February 20, 2015

Editor's note: Thanks to healthcare commentator Wendell Potter, who gave us permission to print his entire piece.


Would you trust someone with two years of dental training to pull one of your teeth or fill a cavity?If you’re like me–or like I used to be–I’m pretty sure you’re saying, “Not a chance.”

Until a few years ago, I wouldn’t have believed that anyone with 24 months of training (plus a six- to 12-month preceptorship) could help solve America’s dental healthcare crisis. Now I know better.

I first heard about dental therapists from Dr. Gail Christopher, Vice President of the W.K. Kellogg Foundation, at a conference we both attended in Los Angeles a few years ago. Dr. Christopher told me that after she and her colleagues were made aware that mid-level dental providers (similar to physician assistants and nurse practitioners) were making a big difference in the oral health of thousands of Alaska Natives, most of whom live in small villages hundreds of miles from the nearest dentist, the Kellogg Foundation agreed to provide funding to ensure the continuation of a program.

The foundation did so only after doing considerable due diligence into the quality of care provided by the Dental Health Aid Therapists (DHATs), as they are known in Alaska, and also by mid-levels who’ve been practicing in at least 50 other countries, including Canada, England, Australia and New Zealand, for decades. They’ve been practicing in New Zealand, in fact, for nearly 100 years.

While I didn’t doubt that the foundation had done a lot of research, I remained skeptical and decided to do my own investigation. I quickly came across comments from some dentists–and organizations that represent their interests, including the American Dental Association–that were, frankly, dismissive of the very idea that anyone could be sufficiently trained to do irreversible dental procedures in two years. The ADA’s comments on dental therapists imply that the care they provide might be substandard and very possibly unsafe.

I couldn’t find any credible studies to substantiate that claim. So, with more of an open mind, I accepted an invitation from the Kellogg Foundation to travel to Alaska to see firsthand how DHATs are trained and how they practice.

As it turned out, I was part of a group that included several dentists and health policy experts, including Dr. Louis Sullivan, President George H. W. Bush’s Secretary of Health and Human Services. (Full disclosure: The Kellogg Foundation, which is one of several foundations supporting the expansion of the workforce to include dental therapists, sponsored the trip.)

When we returned home, we were all convinced that the dental therapists in Alaska are providing safe and effective care and meeting a great need. We had talked not only to DHATs who’ve been practicing for several years (including Bonnie Johnson, whom you will meet in the accompanying video) but to their supervising dentists. We spent time with the University of Washington Medical School faculty that trained them. And we observed the DHATs treating patients.

We also learned something that surprised us all: DHATs actually receive more training in the procedures they’re licensed to perform than dentists do.

Dr. Sullivan was so impressed that he has become a national leader in the effort to encourage all the states to expand the dental workforce to include dental therapists. He’s made compelling arguments in numerous speeches, media interviews and a New York Times op-ed.

Having served as the nation’s top healthcare official, Dr. Sullivan understands more than most why we are in the midst of a dental healthcare crisis in this country: 50 million of us live in rural or poor areas where dentists don’t practice, more than a third of us lack dental benefits, and we have a growing shortage of dentists that is worsening every year. As a result, the crisis is no longer just affecting poor people and folks who live in rural areas. It’s spreading rapidly through the middle class. Dr. Sullivan also understands the terrible consequences of inadequate access to dental care, including lost days of school and work because of intense pain and even death.

Lawmakers in several states are listening to Dr. Sullivan and the growing number of other workforce expansion advocates. In 2009, Minnesota became the first of the lower 48 states to allow dental therapists to practice. Maine last year became the second.

Washington is one of at least 12 other states that may soon follow suit. Last November, the state’s Board of Health conducted a study to determine if dental therapists provide quality care, as advocates contend, or whether they might do more harm than good, as the ADA suggests. Not only did the Board of Health find no evidence of harm in any place where dental therapists practice, but it found “strong evidence that mid-level dental professionals provide high quality, safe and effective care.”

The Board of Health’s researchers also wrote that mid-levels not only could increase access to oral health care in Washington but could decrease the cost of providing it.In a report about its findings, the researchers pointed out the care dental therapists provide within their scope of practice–typically ranging from education and prevention to simple extractions and fillings–“is at least as high in quality as care provided by a licensed dentist.”

Dental therapists have been practicing in Alaska for more than 10 years now and have provided care to more than 40,000 people. They work as part of a broader dental team under the general supervision of a dentist. When they encounter a patient requiring care beyond their scope of practice, they immediately refer the patient to a dentist.

It is a program that works. And it’s a free-market solution requiring no additional government funding that is also creating good paying jobs.

If the ADA leadership went to Alaska to check it out, as Dr. Sullivan and I did, I’m confident they would drop their opposition.

And yes. I would have absolutely no hesitation having a DHAT work on my teeth.

Author’s Note: This blog post is part of a series examining America’s oral healthcare crisis. Be sure to read the previous post, “A Free-Market Solution to Alleviating America’s Oral Health Crisis: Dental Therapists.”

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