Dental therapy is Michigan’s newest licensed profession, and its potential is recognized by a variety of stakeholders. In Michigan, organizations such as the Michigan Council for Maternal and Child Health, Michigan Primary Care Association, American Association of Retired Persons Michigan, Michigan Association of School Nurses, and many more have publicly endorsed dental therapy, according to MI Dental Access. 

Nationally, more than 170 organizations have signed on in support, and that list continues to grow. Yet despite its popularity, dental therapy faced opposition from a number of dentists during its legislative push in Michigan.

Strong arguments and evidence supporting how the new profession could contribute to better access to care were acknowledged, and with the leadership of the bill’s sponsor, Senator Mike Shirkey (R), SB 541 was passed on December 27, 2018. Administrative rules have recently been promulgated, and Michigan can officially license dental therapists.

The Need for Dental Therapy

There is a reason dental therapy has gained so much support. It is widely recognized that the existing oral healthcare system creates greater barriers to care for some communities than for others, and the resulting disparities in oral health are vast.

Compared with their white counterparts, Hispanic and non-Hispanic Black children are less likely to receive dental sealants and have much higher cavity rates, and by adulthood these groups are more likely to experience tooth loss than white adults, as reported by Michigan State Oral Health Plan 2020.

Communities of color and those with low socioeconomic status also experience a significant shortage of providers. Dentists are unevenly distributed in favor of affluent areas, and dental provider recruitment and retention is an ongoing problem in underserved areas. This is where dental therapy can help.

Under the statute, dental therapists are permitted to work only in underserved areas, providing services to the communities that need them the most. Practice settings include, but are not limited to, safety net settings such as federally qualified health centers (FQHCs) and tribal health clinics; settings where at least half of the patient base is uninsured, on public insurance, or low income; and in federally designated dental Health Professional Shortage Areas (HPSAs). A dental HPSA is an area with a ratio of at least 5,000 patients to each dentist, and Michigan has 243 of them.

Even some affluent counties in Michigan have dental HPSA areas, highlighting the stark disparities that exist for communities of color and low socioeconomic status. By and large, dental HPSAs encompass rural areas and urban centers that lack sufficient numbers of oral healthcare providers.

Because dental therapists may practice without their supervising dentists being physically present, they can reach into the hearts of underserved communities, working in non-traditional settings and during times when patients can more conveniently access their services.

Hospitals, nursing homes, school-based health centers, correctional facilities, and mobile units are just a few practice settings where dental therapists can help bring care to patients, sidestepping barriers such as transportation, missing work or school, fear of the dental clinic, and lack of providers in the area.

The Scope of Practice

The scope of practice for a dental therapist includes both preventive and restorative procedures, making them versatile additions to the dental team. Although the list of allowable procedures is smaller than that of a dentist, the dental therapist’s training must be of the same quality and depth as that of the dental student for the services within his or her scope.

Also, dental therapy programs must meet the standards of the Commission on Dental Accreditation (CODA), the body that ensures appropriate education for all dental programs. Patient education and disease prevention are the foundation of a dental therapist’s practice, and treatment plans are decided upon in collaboration with the supervising dentist.

All treatment that is outside of the scope or comfort of the dental therapist is either referred to the supervising dentist or to a dental specialist. The scope of a dental therapist includes, but is not limited to:

• Comprehensive oral evaluations
• Dental cleanings for children and adults
• Preventive services such as fluoride and sealants
• Diagnostic services such as x-rays and pulp testing
• Composite and amalgam restorations on children and adults
• Stainless steel crowns on primary teeth
• Extractions of primary teeth and periodontally involved teeth with class III+ mobility
• Periodontal services such as sutures and changing dressings

Education and Training

The underlying spirit of dental therapy is providing access, not only to oral health services, but also to joining the oral health professions. Institutions considering dental therapy program development are encouraged to innovate and reduce barriers for aspiring students.

A community-focused education model would broaden the current restrictive pathway to dentistry into a more inclusive and attainable pathway for dental therapy students. Recruiting students from the communities in which they will practice would improve provider recruitment and retention, diversity within the dental profession, and cultural competence among dental providers.

