Nine Questions That Dive Deeper into Dental Therapy

Dental therapy is growing.

Similar to physician assistants in medicine, dental therapists can work in various settings — from the dental office to the community — and provide various services, including filling cavities, placing temporary crowns, and extracting teeth under some circumstances. Communities throughout the US that struggle with dental workforce shortages or providing access to care outside of the traditional office setting have identified the occupation as an effective way to increase access for patients.

The National Institute of Dental and Craniofacial Research highlighted dental therapy as one of the most innovative approaches to improving access to care in its follow-up to the 2000 Surgeon General’s report, Oral Health in America: Advances and Challenges. And most recently, the Advisory Committee on Training in Primary Care Medicine and Dentistry issued a report calling on Congress and the Health Resources and Services Administration (HRSA) to take action to support the training and deployment of dental therapists across the US.

To explore these reports and the topic, the APHA Oral Health Section and CareQuest Institute partnered on a continuing education webinar featuring a robust conversation about expanding dental therapy. The expert panel — including a dental sociologist, an advocate, and representatives from organized dentistry and dental hygiene — explored the legal, organizational, and educational frameworks for the occupation. They also discussed the impact on quality of care and potential improvements in access and patient outcomes.

More than 350 oral health stakeholders joined the webinar, ready with questions and comments about dental therapy. The panel didn’t have enough time to answer all of them, so two members of the panel — Ann Lynch, director of advocacy at the American Dental Hygienists’ Association, and Laura (Hale) Brannon, project manager of dental therapy at Community Catalyst — provided answers, links, and resources to the questions below:

1. What are the training requirements to becoming a dental therapist?

The Commission on Dental Accreditation (CODA) serves the public and dental professions by developing and implementing accreditation standards that promote and monitor the continuous quality and improvement of dental education programs. CODA adopted standards in 2015 to set the minimum educational standards for dental therapy. The foundation of these Standards is a competency-based model of education through which students acquire the level of competence needed to begin the practice of dental therapy. The CODA standards indicate the curriculum must include at least three academic years of full-time instruction.

2. Is there a benefit of a dental therapist first being a dental hygienist?

Some dental therapists are dually licensed as dental hygienists, which provides some additional flexibility for employment. Dually trained providers can be more effective in some settings (like nursing homes) where patients need both restorative and periodontal treatment and it’s not possible or cost-effective to send two providers. Some employers prefer to hire dually trained providers for this reason.

3. Does every state require dental therapy to be under direct dentist supervision?

No, most allow general supervision, as requiring direct supervision would limit the efficacy of the model. The Oral Health Workforce Research Center has a helpful resource that shows the authorization status of dental therapists by state.

4. The chart about authorization status by state shows that 14 states have passed dental therapy. Why do only five states have practicing dental therapists and education programs in place?

Currently, 13 states allow dental therapists to practice in at least some setting: Alaska, Arizona, Connecticut, Colorado, Idaho, Maine, Michigan, Minnesota, New Mexico, Nevada, Oregon, Washington, and Vermont. Montana passed legislation authorizing Community Health Aide Program (CHAP) providers, which is the federal program that authorizes dental therapists to work in tribal settings. However, that law removed all the restorative procedures from a dental therapist’s scope, so the provider does not actually meet the minimum scope to be considered a dental therapist.

Passing the legislation to allow dental therapists to practice is just the first step in bringing dental therapy to a state. Establishing a CODA-accredited training program takes time, commitment, and resources. A few dental therapy programs are under development and seeking accreditation.

And there have been other challenges. Congress created a grant program in 2010 to support states and tribal communities with resources necessary for training and development of dental providers like dental therapists, but each year, the federal appropriations bills has included language prohibiting the funding. That language has been removed in the FY2023 appropriations bills and Congress may pass a final version that allows the Health Resources and Services Administration to provide the grant dollars.

Also, the COVID-19 pandemic has had an impact on priorities at some educational institutions.

5. How successful have states been in dental therapists practicing in rural and low-income areas? 

Using Minnesota as an example, the state conducts a workforce study, and the distribution of dental therapists closely follows the distribution of the Minnesota population. All respondents to the workforce study reported serving low-income or uninsured patients, and 92% served recipients of Minnesota Health Care programs. This is in keeping with the statutory requirements that dental therapists focus services on underserved populations and areas.

6. Are there restrictions in some states that require dental therapists to only practice in rural, low-income areas that are not competing with existing dental practices?

Yes. Dr. Mertz’s research indicates there are several states limiting dental therapists to certain populations. The article she coauthored, “Dental Therapists in the United States,” appeared in Medical Care and is free to access online.

7. With the growing number of dental therapist programs across the country, are there any meetings or conferences designed for the educators/program directors of these programs?

The American Dental Hygienists’ Association regularly hosts sessions on dental therapy at its annual conference, the National Oral Health Conference usually has a session or two on dental therapy, and the American Dental Education Association invites educators from all CODA-accredited programs to join.

Additionally, Community Catalyst coordinates the Dental Therapy Educator Learning Collaborative (DENTAL THERAPYELC), a space for dental therapy educators and administrators to connect with each other. Contact Laura Brannon for more information.

8. Do you have a list of colleges in different states that offers dental therapy or advanced dental therapy? I am very interested in becoming a dental therapist and possibly an advanced dental therapist.

There are currently four dental therapy education programs in the US, with a fifth expected to open next month. Here is a summary of the programs:

Note that advanced dental therapy is specific to Minnesota. Here is a resource from ADHA that provides more information on dental therapy education programs.

9. How are dental therapists getting paid? Medicaid and state payments? Any private insurances?

How dental therapists’ services are reimbursed varies by state (in some, they bill under their own provider number, while in others, they bill under their supervising dentists’ provider number). Where they work, their services are reimbursed by all the same payors that would reimburse for a dentist’s services.

This report/toolkit contains a wealth of information, including information on dental therapy reimbursement.

Editor’s Note: You can watch a recording of the webinar, “Advancing Health Equity Through Dental Therapy,” on the CareQuest Institute website.