Healthcare in America has changed. Even before the passage of the affordable care act (ACA), the role of medical doctors in the assessment and treatment of patients has diminished. Nurses, techs, physician’s assistants, and other“providers” render much of the care performed at the hospital and in medical offices. In recent years, politicians have been pushing this model for dentistry as well. Never mind that most direct care for dental patients is both surgical and irreversible. What matters is that we need more access to dental care for the underserved, regardless of the potential consequences for the patient or the negative impact on the profession of dentistry.
The programs that have caused the most controversy in recent years are the dental health aide therapist (DHAT), the dental therapist (DT) and the advanced dental therapist (ADT) programs. These new “midlevel providers” practice primarily in Alaska and Minnesota, but their impact and reach could spread throughout the country in the near future.
The level of education required for the DHAT, DT and ADT is far less than the education and training a dentist receives, and is roughly comparable to a dental hygienist. The typical training of a dentist requires four years of college with a heavy concentration of basic science, passing an entrance exam, and then four years of dental school with challenging written and clinical board examinations. Many new dental graduates then do at least one year of residency. In recent years, admission to dental school has become extremely difficult. See also https://dentalcomfortzone.com/article-how-dental-school-works/
So what can these mid-level providers do? They are essentially able to do most of what a licensed dentist can do, including administering local anesthesia and nitrous oxide, fillings, removing part of the nerve of primary teeth, pulp capping, extracting primary teeth, and “simple” extractions. The problems that these mid-level providers can and will encounter when providing dental treatment to patients are too numerous to list here. When considering oral surgery, problems can occur with fractured roots, damage to the jaw, perforation of the sinus, and excessive bleeding, to name a few. What if there is a medical emergency? Will the mid-level provider know how to handle something as “simple” as a patient fainting or as complicated as chest pain or a heart attack? How will an allergic reaction or aspiration of a foreign body be handled? Even something as routine as administering local anesthesia or nitrous oxide can quickly become a dental emergency.
In my view, treatment provided by those with insufficient education and training is unethical and wrong. It is an irresponsible approach to treating the poor, underserved, or uninsured. Recently, I was asked to share my views on the subject with a prominent dental journal, Dental Abstracts. My commentary will be published in the September/October issue of this year.
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