Dental Therapists in Lower 48
Legislators Bow to Minnesota Dentists
Minnesota is the first state to legalize training of dental therapists. But rather than designing an evidence-based two-year program modeled after the New Zealand prototype, the Minnesota Dental Association with the collaboration of the School of Dentistry has made a mockery of common sense by inducing the legislature to adopt a bloated educational requirement and excessively restrictive practice constraints.
For example, it will take the dental school four years to train dental therapists that are trained throughout the world in two years. By what stretch of the imagination can a two-year curriculum be expanded to four without filling empty space with empty material? No doubt the school's highly expert staff will produce a highly qualified DT that will be permitted to practice only under the direct supervision of a dentist. What if the dentist is sick or takes a day off? What if he or she takes a long lunch? Must the dental therapist cancel patients for lack of “direct supervision?”
As if this is not ridiculous enough, Minnesota also authorized a two-year master’s degree program to create an advanced dental therapist that would free a DT of direct supervision but would still require treatment authorization by a supervising dentist to remove decay and place a filling or extract an exfoliating deciduous tooth. The American Dental Association contends that dental hygienists would have to start from scratch in the dental therapist program and then practice for two years before being allowed to advance to the advanced dental therapist program, but that is not the intent of the Minnesota legislation. According to Dr. Colleen Bickle, co-chair of the Metropolitan State University Dental Hygiene Program, dental hygienists will qualify for direct admission to the state university’s two-year advanced dental therapist program. Parenthetically,the Forsyth Experiment in the 1970s demonstrated dental hygienists could be trained in basic dental therapy skills in less than six months.
Should we not, as public health dental advocates, cheer Minnesota for this groundbreaking achievement, for what some of us have advocated for over half a century? Yes and No. Yes, because the public, as well as the dental profession, will benefit from whatever increase in access to dental care dental therapists can provide. No, because the training program is too long, too expensive, too inefficient, and too restrictive in the practice setting. No, because it is the wrong model for emulation by other states.
Smile, You’re on TV
It is said (by most American dentists) that American dentistry is the best in the world. It is said (by most American dentists) that the United States has the best dental care in the world. If any of you doubt that, just look at all the great smiles on TV, though high-altitude sunglasses might be advisable to protect your eyes against those Chiclet flashing teeth. Those beautiful faces with beautiful chalk-white teeth are proof that dental society “Smile” campaigns are successful. Yes, indeed. Smile America, you’re on TV.
Except that once you’ve switched from talk and song and dance shows to news broadcasts with close-ups of people who don’t belong to the affluent middle and upper classes, that show blue collar workers, farm workers, poor people, inner city folk, homeless people, you don’t see many beautiful smiles. What you see are people of all hues from all social classes, many with missing front teeth, broken teeth, rotten teeth, no teeth. No doubt this is due to neglect. But neglect is not the consequence of thoughtful decision-making. People who can’t afford $2,000 for a root canal filling, post and crown have no choice. No more so than children who become addicted to soda pop that rots their teeth and contributes to obesity are making thoughtful decisions about their diets.
A good part of neglect is social conditioning, commercial in this instance, that induces compulsive behavior to which we are all subject. A good part of neglect is the consequence of our failure to provide effective guidance and adequate care for those who cannot provide for themselves. It is not easy to smile when you have little to smile about.
Jay W. Friedman, Editor
Comments invited: drjfriedman@sbcglobal.net