Educating dental therapy students closer to home while utilizing community colleges, virtual didactic courses, and FQHCs as clinical education sites would open doors for those who are unable to attend one of the two dental schools in Southeast Michigan.

Unique community-based opportunities to complete the clinical hours required during education could also give graduates experience in underserved communities and prepare them to work within their practice settings upon licensure.

To become a dental therapist in Michigan, individuals are required to complete:

• Three academic years in a dental therapy program that meets CODA standards (degree level to be determined by the educational institution)
• 500 hours of clinical practice under the direct supervision of a dentist (to be completed during the three-year education period)
• A comprehensive, competency-based clinical exam
• Application for licensure

Dental therapy education programs have not yet emerged in Michigan, but there is great demand among potential students and employers. As colleges and universities begin to foster opportunities for aspiring dental therapists, we will witness the development of a new workforce of highly skilled oral health professionals. This is an exciting time to be part of a movement that has tremendous potential to positively impact our state.

Ms. Davis is an oral health program specialist with the Michigan Primary Care Association. She can be reached at mdavis@mpca.net or at (517) 827-0879.

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We’re celebrating Dentistry Today’s 40th anniversary by interviewing 40 of the profession’s top leaders. Today we’re speaking with Dr. Wenyuan Shi, CEO and chief scientific officer of the Forsyth Institute, about the role his organization has played in pioneering oral health research, its community outreach efforts, and how it facilitates innovation by partnering with key entrepreneurs.

IQ Dental Supply recently hosted the Fourth Annual Tee for the ToothFairy Charity Golf Tournament to benefit America’s ToothFairy and resources for children’s oral health programs.

Held at the Crystal Springs Resort & Spa in Hamburg, New Jersey, the event featured an appearance by Ken Daneyko, formerly of the New Jersey Devils of the National Hockey League.

Funds raised through the event will provide educational resources to help 3,500 children in disadvantages communities learn to prevent dental disease, America’s ToothFairy said.

“This is an event we look forward to every year. The golfers had a wonderful time while also helping kids stay healthy,”  said IQ Dental Supply president Sergey Kunin.

“As a board member of America’s ToothFairy, I see firsthand all the great work they do. It is an organization that I am proud to support,” said Kunin.

“After a year of lockdowns, it was great to get together with the wonderful people who support our mission to improve the oral health of our nation’s most vulnerable kids,” said Jill Malmgren, executive director of America’s ToothFairy.

“We are incredibly grateful for everyone who participated and of course for our thoughtful host and generous sponsors who made the event possible,” said Malmgren.

Proceeds will fund educational initiatives that help families in underserved communities avoid the consequences of poor dental hygiene habits, America’s ToothFairy said.

Since its founding in 2006, America’s ToothFairy has helped more than 8.8 million children and their caregivers learn how to keep their smiles healthy, the nonprofit said.

Other sponsors of the event included 3M, KaVo Kerr, DMG, GC America, Coltene, and Vatech.

The next Tee for the ToothFairy outing will be at Pine Island Country Club in Charlotte, North Carolina, on November 12, 2021. Opportunities to participate are available.

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Delta Dental of Rhode Island (DDRI) is establishing a scholarship for students at the Tufts University School of Dental Medicine (TUSDM) to improve access to oral healthcare and support underrepresented students with financial needs.

“We are grateful for this scholarship support form Delta Dental of Rhode Island,” said Nadeem Karimbux, dean of TUSDM. “This investment in our students will contribute to supporting a diverse dental workforce, and we are proud to be part of that effort.”

The Delta Dental of Rhode Island Scholarship will be awarded to students from Rhode Island. Recognizing the increased need for oral surgeons in its service area, DDRI said, it is encouraging TUSDM students who have expressed an interest in pursuing advanced studies in oral and maxillofacial surgery to apply for the scholarship.

“Expanding access to oral healthcare is a key priority for Delta Dental of Rhode Island,” said Joseph R. Perroni, DDRI president and CEO. “We are pleased to provide this funding and to partner with Tufts University School of Dental Medicine in fostering the development of oral surgeons and increasing capacity in our state.”

