For the last several years, legislators in several states have been pushing for the addition of a “new” dental practitioner called the dental therapist. The purported goal of the program is to increase dental care in poor and rural communities, especially for the treatment of children. The problem is that the dental therapist has a fraction of the education, training and experience as a licensed dentist and will put the health and welfare of their patients at risk.
A recent article in the Wall Street Journal (WSJ), You Don’t Need to be a Dentist to Fill a Cavity, by Eric Boehm, promotes the concept of dental therapists while ignoring the numerous pitfalls and ethical problems. The main issue with dental therapists is their lack of education. Boehm is apparently unaware of the level of education a dentist receives as he touts the 32 months of training a dental therapist receives, and even refers to them as “specialists.” Most general dentists are first required to complete four years (48 months) of college with a heavy concentration of math and science including calculus, biology, general chemistry, organic chemistry and physics. To get into dental school, the student must then pass a rigorous dental entrance exam called the DAT and have a very high grade point average, at least 3.5 on a 4-point scale. After college, dental school is an additional four years (48 months) and many dental graduates also complete one more year of residency. To be a dental specialist, the dentist must train for two to four more years. So to compare, the dental therapist has completed 32 months of training whereas a general dentist has completed 96 to 108 months and a dental specialist has completed 120-148 months of training. I should also note that the amount and difficulty of the training a dentist receives is far more extensive than that of a dental therapist.
In the WSJ article, Boehm also uses the Minnesota model for his arguments about the safety of having a dental therapist perform irreversible surgical procedures on patients. In Minnesota, dental therapists must work under the supervision of a licensed dentist, but this is not the case in other states. In Alaska, dental therapists can work without a licensed dentist on the premises. This practice is called “general supervision” and is also being proposed in other states as well, including Maine, Oregon, Vermont, New Mexico, and Kansas. Dentists who participate in these programs often do so under a collaborative agreement with the dental therapists where the dentist diagnoses the treatment provided by the dental therapist but are not on site during patient care.
There are many problems that can occur in the course of dental treatment. During the administration of local anesthesia, allergic reactions, fainting or cardiovascular problems can happen. When a cavity is prepared, the nerve can be damaged which would then require the tooth to have a root canal or be extracted, tooth decay could become so extensive that a crown would need to be prepared instead of a “filling.” If a tooth is extracted, excessive bleeding can occur, damage to the jaw, sinus, or other soft tissues of the mouth. These are just a few of the complications that can take place when dental treatment is delivered and would require the management of a licensed dentist or specialist, not a dental therapist.
Boehm and other proponents of the dental therapist model also point to dentists being worried that these practitioners will take patients away from them. On the other hand, they also try to make the case that when dental therapists are working within a dental practice, they could increase profits for the dentist. Even when the dentist is present, treatment by the dental therapist can go wrong and mistakes made cannot always be easily corrected. There would also be the temptation of some dentists to permit dental therapists to provide treatment beyond the scope of their limited training.
What’s missing is the obvious objection that many dentists have. It is simply unethical and dangerous to have insufficiently trained dental therapists treat patients. The fact that many of these patients are often poor or live in rural areas is a shameful excuse for this breach of the public trust.
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). E-mail: email@example.com