Dental therapist

A dental therapist receives specialized training in treating children's teeth and oral hygiene. Local dental regulations determine the duties therapists are able to perform. Typically, therapists under the prescription of a dentist are licensed to examine children's teeth, administer restricted techniques of local anesthesia, take radiographs, provide sealants, scaling and cleaning in children. Also restoring primary teeth and vital pulp treatments such as pulpotomies.

Local dental regulations are constantly changing to include extended duties and exemptions for dental therapists.

By country or state

In the UK a dental therapist working from a prescribed treatment plan can treat children and adults, with direct restorations, periodontal and oral hygiene treatment and extraction of deciduous teeth. They can also place pre-formed stainless steel crowns on deciduous teeth. They can apply medicaments listed by the General Dental Council and administer local anaesthetic by infiltration, intrapapillary, intraligamentary and inferior block techniques. Dental therapists can work independently and outwith the supervision of a dentist. Training is usually by dual diploma in dental hygiene and dental therapy but a few dental schools offer full degree training in combined hygiene/therapy. Therapists trained in the UK can work in the NHS and privately or work in the hospital and community service.

In the United States certain states (Alaska and Minnesota) allow dental therapists to practice basic dental procedures under the supervision of a dentist. Also the dental therapists allowed to practice in Alaska are very different then that in Minnesota. Alaskan dental therapists are taught in Washington state and Bethel Alaska. They can only practice on tribal rural areas. An October 2010 evaluation of the Alaska dental therapists found that they provide safe, effective and competent care.

In Canada dental therapists may practice basic dental surgical procedures only in certain communities and only under the supervision of a dentist.

In Australia and New Zealand, therapists mainly work for state government (public clinics) and school dental programs, treating children's teeth but are increasingly becoming employed in the private sector. In Australia, the scope of practice varied in each state and was set by a statewide board. However, all state boards have joined a nationwide Dental Board of Australia. Due to this, the new scope of practice for therapists in Australia has been set so that a therapist may practice any procedure in which they have been formally trained in and are competent in.

In Sri Lanka a dental therapy program was developed by New Zealand trained dental therapists as a result of the Colombo Plan. Dental therapists are allowed to work in school based clinics and maintain the dental hygiene in young Sri Lankans.

ALASKA DENTAL HEALTH AIDE THERAPIST HISTORY: The May 2000 US Surgeon General’s report, Oral Health In America: A Report of the Surgeon General 1 raised awareness regarding lack of access to dental care for many Americans including American Indian/Alaskan Native children. In response, meetings were held by dental health policy makers at Boca Raton, Florida, and The Forsyth Institute in Boston, Massachusetts to discuss the potential of introducing a New Zealand –style “school dental nurse/therapist” practitioner into the US dental workforce to address oral health disparities. At the same time the Alaska Native Tribal Health Consortium (ANTHC), a network of tribes linked by common health care goals and objectives, was conceptualizing a pediatric oral health therapist to address the unmet needs of Alaska’s tribal children. More than 85,000 Alaska Native people live in rural Alaska with no road access. Among the 269 Indian Health Service (IHS) and tribal dental clinics, vacancy rates for dentists average 25 percent, with an average 30 percent turnover rate. At that time Alaska Native 2-5 year-olds suffered five times the U.S. average for tooth decay, and 6-14 year-olds 2.5 times the national average.2 Development of this new dental professional was to fall under the provisions of the federally authorized Alaska Community Health Aide Program, in existence for more than 30 years. Because training was unavailable in the U.S. for a dental health aide to provide primary care under general supervision, the School of Dentistry at the University of Otago, New Zealand, agreed to enroll six Alaska Native students per year into their dental therapist training program. Funded by the Rasmuson Foundation, three groups of six students were sent to New Zealand between 2003-2005. As of August 2010 ten graduates from that program are practicing in tribal clinics throughout Alaska. As the first New Zealand trained Alaskan Dental Health Aide Therapists (DHAT) were beginning their practice in 2006 the American Dental Association and Alaska Dental Society brought suit against ANTHC and the certified DHATs for working in violation of the Alaska Dental Practices Act (ADPA). At issue was federal preemption over ADPA. In June 2007, a Superior Court judge for the State of Alaska ruled that DHATs are indeed exempt from mandatory compliance with the ADPA thereby enabling certified DHATs to provide dental treatment to Alaska Natives, including preventive and restorative care.3 To reduce education costs, lower attrition rates, and provide a curriculum more closely addressing the community needs in rural Alaska, ANTHC entered into partnership with MEDEX Northwest in the University of Washington’s Medical School to train DHATs locally. With major funding from the W.K. Kellogg Foundation, the program began in January 2007. By the end of 2010, four classes were admitted into the two-year program. Six to eight students enter yearly with guaranteed employment by Tribal Health Organizations throughout the State upon graduation.

