Expanding the Dental Team
Studies of two private practices
Expanding the Dental Team looks at two private dental practices that employ dental therapists to increase access to dental care for underserved populations. It is the first report examining early cost impacts of a dental therapist on a private practice in the United States and how this type of provider functions in that environment on a daily basis.
Watch as Dr. John Powers discusses how the dental therapist in his rural Minnesota practice is helping families "get turned around in terms of their oral health" here.
For decades, millions of Americans—many of them low-income—have been receiving inadequate oral health care. Under a delivery system described by the Institute of Medicine as riddled with barriers,1 millions of people live in areas with a shortage of dentists, and many dentists do not accept Medicaid.2 Difficulties in accessing dental care, especially for low-income individuals, have been well-documented. For instance, in 2009, more than 830,000 dental-related visits to emergency rooms across the United States could have been avoided with earlier care.3 In 2011, most children on Medicaid did not see a dentist.4
More than 50 countries have improved access to dental care by allowing providers other than dentists to offer routine preventive and restorative care, such as filling cavities. In comparison to dentists, these midlevel providers require less education, perform fewer procedures, and command lower salaries. Research has confirmed that they provide high-quality, cost-effective routine care and improve access to treatment in parts of the country where dentists are scarce.5 In the United States, dental therapists are already working in two states—Alaska and Minnesota—and an additional 15 states6 are considering allowing them to do the same.
Pew's analysis of the two practices with dental therapists found the following:
- Significant numbers of underserved patients were able to get care and the practices continued generating profits. Profit levels were influenced by such factors as the size of the patient population receiving government subsidies for care and the amount of the subsidies.
- The dentists were able to focus on more complex procedures that generate higher revenue. By using dental therapists to perform routine restorative procedures, dentists concentrated more of their efforts on advanced procedures such as crowns and bridges.
1Institute of Medicine and National Research Council, Improving Access to Oral Health Care for Vulnerable and Underserved Populations (Washington: National Academies Press, 2011), 1, http://www.nap.edu/openbook.php?record_id=13116.
2U.S. Department of Health and Human Services, Health Resources and Services Administration, “Find
Shortage Areas: HPSA by State & County,” data as of April 8, 2013, http://hpsafind.hrsa.gov/; and U.S. Government Accountability Office, Efforts Under Way to Improve Children's Access to Dental Services, but Sustained Attention Needed to Address Ongoing Concerns (Nov. 2010), accessed Dec. 10, 2012, http://www.gao.gov/new.items/d1196.pdf.
3Pew Children's Dental Campaign, A Costly Dental Destination (Feb. 2012), 1, accessed Jan. 28, 2014, http://www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/Reports/State_policy/Pew_Report_A_Costly_Dental_Destination.pdf.
4This figure counts children 1 to 18 years old eligible for the Early and Periodic Screening, Diagnostic and Treatment Benefit; See U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Annual EPSDT Participation Report, Form CMS-416 (National)Fiscal Year: 2011, accessed April 1, 2013, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html; Analysis by The Pew Charitable Trusts.
5David A. Nash et al., “Dental Therapists: A Global Perspective,” International Dental Journal 58 (2008): 61–70.
6This number is based on personal communications with state legislators and their staffs.