Developed countries have been using midlevel dental providers for decades. New Zealand, for example, has licensed dental nurses (equivalent to a dental therapist) for almost a century. In 2004, the U.S. government’s Indian Health Service partnered with New Zealand to train and license dental health aide therapists to serve rural communities in western Alaska as part of the Alaska Native Tribal Health Consortium’s Community Health Aide Program. By 2005, the first therapists were practicing in Alaska. Today, they serve 81 rural communities with a combined population of more than 40,000.
In more recent years, state legislatures in Minnesota, Maine and Vermont have started to use midlevel dental providers. In 2009, Minnesota created licenses for dental therapists and for advanced dental therapists. These two designations differ in the level of supervision required, but both allow license holders to perform a variety of important preventive and routine procedures, including filling cavities and some extractions. In 2014, Maine passed a law authorizing dental hygiene therapists, and in June 2016 Vermont passed a similar law. Twelve other states have introduced legislation in 2016 to create midlevel dental providers like those in these three states.
There are minor differences in how midlevel dental providers work in different states. But the reason for creating a new provider position is similar: to increase dental care access for underserved groups and boost the supply of dental providers to meet the challenges of an aging dentist workforce. In Minnesota, where dental therapists have been practicing the longest in the U.S., this approach appears to be working. A 2014 report by the Minnesota Department of Health and the Minnesota Board of Dentistry found that the introduction of dental therapists and advanced dental therapists is working as planned. They have increased access to care for underserved populations and enabled dental practices to treat more uninsured and Medicaid patients. The report also found that patients of these midlevel providers were generally satisfied with the services they received and that demand for these professionals is growing.
There is also some evidence that hiring midlevel providers increased the efficiency of dental practices. A case study of one Minneapolis community or safety net clinic — a treatment center that primarily serves low-income patients — found that a single dental therapist performed 1,756 patient visits in a single year. Moreover, increased patient volume at the clinic generated revenues that exceeded the cost of employing the dental therapist by more than $30,000 and allowed the clinic to hire another midlevel provider.
These findings corroborate research showing that midlevel dental providers can safely perform about half the procedures done at safety net dental clinics, 80 percent of procedures done at community clinics, and more than half of those done at hospital-based clinics. The reason for this is simple: Midlevel dental providers are trained to perform procedures that are most common, like filling cavities and extracting teeth — procedures that are also in high demand among underserved and uninsured populations.