Winter 2017-18

18 New Mexico Dental Journal, Winter 2018 It is actually rather hard to define exactly what dental therapy is. Dental therapists do not have a unique scope of practice or educational pathway. Lack of definition has led to a rather amorphous model that is easily reinterpreted by different interests to fit political needs rather than prevalent dental needs. Like a mule, the result is neither horse nor donkey and is not really reproducible. So, the Dental Health Aide Therapist (DHAT) of Alaska and the Advanced Dental Hygiene Practitioner (ADHP, renamed Advanced Dental Therapist) of Minnesota, have spawned offspring which resemble both and neither in Maine and Vermont. Actually, we only know the genetics of the Maine and Vermont offspring since they remain years away from giving birth to any actual dental therapists. It should also be noted that no dental therapists from one state can practice in any of the other states. The Dental Health Aide Therapist The dental therapist of Alaska is not licensed and therefore is restricted to practice outside the jurisdiction of their state’s board. The original DHATs were trained in New Zealand and recruited from rural Native Alaskan villages to practice in remote communities in frontier Alaska. They have been joined by others that are now trained in Bethel, Alaska, in a program operated by the University of Washington. The three year program has no college prerequisites. They were placed in rural health care facilities that rarely saw visiting dentists and were located many hours by air from fully staffed dental clinics. DHATs provide a broad range of treatment that includes restorations, extractions and crowns, and endo on pediatric patients. They work under the supervision of dentists usually located in Bethel via voice and data communications link. Not surprisingly, communities that had almost no care previously, benefit from the preventive and restorative services they provide. Unfortunately, there is very little reliable data coming out of this program because it is largely controlled by interests with a financial stake in the outcome. Would other existing dental team models have a comparable effect? No one knows because the program is effectively proprietary with education, employment, practice resources and patient care controlled by the same entities. The Alaska program became a source of contention between organized dentistry and Native Americans in 2006 when the ADA joined a lawsuit brought by the Alaska Dental Association that challenged the right of the Native Alaskan health care corporations to operate outside the jurisdiction of their state board. Some tribes in the lower 48 mistakenly took this to be a challenge to tribal sovereignty and although the suit was settled in Alaska, the ADA was wrongly held responsible for provisions in federal law that restrict the use of some federal funds to support DHATs outside Alaska. The ADA has not challenged the right of the tribes to utilize any practice model within tribal jurisdictions, but has been working diligently to help the tribes address oral health problems while encouraging them to adopt the CDHC as a more responsive solution to tribal needs. In New Mexico, the ADA has provided financial and logistical support to Navajo students at CNM. THE MINNESOTA DENTAL THERAPIST AND ADVANCED DENTAL THERAPIST An advanced degree dental hygienist and educator in Minnesota, used her doctoral dissertation to postulate a dental hygienist trained to provide restorative and other services beyond the existing scope of dental hygiene. This model was adopted by the American Dental Hygienists Association as the Advanced Dental Hygiene Practitioner and became part of that organization’s platform for state legislative action. With the help of an ardent state legislator, the Minnesota Dental Hygienist Association (MDHA) forced a legislative agreement in 2009, that included the Minnesota Dental Association (MDA) and dental educators to develop a dental “mid-level” model.  The taskforce did extensive research internationally, considering both the Alaskan DHAT and the ADHA’s preferred model and was unable to reach a unified agreement on what the model would look like, ultimately deciding on two different educational paths and scopes of practice. One model, “favored” by the MDA, came to be known as the dental therapist. This program required two years of college prerequisites and two and a half years of clinical dental training at the University of Minnesota Dental School. This resulted in a bachelor of dental therapy degree and allowed dental therapists to perform restorations under indirect supervision and less invasive procedures under general supervision. They were specifically prohibited from prophylaxis or periodontal procedures, unless they received a separate dental hygiene degree. State of the Workforce | continued 2018