Dental therapists worldwide offer safe effective care to children

A new report on dental therapists says the midlevel practitioners offer safe and competent care worldwide, primarily to children in locations with rare access to dentists. But the document was quickly criticized by the American Dental Association, which said it appeared to support a predetermined conclusion.

The $125,000 report was released Tuesday by the W.K. Kellogg Foundation, which has spent millions on training and promotion of dental therapists. It details reviews of the practice and history of dental therapists in 54 countries.

Included in the review was the United States, where only Alaska and Minnesota have dental therapists performing limited work such as extracting teeth and filling cavities. More than a dozen other states are looking into the concept, according to the foundation.

Typically, dental therapists outside the U.S. train for two years after high school before they begin working, compared with dentists, who have four years of training after college graduation.

"Dental therapists provide quality, safe, efficient, effective and economical care for children," said the report's principal author, David Nash, a pediatric dentist and professor at the University of Kentucky who says he is a longtime member of the American Dental Association. "I think that best practices in other countries internationally can inform practices in America."

The ADA slammed the new report, saying it appears to be an "advocacy document intended to support a predetermined conclusion."

The Kellogg Foundation has devoted about $20 million for some efforts geared toward improving oral health for children by adding dental therapists to the workforce. Of that, about $5 million is for training in Alaska, foundation officials said. The foundation's support doesn't mean the 456-page report is biased, said Alice Warner-Mahlhorn, a foundation program officer.

"We didn't know exactly what the findings were going to be," she said. "But we felt that was something the field needed to know."

The ADA, which has long opposed the use of dental therapists, noted its own members have provided millions of dollars to developing a system of community health workers who provide education and preventative help in underserved areas and link people to "fully trained" dentists.

The ADA also said the report failed to assess the impact on the overall health status on people, but concluded only that dental therapists improve access to care and providing care within their level of practice.

"It has to go way beyond that," ADA president Bill Calnon said. "It has to take a look at the overall improvement in oral health, not just how well a filling is done or how many fillings worked, or how many extractions without complications."

The Alaska Native Tribal Health Tribal Health Consortium runs a dental therapist program in the state. The consortium was among entities unsuccessfully sued by the ADA and individual dentists when it began sending dental therapists in 2006 to remote Alaska Native villages far from the road system.