TUSDM said it extends its sincere gratitude to DDRI for its commitment to ensuring that talented current and future dental students have the opportunity to receive the training and education necessary to become highly qualified practitioners.

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The Woody L. Hunt School of Dental Medicine celebrated the opening of the Texas Tech Dental Oral Health Clinic as well as a $323,000 gift from the GECU Foundation during a ribbon-cutting ceremony on June 22. The public clinic will serve as the clinical arm of the new dental school, and the gift will support the Dean’s Excellence Fund and student scholarships.

“GECU’s philosophy is people helping people,” said Crystal Long, president and CEO of GECU. “Our foundation’s commitment to TTUHSC El Paso is a commitment to the health of our entire community. Our aim is to elevate El Paso through education, community programs, and philanthropic giving.”

The GECU Foundation’s commitment to the growth of the Texas Tech University Health Sciences Center (TTUHSC) El Paso campus, where the Hunt School of Dental Medicine is located, aims to help the surrounding community thrive, the school said, and other community partners share this sentiment.

“The entire TTUHSC El Paso campus has transformed the healthcare landscape in our region. Having a single campus in El Paso that houses a medical school, biomedical sciences school, nursing school, and now a dental school allows El Paso to be a national leader on healthcare,” said Woody L. Hunt, chairman of the Woody and Gayle Hunt Family Foundation.

“This institution provides young El Pasoans who want to pursue who want to pursue a career in healthcare the opportunity to do so here locally, fills tremendous health needs in our unique border community, and provides a boost to our regional economy,” Hunt said.

The Hunt School of Dental Medicine will offer reduced-cost dental care in its 38,000 square-foot public Texas Tech Dental Oral Health Clinic. It will have more than 60,000 patient encounters annually by 2025 and is expected to be the top dental care destination for the public and for faculty, staff, students, and their families.

“As the first dental school in Texas in over 50 years, the Hunt School of Dental Medicine will be a change agent for health in the Borderland,” said Richard C. Black, DDS, MS, dean of the Hunt School of Dental Medicine.

“In the past, local patients may not have had access to dental care. With 42% of the inaugural class hailing from West Texas and border regions in Texas, we’re focused on our patients having access to the highest quality care in the region, while also preparing students to be culturally competent providers,” Black said.

The state of the art facility is a first for West Texas and Southern New Mexico, the school said. It includes nine multipurpose suites, two special needs suites, six faculty practice rooms, one CAD/CAM lab, five pediatric suits, five oral surgery suites, and 130 individual student-learning operatories.

“TTUHSC El Paso would not be here today if it weren’t for the support of our community,” said Richard Lange, MD, MBA, president of TTUHSC El Paso.

“Continued investment in our students from generous financial institutions like GECU are investments in our community. The Texas Tech Dental Oral Health Clinic will train future dentists in the most advanced setting, preparing our students for a meaningful career in the healthcare field,” Lange said.

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For more information about GECU, please visit https://www.gecu.com/.

The UCLA Center for Health Policy Research has identified three of the most important factors that have led to disparities in access to dental care in California:

• There are fewer dentists per capita in some parts of the state.
• About 79% of the state’s dentists do not provide care for low-income patients who rely on Medi-Cal.
• Only 8% of the state’s dentists are Latino or Black, compared with 60% of the state’s low-income adult population overall.

Also, a shortage of dentists is looming, according to the researchers. Approximately 23% of dentists are 60 years old or older and nearing retirement age, while only 9% of dentists have graduated from dental school within the past five years.

This imbalance is likely to place additional strain on access to oral healthcare for all Californians, the researchers said, and for lower-income residents in particular.

According to the center’s 2019 California Health Interview Survey, 32% of the state’s residents are adults with incomes under 200% of the federal poverty level.

Additionally, the researchers reported in previous studies that lower-income Californians have poorer oral health and less access to oral healthcare than residents with higher incomes.

The recent study notes regions where there is a relatively small number of dentists per capita, a large proportion of low-income adults, and a small percentage of dentists who see patients with Medi-Cal.

In San Joaquin County, for example, there are just 2.2 dentists per 5,000 residents. And while 65% of the area’s low-income adults have Medi-Cal, only 2% of dentists see Medi-Cal beneficiaries.

