Posts Tagged ‘Oral Healthcare in Rural Communities’

A Personal Story: Trapped, No Options – Nancy and Kate, Thetford

Wednesday, August 31st, 2011

Nancy and her family live in Thetford, Vermont. Nancy, her husband, and their three children all have dental insurance through her husband’s job. Nancy’s middle daughter, Kate, has been going to the dentist since she was two, having regular cleanings every six months. When Kate was three, their family dentist told them that she had cavities that would need to get filled in a year or so, before they started getting painful. Because Kate is so young, she needed to see a pediatric dentist. Nancy started looking and was surprised to find her options were very limited, with only one local pediatric dentist and just a few within driving distance.

Once she had an appointment, even with dental insurance, Nancy had to pay $110 before the pediatric dentist would even look at Kate. The initial exam revealed that Kate had six cavities which would need to be filled in three separate visits. Because of her age, Kate would need nitrous oxide for the procedure, which was not covered by insurance. Completing those six fillings would cost a total of $565. Although it would delay the procedures, Nancy would need to schedule each visit three months apart because, “we don’t have that kind of cash flow.”

At Kate’s first scheduled visit to get two of her cavities filled, Nancy was not comfortable with how the pediatric dentist interacted with her four year old. Ultimately, Kate pitched a fit, and the dentist couldn’t get the procedure done. He charged $67 for ten minutes. He was now recommending Kate have her cavities filled by him under general anesthesia. Nancy is not at all comfortable with this dentist, does not want her daughter under general anesthesia, but doesn’t feel like she has a choice: “I feel trapped. I don’t feel like I have any other option. I just don’t know where to turn.”

Illustration by Dennis Pacheco.

A New Type of Dental Provider

Monday, September 27th, 2010

In early 2009, the Minnesota legislature took a step toward improving dental service access for low-income residents. Surprisingly, the law does not concern increasing dental provider reimbursement rates or improving the quality of school-based oral health programs, but rather paves the way for the training of a new type of dental provider known as a dental therapist. A two-and-a-half-year program that would follow a traditional 4-year bachelor’s degree, the dental therapist program at the University of Minnesota trains individuals to be the dental version of a physician’s assistant. Dental therapists will be trained to provide “relatively simple services such as filling cavities, instructing patients in dental hygiene and performing dietary evaluations and oral cancer screenings.” (1)

While dental therapists will be able to practice outside of dentists’ offices, their work will nonetheless be supervised by dentists who may be off-site. The University of Minnesota program will place each of its nine enrollees into dental professional shortage areas throughout the state with the hope that the reduced cost of their services (as compared to that of dentists) will extend the reach of access to those in lower income brackets.

Minnesota is not the only state which has shown interest in exploring the possibility of new types of dental providers. Since 2003 the state of Alaska has made use of dental health aide therapists (or DHATs) to provide needed services for residents who may be a boat or plane ride away from the nearest practicing dentist. Although the original DHATs were Alaska residents trained in New Zealand who returned to their homes to practice, since 2007 the DHATs have been trained in the U.S. thanks to collaboration between the University of Washington School of Medicine Physician Assistant Training Program and the Alaska Native Tribal Health Consortium.

The fundamental question surrounding the dental therapist model has increasingly become one of quality. The American Dental Association (ADA) has noted that the scope of procedures performed by dental therapists should be limited as their professional training does not match that of a dentist who commits to a minimum of 4 years of professional study. Nonetheless, the Alaska program’s utilization statistics “suggest that dental therapists are improving access to year-round oral health care for individuals who previously could see a dentist only a few weeks each year.” (2) While more extensive evaluation remains to be done, it seems clear that if a balance between practice capabilities and supervision is established, the dental therapist may offer an effective means of providing the most vulnerable populations with quality dental care.

Watch this interesting video about the dental therapist model to learn more about how it’s being used in Alaska.

References:

(1) Minnesota Public Radio
(2) Agency for Healthcare Research and Quality

Vanessa Hurley