First analysis of dental therapists finds increase in access for children, low-income adults

(Press-News.org) Boston, MA, May 14, 2013—A new report assessing the economic viability of services provided by practicing midlevel dental providers in the U.S. shows that they are expanding preventive dental care to people who need it most: children and those who can't afford care. At the same time, they are providing that care at a reduced cost to the dental practice. The report, released today by Community Catalyst, determined that midlevel dental providers currently practicing in Alaska and Minnesota cost their employers 27 and 29 percent respectively of the revenue they generate.

The report is the first to analyze the economic viability of practicing midlevel dental providers in the U.S. It comes at a time when more than a dozen states are exploring using midlevel dental providers as a way to greatly expand access to dental care. According to the federal government, approximately 45 million people in the U.S. live in areas where there are not enough dentists to serve the population. Millions more can't afford dental care.

The economic study conducted for Community Catalyst by Frances M. Kim, DDS, DrPH, a general dentist and public health researcher, details the types of procedures that practicing dental therapists in the U.S. perform, the amount of money they generate in relation to the type of procedure and the population they are able to serve. According to the study, nearly 85 percent of the care they provide is routine and preventive. Filling cavities represented approximately one quarter of their work.

"For the first time we have a real picture of what it means to employ a midlevel dental provider," said Kim. "What we are seeing is that midlevel providers are providing mostly preventive care to the most economically-challenged patients and are still able to generate enough revenue to ensure that dental practices that employ them can care for the poor."

Midlevel dental providers, also known as dental therapists, are fairly new in the United States, practicing in Alaska and Minnesota. Eight states have put forward legislation seeking to authorize dental therapists. Several other states have called for studying the model further. Outside of the U.S. dental therapists have been practicing successfully in close to 50 other countries for the better part of a century.

Dental therapists work as part of a dental care team, helping expand the reach of a dentist -- in much the same way as nurse practitioners, physician assistants and other medical personnel have been able to expand what the medical team has to offer.

The report, Economic Viability of Dental Therapists, assessed dental therapists in practice between August 2011 and December 2012. Key findings include:

The majority of services dental therapists provided (32.8%) were preventive; sealants (44 %) and fluoride varnishes (43%) were the most common preventive services. Less than a quarter (23.7%) of the care dental therapists provided was restorative and extractions represented just a fraction of care (3.8%). Restorative procedures represent the majority of revenue (46.7%) dental therapists generate. Preventive procedures account for 20.5 percent of revenue despite the fact that they are the most commonly performed procedures. Dental therapists primarily treat children, low-income adults, Native Americans and those who would not otherwise have access to dental care. Seventy-eight percent of dental therapists' patients in Minnesota were publicly insured and the majority were under 21. In Alaska, 66 percent of patients served by dental therapists were under 21.

"This report underscores just how critical dental therapists could be to fighting what has become the number one chronic but preventable disease affecting children," said David Jordan, director of the Dental Access Project at Community Catalyst. "Children and families with Medicaid often struggle to find a dentist willing to treat them. In 2014, as many as 5.3 million more kids could be eligible for services, but they need providers to treat them."

Dental therapists have been practicing in Alaska since 2006 and in Minnesota since 2011. Children's Dental Services, a non-profit dental health organization in Minnesota, reports their dental therapists have provided care to more than 2,000 patients, of whom 84 percent were enrolled in Medicaid and 9 percent were uninsured. Practicing primarily in tribal health clinics in rural Alaska, dental therapists there provide care almost exclusively to those with public health insurance, reaching more than 40,000 Alaska Natives who would otherwise go without care.

Nearly 50 million Americans lack access to basic dental care and tooth decay is the most common childhood illness, affecting nearly 60 percent of children. Poor oral health can lead to serious health consequences later in life, including diabetes and heart problems. Children, minorities and the poor are disproportionately affected by the oral health care crisis.

Methodology The researcher examined data regarding productivity of Dental Therapists (DTs) and Dental Health Aide Therapists (DHATs) from 4 employers in Minnesota and Alaska. The study findings are based on data from August 2011 through December 2012 for 8 DHATS (8.0 FTEs) and 6 DTs (5.3 FTEs), two of whom are dually licensed dental hygienists/dental therapists.

### About Community Catalyst Community Catalyst is a national, non-profit consumer advocacy organization founded in 1997 with the belief that affordable quality health care should be accessible to everyone. We work in partnership with national, state and local organizations, policymakers, and philanthropic foundations to ensure consumer interests are represented wherever important decisions about health and the health system are made: in communities, courtrooms, statehouses and on Capitol Hill. For more information, visit http://www.communitycatalyst.org. Read our blog at http://blog.communitycatalyst.org. Follow us on Twitter @healthpolicyhub.