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Permanent link  Q andamp; A on the Minnesota dental therapist


The American Dental Association passed the following information along to state and component societies about the newly signed legislation in Minnesota creating a dental therapist.

After completing a bachelor's degree program, the dental therapist will be able to practice in underserved location and and perform procedures, including restorations and primary extractions with the indirect supervision of a dentist.

Below are answers to some of the commonly asked questions as provided by the ADA's State Government Affairs Department.

The Minnesota Dental Association has also created a catalog of links to news coverage on this legislation.

Q: How did this happen?

A: Two years ago proponents of the American Dental Hygiene Associations' Advanced Dental Hygiene Practitioner (ADHP) introduced legislation to create that position in Minnesota. As designed, the model provides for the ADHP to perform surgery without a dentist being on-site and with virtually no supervision.

The legislation gained momentum in the Senate, but an aggressive media and lobbying effort by the Minnesota Dental Association (MDA) stalled it in the House. The MDA strove to educate lawmakers about the shortcomings of the ADHP model. MDA built a coalition of oral healthcare providers to oppose the legislation and mobilized dental students and others to testify in hearings as well as attend lawmakers' local meetings to speak out on the ADHP issue.

A number of former hygienists who now are dental students were particularly effective in speaking to the dramatic differences between dental and dental hygiene education and training. To help shape communications efforts around these issues, the ADA conducted extensive qualitative and quantitative opinion research.

MDA offered a variety of more realistic proposals to improve access to care, including the Community Dental Health Coordinator (CDHC) as a more integrated member of the dental team and an alternative to the ADHP. Ultimately, the MDA and its allies created enough controversy to scale back the legislation dramatically to the creation of a task force charged with making recommendations about an Oral Health Practitioner (OHP) for the legislature to consider in 2009. However, even this legislation was a turning point-the question was no longer whether to create midlevel providers, but rather how to do so.

The task force included representatives from the MDA, the University of Minnesota School of Dentistry, the Minnesota State Colleges and Universities, the Minnesota Dental Hygienists Association, the Minnesota Board of Dental Examiners and the Safety Net Coalition (SNC).

Unfortunately, the task force was unable to reach consensus. With the political and legal wind assuring the creation of a mid-level provider, the MDA put its efforts into ensuring patient safety and keeping the dentist as the head of the dental team. The state society made the difficult decision to endorse the alternative model proposed by the University of Minnesota School of Dentistry. The dental school's plan provided for an integrated member of the dental team, educated in an accredited dental school, working with the supervision of a dentist. Any procedure permitted in the therapist's scope would be taught to the same standard as a dentist.

The OHP Task Force narrowly approved recommendations that closely mirrored the ADHP design, and sent its report to the legislature. The MDA, the dental school and others offered alternative reports and findings that staked out the principles of one standard of education, patient safety and an integrated dental team as opposed to the fractured model offered by ADHP or OHP.

With the start of the 2009 legislative session both the OHP and dental therapist models garnered legislative support. Looking to avoid conflict, legislators put both provisions into the same bills and appeared poised to pass them both. With that prospect, MDA undertook a print, radio and web ad campaign with support from the ADA State Public Affairs program to raise public and policymaker awareness about the lack of supervision and varying standards of education that led to patient safety concerns in the OHP model. In the wake of that campaign, the Senate considered an MDA-supported amendment to remove the OHP scope, supervision and education requirements and replace them with those of the dental therapist. While that amendment failed by a single vote, it was a far closer outcome than anyone had predicted and provided real momentum heading into the House of Representatives.

In the end, the House the Speaker decided to direct a negotiated settlement. Ultimately the result of that process very closely tracked the School of Dentistry model and the MDA principles.

Q: What exactly will the dental therapist do, and under what level of supervision?
A: The basic dental therapist will qualify for licensure upon graduation from a Bachelor's degree dental therapy program. The University of Minnesota School of Dentistry has stated that it will offer the program as of September 2009, but other institutions may develop them as well. A concern is that the Minnesota State Colleges and Universities system (MnSCU) which had originally agreed to host the ADHP program is exploring advanced placement for dental hygienists with a Bachelor's degree in their version of the dental therapy program (Bachelor's level). The extent, to which the Dental Board will authorize that process without placing the program at risk of not being approved by the Board, remains to be seen.

The Dental Board will grant a therapist license to a candidate who has successfully completed the program and passed a clinical exam, The therapist will work in a dental office with the indirect (on-site) supervision of a dentist, and will be able to provide a range of dental services for the underserved including restorations and extraction of primary teeth.

The supervising dentist must authorize any surgical procedures before treatment may commence. Further, the supervising doctor will be on site to deal with any complications or emergencies.

After practicing as a dental therapist for at least 2000 hours, a candidate may choose to pursue a two-year Master's degree in advanced dental therapy. Upon successfully completing that program and passing a clinical exam, an advanced therapist could practice in a separate site from the supervising dentist. However, any surgical procedure would still have to be specifically approved and authorized by the dentist prior to treatment. The advanced therapist also could extract permanent teeth with a mobility factor of +3 to +4, but only with preauthorization from the supervising dentist. By retaining a level of supervision by the dentist, the MDA has to the extent possible kept the dental team intact, with the dentist as the comprehensive leader of that team.

The law requires the dental board to report to the legislature in 2014 about the safety of dental therapists, the cost-effectiveness of the program and its impact on access to dental care.

Q: What about dental hygiene?
A: The dental therapist program excludes much of the dental hygiene scope of practice. Dental therapists will not perform prophys. The skill set required for a dental therapist is different than that of a dental hygienist.

Claims that the dental therapist law is a breakthrough for proponents of the ADHP model are overstated, to say the least. To become a basic dental therapist one must complete a dental therapy Bachelor's degree. Whether one holds a degree or license in another allied dental profession does not matter. Without the dental therapy degree, one cannot be licensed and cannot practice as a dental therapist. The requirements for admission to the Master's level program are completion of the Bachelor's level therapist program and at least 2,000 hours of practice as a therapist. While someone holding a different type of allied dental professional degree will be free to apply and enroll in either dental therapy program, they will have to complete the appropriate dental therapy degree to practice as a therapist.

Q: How will dental therapists be limited to caring for the underserved?
A: The law sets strict guidelines for the patient base therapists can serve and the areas in which they can practice, including:

  • Critical access dental clinics (which are operated by dentists who receive enhanced reimbursement from Medicaid because they treat a high volume of Medicaid patients);
  • The usual assisted living facilities, FQHCs, etc.;
  • A collaborative hygiene setting (although this would only apply to an advanced therapist, because a basic therapist could not perform surgical procedures with no supervising dentist on the premises);
  • Military and VA facilities;
  • Dental or dental therapy schools; and
  • Any other setting where at least 50 percent of the therapist's patients are among the following groups:
  • Enrollees of a state publicly funded health care program,
  • Having no private or public dental coverage and are at 200 percent FPL or below; or
  • The patients or practice is in a designated DHPSA.


access to care , legislation ,

need more hygienists.<br />Not more administrative dower without requirements of a nurse Dr or hygienist.<br /><br />sincerely<br />Dr. BDC<br />

Posted by: Brian ( on 05/16/2011