TRAINING AND SCOPE OF PRACTICE: The Alaska DHAT training program is a two-year educational program composed of a pre-clinical year at the DENTEX Training Clinic in Anchorage and a clinical year at the Yuut Elitnauviat Dental Training Clinic in Bethel. Enrollment requirement is a high school diploma or equivalent and satisfactory completion of a six-week online anatomy and physiology course. Two resident full-time United States Public Health Service dentists oversee delivery of a competency-based curriculum. Curriculum development and support, and instructor development is provided by faculty and staff of the DENTEX training program, a division of MEDEX Northwest, the physician assistant training program of the University of Washington School of Medicine. The core faculty is augmented with modular lectures provided by visiting faculty members from US dental schools and dentists under contract with the Indian Health Service. The first year curriculum, primarily didactic with pre-clinical course work performed on mannequins, consists of classroom instruction in anatomy and physiology, basic dental clinical skills, general and oral health sciences, community preventative dentistry and behavioral management strategies. The second year curriculum provides clinical instruction under direct faculty supervision, community dentistry and prevention, village practice rotations, and telemedicine communication training. Additional, special, topics consist of maternal oral health, diabetes, geriatrics, equipment repair, research data collection, behavior change modalities: motivational interviewing, recognizing and addressing dental fears, risk assessment for dental disease, and triage. The Program determines competencies based on demonstration of knowledge and skills in training and practice. Specifically, each DHAT must demonstrate and maintain understanding of medical and dental evaluations, clinic management and supervision, restorative dentistry, periodontal maintenance, oral surgery and local anesthesia, infection control, equipment maintenance and repair, and community and preventive dentistry. Additionally, each must satisfactorily perform skills contained in a list of procedures and responsibilities within the DHAT scope of practice. The DHAT’s scope of practice is determined by the supervising dentist based on demonstrated clinical skills and tribal location needs and may include: radiology, preventive dentistry, diagnosis and treatment of caries, uncomplicated primary and permanent tooth extractions, relief of pain and infection, administration of local anesthesia, recognition of and referring conditions needing space maintenance, equipment maintenance, and community/preventive dentistry.

SUPERVISION The DHAT is a dependent practitioner working in a satellite clinic under the general supervision by an off-site licensed dentist located at a distant regional clinic. Off-site supervision becomes an essential part of the professional relationship in day-to-day DHAT-provided dental care. This supervisory relationship begins with on-site, one-to-one supervision throughout a six-month (400 clinic hours) preceptorship beginning immediately after graduation. During this “residency” period the supervising dentist determines competencies for a range of clinical procedures and prescribes a prospective scope of practice for the DHAT. These standing orders define the practice guidelines that he or she will follow while practicing under off-site supervision. At this time the DHAT becomes certified and may be assigned to a remote site. The prospective scope of practice varies according to the level of competencies of the individual DHAT at the conclusion of the preceptorship. This scope of practice is dynamic in that it may change periodically depending upon the maturing skills-set of the therapist. Ongoing requirements by the supervising dentist include concurrent supervision of day-to-day patient care through distance communication. This structured daily contact includes patient diagnosis, treatment plans, review of procedures to be undertaken that day, unexpected problems, emergency care, and potential referrals of patients whose clinical care may require procedures that lie beyond the DHAT scope of practice. Independent assessment of the quality of care provided by practicing DHAT’s has shown no significant evidence to indicate that irreversible dental treatment provided by DHAT’s differs from similar treatment provided by dentists.4

CERTIFICATION Every two years DHATs must be recertified. Recertification by the Community Health Aide Program Certification Board follows completion of 24 hours of continuing education and demonstration of ongoing clinical competency to the supervising dentist. The DHAT supervision model is based on the 40-year experience of physicians directing and regularly reviewing the medical services provided by the physician assistant. As of August 2010, 32 Alaska DHATs are providing oral health care to Alaska Natives at IHS and tribal clinics in rural villages and at the two training sites.

REFERENCES

1. http://www.surgeongeneral.gov/library/oralhealth/index.html (accessed August 25, 2010)
2. Nash DA, Nagel RJ, “A Brief History and Current Status of a Dental Therapy Initiative in the United States,”
J Dent Ed 69(8):857-859, 2005.
3. http://www.law.duke.edu/shell/cite.pl?24+Alaska+L.+Rev.+105 (accessed August 25, 2010)

4. Bolin KA, “Assessment of Treatment Provided by Dental Health Aide Therapists in Alaska - A Pilot Study,” J Am Dent Assoc 139(11):1530-1535,2008.

See also

External links


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