AD Main Menu

Our view: Dental therapists

The Kellog Foundation has found that in five villages studied, dental therapists are doing a competent job of sealing, filling and pulling teeth and easing pain for Bush Alaskans.

If that's the case, then the dental therapists are doing exactly what they've been trained to do, and Alaskans who live far from a dentist's office have better access to basic, skilled care without the expense of flying to village hubs or urban centers.

Some dentists and dental organizations -- including the Alaska Dental Society -- oppose the therapists doing any surgery, including tooth extraction. They warn of potential harm to a patient should a therapist encounter complications they're not trained to handle.

That's a risk in the program, but one that's been well-managed since the first dental therapists were deployed in 2006.

Dental therapists are not required to have college degrees. They undergo two years of training and at least three months of apprenticeship with a dentist. While they may practice on their own, they remain under the supervision of a licensed dentist.

Dentists have college degrees and must graduate from dental schools.

From the standpoint of public dental health, the issue is simple. Do dental therapists provide good, basic dental care in villages? Do patients get competent treatment? Are teeth properly filled? Pain eased?

Do the therapists heed the ancient medical maxim -- first do no harm? In other words, are they careful not to attempt treatment beyond their skills, to make sure they take a cautious approach, and when in doubt, defer to a dentist?

What the on-location study found is that they appear to be doing the job well.

The goal of the program has been expanded dental treatment in parts of Alaska often underserved, and at reasonable cost.

The idea isn't novel. In medical clinics, a physician's assistant or nurse sometimes provide basic care, leaving doctors free to attend more complicated or serious afflictions. The question is where to draw the line.

In the case of dental therapists, dentists' groups would prefer a line well back from surgeries. They recommend a program of dental health coordinators, who could perform cleanings, educate patients and screen patients to determine who had the most urgent need of a dentist.

The therapists' program is more ambitious. So far, it appears to be working, and that's encouraging. Therapists should carry on with care -- and dentists should continue to keep watch on their work.

BOTTOM LINE: Dental therapists' program gets a passing grade, but it hasn't been in practice long enough for a final verdict.