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States battle ADA over nation's teeth

States battle ADA over nation's teeth

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BATTLE CREEK, Mich. — A proposed nationwide model curriculum has been developed to train dental therapists. It is being pushed by the W.K. Kellogg Foundation (of cereal fame) and the Josiah Macy Jr. Foundation. The American Dental Association is not pleased, either with the proposed program or its curriculum.

The proposed model and curriculum to train dental therapists is the result of a growing national discomfort with lack of dental care for both adults and children.

In Alaska in 2005, the state perceived a growing crisis and decided to try to solve the problem by establishing a new class of dental practitioner, the dental therapist. Under the program, dental therapists will be able to fill cavities, pull teeth and even perform root canals.

The University of Minnesota has had a program in place for years and even offers a master's degree in dental therapy. The university says that there is plenty of room for both dentists and dental therapists. The ADA is not buying their argument and is not so accommodating.

Since Alaska entered the fray, at least four other states - California, New Hampshire, Oregon and Connecticut - have followed suit and have or are in the process of developing training programs for dental therapists.

With 17 million children nationwide lacking dental care and health reform expected to increase demand, the stage is set for major battles between states with populations in need, state dental boards and the American Dental Association.

Proponents of the new programs argue claims of insufficient training and of substandard quality by the ADA are simply incorrect and an effort to protect dentists.

Advocates for dental therapists cite international programs that have been shown to be both effective and safe. Their claim is supported by a new study released in May by the W.K. Kellogg Foundation.

Detractors at the ADA say the study is flawed and is merely an “advocacy document.” ADA President Bill Clandon is quoted in the Los Angeles Times as saying, "This is not about dentistry or dentists protecting dentists. This is about dentists doing what they feel is the absolute best for the American public … and doing it in a way that maintains the highest level of quality care possible." The ADA insists that the therapists should be under strict and close supervision of actual dentists.

The Pew Center for the States reported that “nationwide 830,000 emergency room visits in 2009 were due to preventable dental problems.” The problems affect both adults and children. Also, a UCLA study cited by the Times reported that in 2007 half a million children missed school because of dental problems.

While people often talk about the need for better health care, dental care is often overlooked. Though 8 million kids lack health care, three times as many — more than 25 million — don't have dental care.

The estimates of people in need seem to be shifting and are contradictory depending on who researches and interprets the data, and for what reason.

Many of those in need live in areas, often rural, that lack enough dentists to fill the needs of residents. California seems to be the only state with an abundance of dentists, at least in comparison to other states.

Some officials in various states estimate that need will increase by at least 5 million just for children by 2014. The increase will be largely because of new federal health care reform that will increase the eligibility of children.

The ADA issued this statement in a press release, “Lawmakers, charitable organizations and other stakeholders — some of them with very little experience in or understanding of oral health care — are proposing various models for so-called ‘mid-level’ dental providers, nondentists who would perform surgical/irreversible procedures. To date there has been no consensus on the specific prerequisites, scope or duration of educational program, or other critical attributes needed to define any academic model.”

The ADA added, “While we appreciate the work that went into (the AAPHD papers), we disagree on a critical point: The ADA does not believe nondentists should perform (any) surgical/irreversible procedures.

“The ADA supports innovations in the dental team that would improve oral health among people who lack adequate access to care, provided that those innovations do not compromise the very system they seek to extend. Our own Community Dental Health Coordinator pilot project seeks to do that by training community health workers who specialize in oral health education and disease prevention, factors that ultimately are the nation’s best hope of ending what we all agree are unacceptable levels of oral disease.”

For now, it looks like dental therapists may soon become a permanent feature in the area of American dentistry, and the movement is gaining momentum and may soon be unstoppable.

See various UCLA dental studies on related topics.

Mel Borup Chandler lives in California. He writes about science-related topics, technological breakthroughs and medicine. His email address is

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