- Email: [email protected]
Dental therapists
THE BIG PICTURE Improved dental care delivery Background.—Over the past 60 years, the quality of dental care has improved, but there remains a significant portion of the U.S. population who are underserved. They lack access to the regular dental care that would improve their oral health. Most of the oral disease occurs among underserved populations, just as it did 10 years ago. The problem involves not only the distribution of dental healthcare providers but also an anticipated manpower shortage. Efforts are now being made to encourage more young people to become involved in dentistry and to bring dentists and physicians into closer working relationships. Predental Programs.—Predental programs have been introduced successfully at the high school level, beginning at ninth grade. As students progress, they can learn dental assisting, with enough coursework and clinical experience completed by graduation to permit them to become dental assistants. If they choose to continue their dental studies, they will have a head start professionally. Dental-Medical Links.—Dentists and physicians would benefit from more collaboration and communication. Research has documented the relationship between oral disease and systemic involvement and shown the potential for oral diagnostics to reveal systemic problems in patients before symptoms develop. The dentist is in a unique position to work closely with medical colleagues with respect to oral diagnostics. Saliva, in particular, has shown promise as a diagnostic fluid. What remains unclear, however, is whether the dentist or the physician will be the one to isolate certain conditions. Even though many dentists may suspect hyperglycemia
on the basis of a patient’s history and/or oral examination, they must currently report their findings to the patient’s physician, who makes the diagnosis. Physicians are being encouraged to learn more about the oral cavity. In an initiative developed at the Drexel University College of Medicine, second-year medical students can elect to attend lectures on oral health and spend time at the Kornberg School of Dentistry at Temple University, observing an emergency clinic and the pedodontic department. This will make them much better informed about the oral cavity.
Clinical Significance.—A powerful message was sent with the tragic death of Deamonte Driver. Congress can no longer sweep the problem of underserved populations, especially those lacking dental care, under the rug. Medical insurers are also recognizing the value of fluoride varnish applications to reduce the incidence of early childhood caries, a plague in underserved communities. It is hoped that the next 10 years will see significant progress in these areas.
Cohen DW: Improving oral healthcare delivery. Compend Contin Educ Dent 32:96, 2011 Reprints not available
Dental therapists Background.—Dental therapists have provided basic dental care and more in over 53 countries worldwide. These practitioners are now licensed to perform prophylaxis, sealants, fillings, stainless steel crowns, pulpotomies, and
simple extractions with local anesthesia for Alaska’s native population in rural areas. Minnesota has also authorized dental therapist training to provide dental care in underserved areas of that state. Several dental associations are
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Issue 4
2011
179
reviewing the potential presented by dental therapists to address the access to care problem in the United States. The development and acceptance of dental therapists in other countries reveal positive benefits these practitioners may offer. Development.—New Zealand found that many of its young men and women were rejected for military service during World War I because of severe, rampant dental disease. As a consequence, a training school for ‘‘dental nurses’’ was established in 1920 to treat children aged % 12 years in school dental service sites. Adolescents and adults were treated by private practicing dentists. By the 1970s, >60% of preschoolers and 95% of school-aged children were enrolled in the program. Permanent tooth loss was nearly eliminated long before water fluoridation came about. Other countries facing similar widespread dental disease and dentist shortages adopted the New Zealand dental model. Today, most countries are underdeveloped with respect to their ability to provide oral health care to their entire population. Dental therapist programs that are widely accepted by the public have been established in many countries, with more than 14,000 dental therapists practicing worldwide. In addition, China has about 25,000 ‘‘assistant dentists’’ who have similar training and practice independently in rural areas. Supervision and Quality of Care.