“The availability of dentists willing to provide care to the low-income and uninsured population of California is crucial in ensuring access to oral healthcare and improved oral health status,” said Nadereh Pourat, PhD, the center’s associate director and lead author.

“Our findings indicate regional disparities in where low-income populations live and where California dentists practice. We also found low participation of dentists in Medi-Cal and limited numbers of dentists from communities of color,” Pourat said.

“These factors perpetuate income disparities in both access to oral healthcare and oral health status of low-income Californians,” said Pourat.

The researchers analyzed data from the Dental Board of California, the California Dental Association, and California Health and Human Services. They also found:

• 39% of low-income California adults reported that their oral health was fair or poor.
• 41% of low-income California adults had not visited the dentist in the previous year.
• 23% of the state’s dentists were 60 years old or older.
• Although 53% of the state’s low-income adults were Latino and 7% were Black, only 6% of practicing dentists were Latino, and 2% were Black.

“The data clearly show the importance of increased participation of dentists in Medi-Cal,” Pourat said. “Policy tools to incentivize participation have been used for low-income children and can be tailored for low-income adults.”

The researchers suggest expanding the roles of hygienists and dental therapists to reduce the burden on dentists.

Also, the researchers suggest that dentists use mobile clinics to bring oral healthcare into underserved neighborhoods and offering at least some appointments, particularly for consultations or basic diagnoses, through web-enabled devices for people who cannot immediately visit a dentist’s office.

The policy brief, “The Challenge of Meeting the Dental Care Needs of Low-Income California Adults With the Current Dental Workforce,” was published by the UCLA Center for Health Policy Research.

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The Delta Dental of Arkansas Foundation (DDAF) is awarding $340,000 to 21 organizations that will implement or expand community-focused oral health education programs that will benefit more than 25,500 low-income, uninsured, and underserved residents.

“Arkansas ranks near the bottom nationally for oral health. The solution starts with three basic, straightforward habits: brush and floss daily and see the dentist regularly,” said Chrissy Chatham, executive director of the DDAF.

“Our funding supports projects that teach these fundamentals to empower more Arkansans with knowledge of habits that can be integrated into their daily lives and improve their oral health,” Chatham continued.

“Because improved oral health typically improves the individual’s overall health, we hope that the beneficiaries of our grant support achieve greater well-being and a higher quality of life,” Chatham said.

The 2021 Community Education Grantees, who received grants ranging from $2,500 to $30,000 each, include:

• 100 Black Men of Greater Little Rock, Little Rock
• Arkansas Council on Economic Education, dba Economics Arkansas, Little Rock
• Boys & Girls Club of Central Arkansas, Little Rock
• Boys & Girls Club of McGehee, McGehee
• Boys & Girls Clubs of Arkansas River Valley, Russellville
• CareLink, North Little Rock
• Centers for Youth and Families, Little Rock
• City of Quitman, Quitman
• Conway Regional Health Foundation, Conway
• DePaul Community Health Centers, Dumas
• Hispanic Community Services Inc., Jonesboro
• Inspired Communities Foundation, Timbo
• PARK Foundation Inc., Little Rock
• REFORM Inc., Resiliency Empowerment Faith Overcomer, Pine Bluff
• Ronald McDonald House Charities of Arkansas, Little Rock
• Safe Haven Ministries Inc., Clarksville
• Shared Beginnings, Fayetteville
• Special Olympics Arkansas, North Little Rock
• Transformations Little Rock Angels, Little Rock
• UA Little Rock Children International, Little Rock
• WelcomeHealth, Fayetteville

“Offered for the first time in 2021, Community Education Grants are designed to support a wide variety of oral health educational programs, in contrast to the DDAF’s annual Community Grants, which typically fund dental treatments and other clinical services.

