Dental Therapists – the first post

On May 10, 2013, in Dental Therapists, by kbatchelder


This is the first post on  I hope this site can help improve access to quality dental care by sharing information and fostering discussion about dental therapists.

I am going to start that discussion by addressing what I see as a core issue in the “controversy” about dental therapists – Economics.

On July 25, 2012, the American Dental Association (ADA) released a report,  written by ECG Management consultants, “The midlevel dental provider (MLP) model is not economically realistic or sustainable,” (Study of Alternative Dental Providers Five-State Comparison Summary Report)

I found Dr. Friedman’s analysis and deconstruction of this report fascinating,  “Is the ADA’s midlevel provider economic analysis fair?”   He says, “The ADA studies on the economic viability of alternative dental providers released this week have more holes in them than a slice of Swiss cheese.”

The studies actually documented the financial feasibility of a dental therapist “within a larger dental practice.” Yet, the overall summary conclusion is that “the introduction of additional providers does nothing to address this issue [of providing care to underserved populations].

Frankly, if I were a dues-paying member of the ADA, I would demand my money back for sponsoring a study that is so transparently an effort to disparage dental therapists without offering a reasonable alternative to providing dental care for our neglected populations.

Dr. Hinden chimes in with, “ADA misses opportunity with MLP analysis.”

The ADA needs to raise the tone and quality of the discussion, which has for too long been derisive and shrill, too often based on bias rather than evidence. This will only happen when leadership rises to the challenge. Judging from increasing attention being focused upon therapists, by public media, health-related foundations, public health dentists, and governments, it is time for the ADA to reconsider its longstanding opposition to therapists, particularly in pilot/demonstration projects.

According to the New York Times, Low-Cost Dental Care Ignites Wide Debate”, the ADA also plays the “patient safety” card.

But the American Dental Association, the nation’s leading dental society, opposes the use of nondentists for “irreversible procedures” — including drilling and extraction — citing patient safety.

I believe that  Dentistry can be viewed as a guild (Wikipedia, a guild is an association of artisans who control the practice of their craft in a particular town).  Guilds have been accused of rent seeking (Wikipedia, a famous example of rent-seeking is the limiting of access to lucrative occupations, as by medieval guilds or modern state certifications and licensures.)

I have heard arguments like this before in the medical setting,  when nurse practitioners and physician assistants were introduced.

I am reminded of this aphorism – When someone says, ‘It’s not the money, it’s the principle of the thing’, it’s the money. – Kin Hubbard (1868 – 1930)

What do you think?

Add your perspective in the Forum.



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