—Since the 1950s, studies of dental therapists have shown that they maintain technical standards similar to those of dentists. Part of their training includes an understanding of their limitations, their parameters of care, and their need to work closely and consult with dentists. Even when dental therapists are permitted to practice independently, regulations usually require that they maintain a consultative collaboration with a supervising dentist. In New Zealand and Malaysia, dental therapists have been especially successful, with nearly 100% of elementary and more than half of secondary schoolchildren seen by school dental nurses or dental therapists. Current Trends.—In New Zealand, >95% of children aged <13 years and 56% of preschoolers receive preventive and curative oral health care through dental therapists on the school grounds. There is virtually no untreated dental caries by the end of the school year. Mobile units and community health (hub) centers that promote a team approach are increasingly being used. Adolescents aged 13 and 18 years can receive care from private practitioners at no cost to the patient; however, only 54% access private dentists. Water fluoridation has reduced the number of caries and the number of dental therapists employed. In 2007, schools merged the dental therapist and dental hygiene programs into a single 3-year program with a bachelor of oral health degree. At graduation, candidates must choose either general dental therapy practice or general dental hygiene practice. The former is allowed only to treat patients
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to age 18 years. Since 2003, oral health therapists are also allowed to work in the private sector for dentists and care for adolescent patients, but most provide dental therapy through the School Dental Service. Dental therapists can own a practice as long as they have a supervisory contract with a dentist. In 2008, about 60% of dentists in private practice said they would be willing to employ a dual-trained therapist/hygienist. As the population increases and the existing workforce shrinks, a shortage of dental therapists is anticipated. In Australia, 87% of dental therapists are employed at least part-time in schools. In Western Australia, dental therapists have always worked in private practice and public service, and since 1983, they have been allowed to treat adults as prescribed by dentists. Some dental hygiene skills are required, but training is limited to a single 6- to 12-week course. In the public sector, dental therapists can only serve children and adolescents to age 18 years but do not require a dentist’s diagnostic prescription. At present, several universities offer 3-year ‘‘oral health therapist’’ programs that combine traditional dental therapy and dental hygiene, as in New Zealand. Most dental therapists now work in the private and public sectors concurrently, with many filling parttime positions. In Great Britain, 17 schools provide dual qualification in dental therapy and dental hygiene. Dual qualifications are preferred because of a shortage of dental therapist positions in government and hospital sites. Since 2002, dental therapists have been allowed to work in private dental practices, and 5% of them are now employed in these sites. More than half work part-time, about two-thirds work in multiple locations and are paid an hourly or monthly salary, and one-third are self-employed. Both adults and children are treated. The training programs for dentists and dental therapists are often the same. However, a written treatment plan is first developed by a registered dentist, then the dental therapist is free to implement treatment independently. As yet, the National Health Service does not pay for treatment by dental therapists in private practice. In addition, most of the British public does not know the role dental therapists fill. Patients treated by dental therapists, however, are more satisfied than those treated by dentists. In Fiji, in 1998, a ‘‘multientry multiexit’’ career ‘‘Dental Ladder’’ was established. This modular approach to dental education gives full credit to work experience; thus, only a second year of training after the first year of introductory dental assisting courses is needed to obtain certification as a dental hygienist. After 3 years, the student obtains a diploma in dental therapy and after 5 years, the equivalent of a U.S. DDS/DMD degree. Entry into the ladder is determined by the needs and monetary availability, as assessed by the Ministry of Health. Dental therapists perform preventive and restorative services and extractions on both adults and children.
