Rumor has it that 20 new dental schools are in various stages of contemplation or development. That there is a shortage of dentists in the United States and that it is increasing should not be in doubt. But is increasing the number of dentists the only or the best option?

Some would answer that prevention of dental disease is the answer. But prevention that is highly dependent on individual behavior cannot withstand the onslaught of behavioral patterns, particularly the excessive consumption of sugared foods and beverages that subsidize dental diseases. Water fluoridation, topical fluorides, fluoride toothpaste and sealants do a good job, but they are not completely effective. Enamel still dissolves in the acid of sugar-bred bacteria, and periodontal disease is just as ubiquitous.

Secondary prevention, or the treatment of disease that cannot be prevented, to prevent further disease is therefore necessary. That is what dentists do. But that is also what dental therapists and dental hygienists do within the parameters of their training. Given the assurance of economic difficulties in the foreseeable future with the equal assurance of insufficient funding for education and training programs at every level, all options for increasing the dental workforce to meet the needs of an expanding population should be weighed carefully.

There are 61 dental and nearly 300 dental hygiene schools in the United States. It takes close to eight years after high school to graduate a dentist, compared to two years for a dental hygienist or dental therapist. Reported total expenditures for the four years to educate a dentist average $312,000 for public schools, $233,000 for private schools, and $184,000 for private-state related schools [ADA, 2004]. These figures do not include the cost of three to four  years of pre-dental education or the opportunity cost ― what the student could be earning if not attending professional school. If these additional costs are included and updated to 2011, the total direct and indirect cost involved in the education of a dentist might be $700,000 or more.

The tuition, fees, books, instruments, and living expenses for a two-year dental hygiene program approximates $50,000, plus the two-year opportunity costs, which would bring the total cost to produce a dental hygienist to perhaps $90,000. Many RDH programs in the United States require a year of pre-requisite studies, which has not been included in this guestimation. It would add another $20,000 for a total of $110,000. Assuming the cost to train a dental therapist is about the same as a dental hygienist in a two-year program, seven or eight dental therapists could be trained in one-fourth the time at the same equivalent cost of one dentist.

Setting up a new dental school requires a large investment in the physical structure. On the other hand, existing dental therapy programs could be quickly, easily and inexpensively developed within existing dental hygiene schools with minimal capital costs. Thus, large numbers of dental therapists could be trained quickly at a fraction of the cost of training dentists in order to expand the dental workforce sufficiently to meet the needs of the underserved population in schools, community health centers and public health clinics in collaboration with dentists. Meanwhile, the existing dental schools will continue to train sufficient dentists to serve the needs of the public.

Is there really any doubt as to the answer to the question?

Jay W. Friedman