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The ADA has asked the Centers for Medicare & Medicaid Services (CMS) to prioritize oral healthcare. In a letter to Administrator Chiquita Brooks-LaSure, the ADA said that it looks forward to working with CMS in:

• Ensuring that a permanent position of chief dental officer within the CMS is filled, as the position has been vacant since 2017
• Expanding the participation of dentists through increased reimbursement and reduced administrative burden, such as the easement of credentialing, audit processes, and encouragement of clean claims paid within 15 days
• Requiring the CMS Center for Program Integrity to issue guidance to state Medicaid agencies (SMAs) concerning best practices in dental audits and develop standardized training for dental auditors
• Providing guidance to SMAs to streamline dentist credentialing by utilizing the ADA Council for Affordable Quality Healthcare credentialing service or equivalent
• Establishing a benchmark floor for all Medicaid dental fees at 75^th percentile of regional dental fees based on ADA survey data
• Working to enhance consistent adult dental benefits across all Medicaid programs
• Working with the dental community to establish an appropriate Healthcare Common Procedural Coding System billing code to help address ongoing challenges regarding access to dental rehabilitative services
• Making pediatric oral health coverage mandatory for families with children and including maternal oral health as an essential health benefit for one year post-partum within the Affordable Care Act’s exchange plans
• Instituting activities to increase oral health equity, including incentivizing dentists to practice in underserved communities across the United States and strengthening support for Action for Dental Health Initiatives

“We would welcome the opportunity to meet with you to discuss how we can meet these challenges together,” said the letter, which was signed by ADA president Daniel J. Klemmedson, DDS, MD, and executive director Kathleen T. O’Loughlin, DMD, MPH.

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The National Institutes of Health (NIH), the National Institute for Dental and Craniofacial Research, and other participating organizations are seeking applications for two initiatives centering on health disparities and their effect on oral health:

• Addressing Social Determinants of Health to Eliminate Oral Health Disparities: This initiative seeks to identify and address the social determinants of health that affect oral health and also contributed to oral health disparities in vulnerable and underserved groups. Applications are due July 8 for non-AIDS proposals and July 26 for those researching AIDS as a social determinant.
• Understanding and Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities: This initiative looks at how structural racism and discrimination help cause and sustain health disparities, as well at how intervention research addressing structural racism and discrimination can lead to improving minority health or reducing health disparities. Applications are due August 24.

To apply, candidates should first visit the NIH application guide. Applications only will be accepted via the NIH ASSIST program, institutional systems-to-systems programs, or grants.gov. The NIH also provides an FAQ page for more information.

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Delta Dental invested more than $102.5 million in communities in 2020, supporting more than 2,400 programs, impacting 24.7 million lives, and volunteering 20,000 hours, which is more than ever before in the company’s 65-year history.

According to the Delta Dental Institute’s 2020 Community Impact Report, Delta Dental companies across the United States also committed more than $1.1 billion to COVID-19 response relief.

“As our country grappled with a pandemic, injustice, and lingering gaps in oral healthcare access and education, Delta Dental stood with our communities to meet their most pressing needs,” said James W. Hutchinson, president and CEO of the Delta Dental Plans Association.

“In a time of crisis and uncertainty, Delta Dental never wavered in its enduring commitment to achieve access and equity for all,” Hutchinson said.

The 2020 Community Impact Report, “Our Promise to Our Communities,” centers on Delta Dental’s mission to advance the oral and overall health of its communities, the company said. Last year, Delta Dental supported programs in all 50 states, Washington, DC, and Puerto Rico.

The report highlights three main areas of giving in 2020: advancing oral health, responding to COVID-19, and addressing health inequities and disparities.

For example, Delta Dental said its companies served communities’ oral health by supporting direct dental treatment in underserved communities, water fluoridation initiatives, and oral health education.

Delta Dental also said its companies responded to COVID-19 by delivering loans to safety net dental clinics, enabling dental offices to acquire personal protective equipment, and supporting local safety nets like food banks.

Plus, Delta Dental’s companies invested in organizations such as the NAACP and the National Urban League, reached underserved communities of color with oral health programs, and supported scholarships and training for dentists of color.

“Community is everything to us at Delta Dental,” said Vivian Vasallo, executive director of the Delta Dental Institute. “While the memories of 2020 will stay with us for years to come, so will the positive impact the Delta Dental companies had on millions of lives by keeping our promise to serve the oral and overall health of our communities.”

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