Canada presently has 280 to 300 dental therapists who serve in governmental, nongovernmental, territorial, and aboriginal organizations, with about 45% in private practice. By the 1980s, >80% of school children received annual examination, and preventive and restorative treatments in school and community clinics. However, declining financial support led to the current situation, where children receive care only from the private dental sector, and there has been a sharp decline in use and a sharp increase in untreated dental disease. Dental therapists serving in Saskatchewan are self-regulating professionals, licensed by the Dental Therapists Association. They are required to have a formal referral or consulting relationship with a dentist. In general, they are well-incorporated into the private sector by dentists, and continue to serve in the public sector as colleagues on the dental team. In The Netherlands, there are no longer dental therapists and dental hygienists, but rather a combination of the two that is called a ‘‘dental hygienist.’’ This professional provides basic preventive and periodontal services, basic restorative treatment, and noncomplex extractions. A 3- to 4year degree is required. The ‘‘prevention assistant’’ is a trained dental assistant who does prophylaxis, including supragingival scaling and fluoride applications, and is paid less than a dental hygienist. Dentists’ practice is devoted more toward medically compromised and elderly populations who require more knowledge along with greater skill
and experience. Eventually, dental hygienists will provide routine oral health care for younger, healthier patients. This quantum change in dental care was supported by other professional organizations, educational institutions, consumer organizations, and the health insurance industry, but was opposed by Dutch dental professionals.
Clinical Significance.—Dental therapists have a long history of service worldwide, as demonstrated by the five representative countries outlined. They have contributed significantly to the health of underserved populations and been used effectively in private dental practices. Advocates of dental therapists believe that adding them to the oral health workforce in the United States would provide a positive effect, permitting dentists to practice at a higher level of proficiency and efficiency.
Friedman JW: The international dental therapist: History and current status. Calif Dent Assoc J 39:22-29, 2011 Reprints available from JW Friedman, 3057 Queensbury Dr, Los Angeles, CA 90064; e-mail: [email protected]
EXTRACTS WHAT ARE YOU THINKING? The human mind is uniquely capable of focusing on the nonpresent. However, this comes at a price according to new research. When people’s minds drift from the task or activity in which they are engaged, they feel less happy than when they are completely focused. The 2250 participants were drawn from 83 counties, had many different occupations, and were between the ages of 18 and 88 years. They were prompted at random times using an iPhone Web application to report how they were feeling, what they were doing, whether they were thinking about something other than what they were doing, and whether the thoughts were pleasant, unpleasant, or neutral. Subjects spent almost 47% of their waking hours with their minds wandering. About 43% reported thinking pleasant thoughts, about 27% unpleasant thoughts, and 31% neutral thoughts. Even people thinking happy thoughts, however, were less happy than those who were fully engaged in the present. The only activity in which people were quite good at remaining focused mentally was making love, with just 10% of people reporting wandering thoughts. People also reported being happiest while making love, exercising, or talking with others, and being least happy when resting or sleeping, working, or using a computer at home. These findings provide scientific evidence that is in line with what many self-help books and religious traditions recommend—being in the ‘‘here and now’’ is essential for happiness. [Jennifer Goodwin: Happiness Is a Focused Mind. HealthDay News, November 12, 2010]
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2011
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on the basis of a patient’s history and/or oral examination, they must currently report their findings to the patient’s physician, who makes the diagnosis. Physicians are being encouraged to learn more about the oral cavity. In an initiative developed at the Drexel University College of Medicine, second-year medical students can elect to attend lectures on oral health and spend time at the Kornberg School of Dentistry at Temple University, observing an emergency clinic and the pedodontic department. This will make them much better informed about the oral cavity.
Clinical Significance.—A powerful message was sent with the tragic death of Deamonte Driver. Congress can no longer sweep the problem of underserved populations, especially those lacking dental care, under the rug. Medical insurers are also recognizing the value of fluoride varnish applications to reduce the incidence of early childhood caries, a plague in underserved communities. It is hoped that the next 10 years will see significant progress in these areas.
