dentist’s Practice? Dentists will determine how dental therapists will practice in Maryland. Dental therapists will always practice under the supervision of a dentist. Research shows that dental therapists can enhance dentists’ earnings and allow them to treat more underserved people.[16] In Minnesota, one private practice that employs a dental therapist made an additional $24,000 in profit and increased by 50 percent (more than 200) the number of Medicaid patients served in the therapist’s first year.[17]

Won’t Raising Reimbursement Rates Solve Dental Access Problems?

While worthwhile, raising reimbursement rates, like so many other initiatives, are not a silver bullet for solving dental access challenges. It does nothing for those living in dentist shortage areas or for those who find it hard to travel to an office for care. The unique upside of dental therapy is its ability to deliver cost-effective care at locations more convenient to patients – whether they are children in school or seniors in long-term care. ______

Footnotes [1] Deborah Levy, Maryland Public Health Dental Hygiene Act: Impact Stud y (Baltimore: Maryland Department of Health and Mental Hygiene Office of Oral Health, 2013).

[2] C. Betley et al., “Adult Dental Coverage in Maryland Medicaid,” The Hilltop Institute (2016), http://www.hilltopinstitute.org/publications/AdultDentalCoverageInMarylandMedicaid-Feb2016.pdf; Maryland Health Care Commission, “An Evaluation of Regional Health Delivery and Health Planning in Rural Areas,” (2014), http://mhcc.maryland.gov/mhcc/pages/plr/plr/documents/lgspt_Regional_Health_Evaluation_rpt_2014.pdf.

[3] Ibid. Footnotes

[4] U.S. Department of Health and Human Services, Oral Health in America: A Report of the Surgeon General (Rockville: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000), https://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/Documents/[email protected].

[5] The Centers for Disease Control and Prevention, “Dental Caries (),” accessed Jan, 23, 2017 at https://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html; R egina M. Benjamin, “Oral Health: The Silent Epidemic,” Public Health Reports, 123 (2010), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821841/pdf/phr125000158.pdf.

[6] This figure counts children ages 1 to 20 who were eligible for the Early and Periodic Screening, Diagnostic and Treatment Benefit for 90 continuous days and received any dental service. See U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Annual EPSDT Participation Report, Form CMS-416 (State) Fiscal Year: 2015, as of September 7, 2016, http://www.medicaid.gov/Medicaid-CHIP-Program- Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html.

[7] U.S. Department of Health and Human Services, Health Resources and Services Administration, Designated Shortage Areas (HPSA) Statistics, data as of December 13, 2016, http://datawarehouse.hrsa.gov/HGDWReports/RT_App.aspx?rpt=HH).

[8] Maryland Department of Legislative Services, “Analysis of the FY 2018 Maryland Executive Budget, M00F03 Prevention and Health Promotion Administration Department of Health and Mental Hygiene” (2017), http://mgaleg.maryland.gov/pubs/budgetfiscal/2018fy-budget-docs-operating- M00F03-DHMH-Prevention-&-Health-Promotion-Administration.pdf.

[9] Ibid.

[10] Maryland Department of Health and Mental Hygiene (DHMH), “Maryland’s 2015 Annual Oral Health Legislative Report,” (Oct. 30, 2015), http://phpa.dhmh.maryland.gov/oralhealth/Documents/2015LegislativeReport.pdf. There were 4,022 total active dentists in the state, and 1,385 dentists enrolled in the Maryland Healthy Smiles Program, including 182 out of state dentists. 34% (1,385/4,022) of Maryland dentists are enrolled in Healthy Smiles, however that ratio is including the out of state dentists in the numerator and just the total active dentists licensed in Maryland in the denominator.

[11] Minnesota Department of Health and Minnesota Board of Dentistry, “Early Impact of Dental Therapists in Minnesota: Report to the Minnesota Legislature 2014,” (February 2014), http://www.health.state.mn.us/divs/orhpc/workforce/dt/dtlegisrpt.pdf.

[12] The Pew Charitable Trusts. “Expanding the Dental Team: Studies of Two Private Practices,” (February 2014), http://www.pewtrusts.org/~/media/assets/2014/02/12/dental_therapist_case_studies.pdf; The Pew Charitable Trusts, “Expanding the Dental Team: Increasing Access to Care in Public Settings,” (June 2014), http://www.pewtrusts.org/~/media/assets/2014/06/27/expanding_dental_case_studies_report.pdf.

[13] Veerasathpurush Allareddy, Sankeerth Rampa, Min Kyeong Lee, Veerajalandhar Allareddy, and Romesh P. Nalliah, “Hospital-based emergency department visits involving dental conditions: Profile and predictors of poor outcomes and resource utilization,” Journal of the American Dental Association 145, no. 4 (2014): 331-337, doi:10.14219/jada.2014.7; Stephanie L. Jackson, et al., “Impact of Poor Oral Health on Children’s School Attendance and Performance,” American Journal of Public Health 101, (2011): 1900-06. doi: 10.2105/AJPH.2010.200915.

[14] David A. Nash, et al., “Dental therapists: a global perspective,” International Dental Journal 58 (2008): 61-70 https://www.researchgate.net/publication/5372424_Dental_therapists_A_global_perspective.

[15] Craig Palmer, “Do midlevel providers improve oral health?” ADA News, (Jan. 2, 2013), http://www.ada.org/en/publications/ada-news/2013- archive/january/do-midlevel-providers-improve-oral-health.

[16] Minnesota Department of Health and Minnesota Board of Dentistry, “Early Impact of Dental Therapists in Minnesota: Report to the Minnesota Legislature 2014,” (February 2014), http://www.health.state.mn.us/divs/orhpc/workforce/dt/dtlegisrpt.pdf; The Pew Charitable Trusts, “It Takes a Team: How New Dental Providers Can Benefit Patients and Practices,” (December 2010), http://www.pewtrusts.org/~/media/legacy/uploadedfiles/pcs_assets/2010/pewittakesateampdf.pdf.

[17] The Pew Charitable Trusts, “Expanding the Dental Team: Studies of Two Private Practices,” (February 2014) http://www.pewtrusts.org/~/media/legacy/uploadedfiles/pcs_assets/2014/expandingdentalteamreportpdf.pdf.