In the first long-term study of dental therapist utilization, University of Washington researchers have found that greater access to the therapists’ services in Alaska resulted in more use of preventive dental services and fewer extractions among adults and children. In addition, fewer children with more access required extractions of their four front teeth.
Researchers led by Dr. Donald Chi of the School of Dentistry analyzed 10 years of electronic health records and Medicaid claims data (from 2006 through 2015) for residents of Alaska’s Yukon Kuskokwim Delta communities.
The electronic health records also showed that higher availability of dental therapists was significantly linked to a lower incidence of children having dental care under general anesthesia, which is usually related to extensive dental work. Medicaid records, however, did not show a similar correlation.
“There appear to be clinically meaningful differences between communities with no dental therapists and communities with the highest number of dental therapist treatment days,” the report concluded.
“Our study shows that in a relatively short time period, dental therapists have made a difference,” Dr. Chi said. “Dental therapists in Alaska Native communities were associated with significantly higher rates of preventive care use and lower rates of extraction – for both children and adults. These findings should be of great interest to lawmakers who support evidence-based policymaking.”
These dental providers, also known as dental health aide therapists (DHATs) or midlevel providers, have been employed in New Zealand and other countries for nearly a century. They receive basic dental training, but unlike dental hygienists, they can perform irreversible procedures such as extractions and fillings. In the Yukon Kuskokwim Delta, where the therapists were first deployed in 2006, they are recruited from local communities and work under the supervision of licensed dentists.
Alaskans face two major challenges in oral health. Not only does much of the population, especially Alaska Natives, have a significantly greater incidence of dental disease, but access to dental care can be severely limited in the state’s interior.
“Tooth decay is major public health problem in the United States,”Dr. Chi said. “Children go to bed with unresolved toothaches and they miss school because of the pain. Adults have trouble finding work because of missing teeth. Poor oral health perpetuates the cycle of poverty. Dental therapists are a starting point in addressing the consequences of dental disease and solving oral health inequalities in communities that lack dental providers.”
Dr. Chi noted that the study does have some limitations, noting that it was only observational and could not draw conclusions about cause and effect. “We did not assess unmet dental care needs, disease prevention, and quality of life,” the study also noted.
“Dental care use is not a panacea,” the study also cautions. “This underscores the importance of other behaviors relevant in oral health such as limiting sugar intake, optimizing fluoride exposure, and tobacco cessation.”
The study recommends that future research examine how extensively the Alaskan Native dental care network helps patients with strategies for behavioral changes and how their behavior and habits are influenced by dental therapists.
“This is especially relevant in in the Yukon Kuskokwim Delta, in which dental therapists maintain familial ties, share a common history, and understand the strengths and challenges as experienced by local populations,” the study says. “The eventual goal would be to harness the dental care delivery system as a way to improve oral health behaviors among individuals and norms within families and communities.”
The study is under review for publication by the PLOS ONE journal.