Cohen DW: Improving oral healthcare delivery. Compend Contin Educ Dent 32:96, 2011 Reprints not available
Dental therapists Background.—Dental therapists have provided basic dental care and more in over 53 countries worldwide. These practitioners are now licensed to perform prophylaxis, sealants, fillings, stainless steel crowns, pulpotomies, and
simple extractions with local anesthesia for Alaska’s native population in rural areas. Minnesota has also authorized dental therapist training to provide dental care in underserved areas of that state. Several dental associations are
Volume 56
Issue 4
2011
179
reviewing the potential presented by dental therapists to address the access to care problem in the United States. The development and acceptance of dental therapists in other countries reveal positive benefits these practitioners may offer. Development.—New Zealand found that many of its young men and women were rejected for military service during World War I because of severe, rampant dental disease. As a consequence, a training school for ‘‘dental nurses’’ was established in 1920 to treat children aged % 12 years in school dental service sites. Adolescents and adults were treated by private practicing dentists. By the 1970s, >60% of preschoolers and 95% of school-aged children were enrolled in the program. Permanent tooth loss was nearly eliminated long before water fluoridation came about. Other countries facing similar widespread dental disease and dentist shortages adopted the New Zealand dental model. Today, most countries are underdeveloped with respect to their ability to provide oral health care to their entire population. Dental therapist programs that are widely accepted by the public have been established in many countries, with more than 14,000 dental therapists practicing worldwide. In addition, China has about 25,000 ‘‘assistant dentists’’ who have similar training and practice independently in rural areas. Supervision and Quality of Care.—Since the 1950s, studies of dental therapists have shown that they maintain technical standards similar to those of dentists. Part of their training includes an understanding of their limitations, their parameters of care, and their need to work closely and consult with dentists. Even when dental therapists are permitted to practice independently, regulations usually require that they maintain a consultative collaboration with a supervising dentist. In New Zealand and Malaysia, dental therapists have been especially successful, with nearly 100% of elementary and more than half of secondary schoolchildren seen by school dental nurses or dental therapists. Current Trends.—In New Zealand, >95% of children aged <13 years and 56% of preschoolers receive preventive and curative oral health care through dental therapists on the school grounds. There is virtually no untreated dental caries by the end of the school year. Mobile units and community health (hub) centers that promote a team approach are increasingly being used. Adolescents aged 13 and 18 years can receive care from private practitioners at no cost to the patient; however, only 54% access private dentists. Water fluoridation has reduced the number of caries and the number of dental therapists employed. In 2007, schools merged the dental therapist and dental hygiene programs into a single 3-year program with a bachelor of oral health degree. At graduation, candidates must choose either general dental therapy practice or general dental hygiene practice. The former is allowed only to treat patients
180
Dental Abstracts
to age 18 years. Since 2003, oral health therapists are also allowed to work in the private sector for dentists and care for adolescent patients, but most provide dental therapy through the School Dental Service. Dental therapists can own a practice as long as they have a supervisory contract with a dentist. In 2008, about 60% of dentists in private practice said they would be willing to employ a dual-trained therapist/hygienist. As the population increases and the existing workforce shrinks, a shortage of dental therapists is anticipated. In Australia, 87% of dental therapists are employed at least part-time in schools. In Western Australia, dental therapists have always worked in private practice and public service, and since 1983, they have been allowed to treat adults as prescribed by dentists. Some dental hygiene skills are required, but training is limited to a single 6- to 12-week course. In the public sector, dental therapists can only serve children and adolescents to age 18 years but do not require a dentist’s diagnostic prescription. At present, several universities offer 3-year ‘‘oral health therapist’’ programs that combine traditional dental therapy and dental hygiene, as in New Zealand. Most dental therapists now work in the private and public sectors concurrently, with many filling parttime positions. In Great Britain, 17 schools provide dual qualification in dental therapy and dental hygiene. Dual qualifications are preferred because of a shortage of dental therapist positions in government and hospital sites. Since 2002, dental therapists have been allowed to work in private dental practices, and 5% of them are now employed in these sites. More than half work part-time, about two-thirds work in multiple locations and are paid an hourly or monthly salary, and one-third are self-employed. Both adults and children are treated. The training programs for dentists and dental therapists are often the same. However, a written treatment plan is first developed by a registered dentist, then the dental therapist is free to implement treatment independently. As yet, the National Health Service does not pay for treatment by dental therapists in private practice. In addition, most of the British public does not know the role dental therapists fill. Patients treated by dental therapists, however, are more satisfied than those treated by dentists. In Fiji, in 1998, a ‘‘multientry multiexit’’ career ‘‘Dental Ladder’’ was established. This modular approach to dental education gives full credit to work experience; thus, only a second year of training after the first year of introductory dental assisting courses is needed to obtain certification as a dental hygienist. After 3 years, the student obtains a diploma in dental therapy and after 5 years, the equivalent of a U.S. DDS/DMD degree. Entry into the ladder is determined by the needs and monetary availability, as assessed by the Ministry of Health. Dental therapists perform preventive and restorative services and extractions on both adults and children.
