Dental therapy is Michigan’s newest licensed profession, and its potential is recognized by a variety of stakeholders. In Michigan, organizations such as the Michigan Council for Maternal and Child Health, Michigan Primary Care Association, American Association of Retired Persons Michigan, Michigan Association of School Nurses, and many more have publicly endorsed dental therapy, according to MI Dental Access.
Nationally, more than 170 organizations have signed on in support, and that list continues to grow. Yet despite its popularity, dental therapy faced opposition from a number of dentists during its legislative push in Michigan.
Strong arguments and evidence supporting how the new profession could contribute to better access to care were acknowledged, and with the leadership of the bill’s sponsor, Senator Mike Shirkey (R), SB 541 was passed on December 27, 2018. Administrative rules have recently been promulgated, and Michigan can officially license dental therapists.
The Need for Dental Therapy
There is a reason dental therapy has gained so much support. It is widely recognized that the existing oral healthcare system creates greater barriers to care for some communities than for others, and the resulting disparities in oral health are vast.
Compared with their white counterparts, Hispanic and non-Hispanic Black children are less likely to receive dental sealants and have much higher cavity rates, and by adulthood these groups are more likely to experience tooth loss than white adults, as reported by Michigan State Oral Health Plan 2020.
Communities of color and those with low socioeconomic status also experience a significant shortage of providers. Dentists are unevenly distributed in favor of affluent areas, and dental provider recruitment and retention is an ongoing problem in underserved areas. This is where dental therapy can help.
Under the statute, dental therapists are permitted to work only in underserved areas, providing services to the communities that need them the most. Practice settings include, but are not limited to, safety net settings such as federally qualified health centers (FQHCs) and tribal health clinics; settings where at least half of the patient base is uninsured, on public insurance, or low income; and in federally designated dental Health Professional Shortage Areas (HPSAs). A dental HPSA is an area with a ratio of at least 5,000 patients to each dentist, and Michigan has 243 of them.
Even some affluent counties in Michigan have dental HPSA areas, highlighting the stark disparities that exist for communities of color and low socioeconomic status. By and large, dental HPSAs encompass rural areas and urban centers that lack sufficient numbers of oral healthcare providers.
Because dental therapists may practice without their supervising dentists being physically present, they can reach into the hearts of underserved communities, working in non-traditional settings and during times when patients can more conveniently access their services.
Hospitals, nursing homes, school-based health centers, correctional facilities, and mobile units are just a few practice settings where dental therapists can help bring care to patients, sidestepping barriers such as transportation, missing work or school, fear of the dental clinic, and lack of providers in the area.
The Scope of Practice
The scope of practice for a dental therapist includes both preventive and restorative procedures, making them versatile additions to the dental team. Although the list of allowable procedures is smaller than that of a dentist, the dental therapist’s training must be of the same quality and depth as that of the dental student for the services within his or her scope.
Also, dental therapy programs must meet the standards of the Commission on Dental Accreditation (CODA), the body that ensures appropriate education for all dental programs. Patient education and disease prevention are the foundation of a dental therapist’s practice, and treatment plans are decided upon in collaboration with the supervising dentist.
All treatment that is outside of the scope or comfort of the dental therapist is either referred to the supervising dentist or to a dental specialist. The scope of a dental therapist includes, but is not limited to:
- Comprehensive oral evaluations
- Dental cleanings for children and adults
- Preventive services such as fluoride and sealants
- Diagnostic services such as x-rays and pulp testing
- Composite and amalgam restorations on children and adults
- Stainless steel crowns on primary teeth
- Extractions of primary teeth and periodontally involved teeth with class III+ mobility
- Periodontal services such as sutures and changing dressings
Education and Training
The underlying spirit of dental therapy is providing access, not only to oral health services, but also to joining the oral health professions. Institutions considering dental therapy program development are encouraged to innovate and reduce barriers for aspiring students.
A community-focused education model would broaden the current restrictive pathway to dentistry into a more inclusive and attainable pathway for dental therapy students. Recruiting students from the communities in which they will practice would improve provider recruitment and retention, diversity within the dental profession, and cultural competence among dental providers.
Educating dental therapy students closer to home while utilizing community colleges, virtual didactic courses, and FQHCs as clinical education sites would open doors for those who are unable to attend one of the two dental schools in Southeast Michigan.
Unique community-based opportunities to complete the clinical hours required during education could also give graduates experience in underserved communities and prepare them to work within their practice settings upon licensure.
To become a dental therapist in Michigan, individuals are required to complete:
- Three academic years in a dental therapy program that meets CODA standards (degree level to be determined by the educational institution)
- 500 hours of clinical practice under the direct supervision of a dentist (to be completed during the three-year education period)
- A comprehensive, competency-based clinical exam
- Application for licensure
Dental therapy education programs have not yet emerged in Michigan, but there is great demand among potential students and employers. As colleges and universities begin to foster opportunities for aspiring dental therapists, we will witness the development of a new workforce of highly skilled oral health professionals. This is an exciting time to be part of a movement that has tremendous potential to positively impact our state.
Ms. Davis is an oral health program specialist with the Michigan Primary Care Association. She can be reached at mdavis@mpca.net or at (517) 827-0879.
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