On November 17, 2010, the W.K. Kellogg Foundation Nov. 17 announced that it will invest more than $16 million by 2014 in its Dental Therapist Project, primarily focusing its efforts in Kansas, New Mexico, Ohio, Vermont and Washington. The project is based on the controversial Alaska Dental Health Aide Therapist which allows someone who has taken a two year course in New Zealand and 400 hours of education in the United States to perform unsupervised dental surgery on patients. The purported goal of the program is to address undeserved communities with “dental therapists” instead of dentists. This program is dangerously irresponsible and is likely to erode the quality of care for dentistry as a whole.
The Alaska Dental Health Aide program attempts to mitigate some of the potential problems associated with having a person with only two years of education providing dental surgery by having a “telehealth network”; where a dentist can remotely evaluate x-rays the dental therapist is seeing in real time. The problem is that x-rays can only tell you so much about the clinical situation a patient has, and what can seem like a simple or routine dental surgery can become complicated and risky very quickly. The other problem is with the lack of education and experience, The Alaska Dental Health Aide may not know enough to evaluate the patient properly and defer treatment that is beyond the scope of their limited training.
Consider this scenario when The Dental Health Aide has to extract a tooth: What if there is swelling around the tooth? Is it better to drain the infection first, then remove the tooth, or do both at the same time? Will the Dental Health Aide know that if an infection is not drained that the person can become gravely ill and even die from this complication, even if the tooth has been pulled? What happens when the simple tooth extraction becomes difficult, and the roots break off in the jaw? Not trained or permitted to do what is necessary to remove the root fragments surgically, will there be a general dentist or oral surgeon available to complete the procedure in a safe and timely manner? What will the Dental Health Aide do if they cannot stop the patient from bleeding, or the sinus is damaged during the procedure? These are just a few of the things a dentist must consider each time a tooth is extracted. In fact, some dentists do not even do extractions, opting to send these patients to an oral surgeon, who has three to four more years of training than the general dentist.
Most dentists are required to attend four years of college with a heavy concentration of science (including two semesters of Biology, General Chemistry, Organic Chemistry, Physics and Calculus), and four years of dental school before practicing dentistry. Many dentists then do at least one more year of dental residency before treating patients unsupervised. There is no way you can compare a person who has taken a two year program to a dentist who has had nine years. The Dental Health Aide model is seriously flawed and the Kellogg foundation's investment will end up harming the dental profession and the people they are trying to help.
Dr. Jerry Gordon can be reached at (215) 639-0571. Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket). To learn more: www.dentalcomfortzone.com, E-mail:DrGordon@dentalcomfortzone.com