Canada presently has 280 to 300 dental therapists who serve in governmental, nongovernmental, territorial, and aboriginal organizations, with about 45% in private practice. By the 1980s, >80% of school children received annual examination, and preventive and restorative treatments in school and community clinics. However, declining financial support led to the current situation, where children receive care only from the private dental sector, and there has been a sharp decline in use and a sharp increase in untreated dental disease. Dental therapists serving in Saskatchewan are self-regulating professionals, licensed by the Dental Therapists Association. They are required to have a formal referral or consulting relationship with a dentist. In general, they are well-incorporated into the private sector by dentists, and continue to serve in the public sector as colleagues on the dental team. In The Netherlands, there are no longer dental therapists and dental hygienists, but rather a combination of the two that is called a ‘‘dental hygienist.’’ This professional provides basic preventive and periodontal services, basic restorative treatment, and noncomplex extractions. A 3- to 4year degree is required. The ‘‘prevention assistant’’ is a trained dental assistant who does prophylaxis, including supragingival scaling and fluoride applications, and is paid less than a dental hygienist. Dentists’ practice is devoted more toward medically compromised and elderly populations who require more knowledge along with greater skill
and experience. Eventually, dental hygienists will provide routine oral health care for younger, healthier patients. This quantum change in dental care was supported by other professional organizations, educational institutions, consumer organizations, and the health insurance industry, but was opposed by Dutch dental professionals.
Clinical Significance.—Dental therapists have a long history of service worldwide, as demonstrated by the five representative countries outlined. They have contributed significantly to the health of underserved populations and been used effectively in private dental practices. Advocates of dental therapists believe that adding them to the oral health workforce in the United States would provide a positive effect, permitting dentists to practice at a higher level of proficiency and efficiency.
Friedman JW: The international dental therapist: History and current status. Calif Dent Assoc J 39:22-29, 2011 Reprints available from JW Friedman, 3057 Queensbury Dr, Los Angeles, CA 90064; e-mail: [email protected]
EXTRACTS WHAT ARE YOU THINKING? The human mind is uniquely capable of focusing on the nonpresent. However, this comes at a price according to new research. When people’s minds drift from the task or activity in which they are engaged, they feel less happy than when they are completely focused. The 2250 participants were drawn from 83 counties, had many different occupations, and were between the ages of 18 and 88 years. They were prompted at random times using an iPhone Web application to report how they were feeling, what they were doing, whether they were thinking about something other than what they were doing, and whether the thoughts were pleasant, unpleasant, or neutral. Subjects spent almost 47% of their waking hours with their minds wandering. About 43% reported thinking pleasant thoughts, about 27% unpleasant thoughts, and 31% neutral thoughts. Even people thinking happy thoughts, however, were less happy than those who were fully engaged in the present. The only activity in which people were quite good at remaining focused mentally was making love, with just 10% of people reporting wandering thoughts. People also reported being happiest while making love, exercising, or talking with others, and being least happy when resting or sleeping, working, or using a computer at home. These findings provide scientific evidence that is in line with what many self-help books and religious traditions recommend—being in the ‘‘here and now’’ is essential for happiness. [Jennifer Goodwin: Happiness Is a Focused Mind. HealthDay News, November 12, 2010]
Volume 56
Issue 4
2011
181