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
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
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
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
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,
- 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
- 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.
need more hygienists.<br />Not more administrative dower without requirements of a nurse Dr or hygienist.<br /><br />sincerely<br />Dr. BDC<br />http://www.emergencydentistdownersgrove.com/
Posted by: Brian (firstname.lastname@example.org) on 05/16/2011