Winter 2017-18

20 New Mexico Dental Journal, Winter 2018 Vermont is currently working toward getting a qualifying program started, and may be seeking provisional accreditation in the next 1-2 years. For the most part, Maine and Vermont have followed the Minnesota model requirement that dental therapists be advanced-trained dental hygienists, however, both restrict cutting procedures to indirect supervision. Other scope issues are similar, but not identical. WASHINGTON AND OREGON DENTAL HEALTH AIDE THERAPISTS Neither Washington nor Oregon allow dental therapists to be licensed, however Native American tribes in each state are in the process of using DHATs from Alaska to practice on tribal lands and have sent or are considering sending tribal members to the training program in Alaska. Since these programs are unregulated, only time will tell exactly how they are utilized and what the extent of their scope will be. Their training will be similar to the DHATs of Alaska, but the practice settings are far less remote. Much could depend on sources of funding and their sustainability. OTHERS Legislation allowing licensing of dental therapists has passed one chamber in Michigan, Massachusetts, and New Mexico, though no bills have passed in any of those states. All have similarities and significant differences from legislation that has passed in other states. All utilize advanced-trained dental hygienists in CODA-accredited programs and limit cutting procedures to indirect supervision. None of the legislation is modeled specifically after legislation in other states. Other states have seen legislation or proposals to license dental therapists, with more limited action. Most begin as hygienist- based or rapidly morph into that model to gain acceptance by the dental hygienist lobby. Curiously, a recent critique by advocates, of dental therapy trends, in the Journal of Public Health Dentistry , suggested that there are a number of reasons this should not be the preferred model. This echoes a Foundation- funded study from several years ago that concluded that the financial viability of dental therapists in most countries required that they not spend time performing functions that are better provided by assistants and hygienists. It is also worth noting that the decades-old dental therapy program in Canada was recently discontinued because dental therapists trained in government- funded programs were steadily migrating to the private sector. It is really not a wonder that the dental therapist “movement” is characterized by a bit of chaos. The barriers to oral health care are not primarily workforce issues outside of the ultra-remote villages of the Alaskan frontier. However well-intentioned, dental mid-levels, regardless of model, are poorly adapted to the challenges dentistry faces. Mid-levels in medicine were created to solve an acute shortage of primary care providers, anesthesiologists, and people delivering babies. There is no similar shortage in dentistry. Addressing the barriers to oral health care when financial resources are so limited is going to require serious and thoughtful attention to details and careful planning to overcome specific problems. K-league chaos may be cute when you are in Kindergarten, but it is a waste of valuable resources that should be taking down barriers to care. State of the Workforce | continued 2018 1397 2814 HYGIENISTS NM DENTAL BOARD (NOVEMBER 2017) 204,990 327,290 BUREAU OF LABOR STATISTICS (MAY 2016) DENTISTS 1171 NM HEALTHCARE WORKFORCE REPORT 2017 ADA 2106 DENTAL ASSITANTS 196,441 STATE AND NATIONAL WORK FORCE NUMBERS State of the Workforce FAST FACTS