At Maplewood Community Dental Care outside Minneapolis, dental therapist Megan Meyer regularly fills cavities, extracts primary teeth and puts in crowns and spacers.
In most U.S. dental practices, these are the sole responsibility of a dentist. But that's not the case at a handful of clinics in Minnesota, where a new type of practitioner handles these and other basic preventive and restorative services under the supervision of a dentist on-site.
With a growing number of people on medical assistance or without insurance requiring dental care, "the need for dental therapists is huge," says Meyer, who is among the first nine graduates of the University of Minnesota School of Dentistry's dental therapy program in 2011. Its second graduating class of nine students got their degrees last month.
Though Minnesota is the only state to license dental therapists, others, including California, Kansas, Maine and New Hampshire, are considering such midlevel providers as a way to get more care to people in need. Dental therapists get a 2-year degree (vs. four years for dentists) and earn roughly half what a dentist does.
Meyer, 28, likens the role to a nurse practitioner or physician assistant: "Dentists can't see everyone who needs to be seen. I am able to free them up from some procedures, allowing them to concentrate on more higher-level, complex services."
The nation's unmet dental needs have been the focus of numerous reports recently, all of which note that untreated oral diseases can contribute to a risk for serious conditions, including diabetes and heart disease.
A Senate subcommittee report noted last year that 130 million Americans have no dental insurance; and 830,000 ER visits in 2009 were the result of preventable dental problems, up 16% from 2006. Though 5 million more children will have dental coverage in 2014 because of the Affordable Care Act, coverage alone does not guarantee access to care.
"Many Americans assume that if you have insurance from Medicaid, it means you can get dental care, but that's not true," says Shelly Gehshan, director of the Pew Center on the States Children's Dental Campaign. "Most dentists don't participate, and that means a lot of low-income children and adults struggle to find care."
Minnesota's move to license dental therapists in 2009 was based on the idea that "by educating a provider in a shorter time, at less cost to the health care system, you could have an individual who can provide a basic set of preventative and restorative services to underserved populations at a lower cost to the system," says Karl Self, director of the University of Minnesota School of Dentistry dental therapy program.
The state requires that practitioners graduate from an approved bachelor's or master's program that takes about 2 years to complete. Their employment is restricted to dental practices where 50% or more of patients are low-income.
Meyer worked as a dental assistant at Community Dental Care after college and says she entered the dental therapy program because "I saw the work they do and knew there was so much need." She works under a "collaborative management agreement" with three dentists who agree to provide assistance when needed. A dentist must diagnose patients and formulate a treatment plan before delegating work she carries out.
Metropolitan State University in St. Paul also offers a master's program for students who are already licensed dental hygienists. After acquiring 2,000 hours of clinical experience as a dental therapist (DT), graduates can be certified as an advanced dental therapist (ADT), allowing them to perform more basic procedures, such as extractions of adult teeth, when authorized by a supervising dentist, who does not have to be on the premises, says Ann Leja, interim dean of nursing and health sciences at Metropolitan State.
That lets the ADT provide services in nursing homes, homeless shelters, schools and emergency rooms at a fraction of the cost of a dentist, says Sarah Wovcha, executive director of Children's Dental Services in Minneapolis. The non-profit sees nearly 30,000 low-income children and pregnant women a year. It employs two dental therapists and plans to hire others, Wovcha says.
"Do the math. You get twice as many restorative procedures for the cost of a dentist," she says.
Emily Eggebrecht, a dentist with Children's Dental, says she was initially "a little skeptical" of the concept, but no longer. The team approach that's required "has been wonderful," and "it really increases the amount of patients that we can see and, therefore, access for patients who otherwise would not be seen."
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