Massachusetts enlists dental therapists in fight for equity

Jeremy Booth, Dental Tribune International

Wed. 26. July 2023

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BOSTON, US: More than 300,000 Massachusetts residents lack access to oral care, and state legislators hope that licensing more dental therapists could increase the equity and cost-efficiency of dental care in the state. A bill that would allow the licensure of dental therapists in Massachusetts has been referred to the state’s Joint Committee on Public Health, and educators hope to establish dental therapy training programmes, pending regulatory approval.

Bill H.2253 would require dental therapists to gain a master’s degree-level qualification and to work temporarily under the supervision of a dentist. Dental treatments permitted to be performed by dental therapists would include preventive care, oral assessments and assessments of dental disease, tooth restorations, and dispensing and administration of non-narcotic analgesics, anti-inflammatories and antibiotics.

Public News Service reported that education for dental therapists is shorter and less costly than for dentists, making it more accessible for those living in rural areas. Dr William Giannobile, dean of Harvard School of Dental Medicine in Boston, told the news outlet that he envisions dental therapists working in public health clinics and emergency rooms in Massachusetts. “There’s a bottleneck in the whole approach,” however, Dr Giannobile explained, because some dentists and dental organisations were still “grappling with the dental therapist model on how they can build it into a practice setting”.

Dental therapists can help to increase diversity in the dental workforce and to bridge cultural barriers that exist in the provision of oral care in migrant and low-income communities. “We have a much higher success rate with patients being compliant, understanding what their needs are and continuing to seek treatment and getting it at our clinic if they’ve had a clinician that speaks the same language,” Dr Dianne Smallidge, dean of the Forsyth School of Dental Hygiene at Massachusetts College of Pharmacy and Health Sciences in Boston, told the news outlet.

The dental therapy movement in the US has been largely based on tribal self-determination and community engagement, seeking to improve oral healthcare equity by developing local oral care workforces within underserved communities and in remote areas. Dental therapy was first authorised in the US on certain reservations in Alaska in 2005, followed by state authorisation in Minnesota in 2009. In 2019, Native Americans made up 4.0% of Minnesota’s dental therapist workforce, despite accounting for just 1.4% of the population, according to US census data. In the same year, less than 1% of the state’s dental workforce were Native Americans.

The profession has since been authorised in Arizona, Colorado, Connecticut, Idaho, Maine, New Mexico, Nevada, Oregon, Vermont and Washington. However, there are currently just five dental therapy training programmes in the US, of which only three are accredited by the Commission on Dental Accreditation—three in Minnesota, one in Alaska and one in Washington, according to the American Dental Therapy Association.