OKPOLICY.ORG
This guest post was written by Michelle Dennison, Vice President of Policies and Prevention at the Oklahoma City Indian Clinic, and Julie Seward, the Oral Health Programs Manager at the Southern Plains Tribal Health Board.
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Oklahoma does not have the number of oral health providers needed to support its population, with 48.5 dental care providers per 100,000 people compared to 61.0 nationally. Nearly 1 in 4 Oklahomans live in counties considered dental health professional shortage areas, hindering access to care, and the state has a failing grade in oral health.
The lack of oral health providers in these areas leaves residents with few options other than to travel long distances for care or forgo care entirely. Without other options, patients often turn to urgent care facilities and emergency rooms. This adds unnecessary costs to the patient and the state, and it ultimately leaves the root cause of dental issues untreated.
Allowing dental therapists to practice in Oklahoma would significantly increase access to services. These professionals — who provide basic preventive and restorative treatment to children and adults — can bring care directly to people where they are, such as in schools, nursing homes, tribal communities, and rural areas. They could support other dental professionals working in these settings. Dental therapists are licensed professionals that provide some of the most common dental procedures, such as exams and fillings. They work under the supervision of a dentist, and they can reach underserved areas through telehealth technology and off-site (i.e. general) supervision.
Dental therapy is one policy option to improve access to dental care in Oklahoma.
Dental therapists have been working in the U.S. for 17 years and are currently authorized to work in 13 states and several tribes. While dental therapy providers have been working globally for a century, the dental therapy profession was brought to the U.S. by Alaska Native communities seeking to improve oral health amid a chronic shortage of dentists. Under federal authority, these communities created the Community Health Aide Program (CHAP) that included Dental Health Aide Therapists (DHAT) that focused on educating Alaska Natives to deliver the dental care their communities needed most. By focusing the scope of dental therapists on a small set of commonly needed procedures such as exams and fillings, they were able to create an accessible and affordable program to improve dental services and education. The result has been a sustainable, culturally appropriate dental therapy program that creates well-paying jobs in underserved communities while increasing access to dental care and improving oral health outcomes.
Dental therapy standards – developed in 2015 by the Commission on Dental Accreditation (CODA) – ensure the providers are educated to the same high standards as other dental providers. These standards also take the burden off individual states to set the education requirements for dental therapists. Additionally, 60 years of data from dental therapists practicing all over the world have found that the technical quality of care provided within their scope of practice was comparable to that of a dentist.
In addition to improving access to care for underserved communities, dental therapists also improve oral health. Transferring lower-level dental procedures to dental therapists allows dentists to focus on more complex care, making the entire dental team more efficient and allowing more high-need patients to access care. Community health centers, the Indian Health Service, and tribal and urban Indian clinics can stretch their limited budgets to treat more patients because dental therapists have lower employment costs than traditional dentists. Private practice dentists can also take advantage of these lower employment costs to increase their profitability.
Dental therapy would create good paying jobs around the state.
If allowed by state law, dental therapists can provide preventive and restorative dental care throughout the state, under the supervision of a dentist. Dental therapy has created accessible workforce pipelines from underserved communities because dental therapy education is shorter and less expensive than general dentistry programs; it also can be offered at tribal or community colleges. The average total cost of a four-year dental program in the US is about $268,000 ($342,000 for non-residents), while schools with dental therapy programs provide options that can be completed in two or three years for about the cost of an associate degree.
Dental therapy programs can also fill the dental education gap in the 14 states that do not have four-year dental programs and the other 19 states, including Oklahoma, that only have one four-year dental program. For example, Alaska does not have a four-year dental program, but Iḷisaġvik College – a public tribal college in Alaska – offers an Associate of Applied Science in Dental Therapy. In-state tuition and fees for its dental therapy degree is about $21,000, while the out-of-state tuition costs at the nearest dental school in Washington state would be about $379,000.
The dental therapy model is often used in rural areas, and it stimulates rural economies by increasing good-paying jobs and providing accessible educational opportunities. In places where it’s available, dental therapy strengthens the state’s health workforce and facilitates accessible care to communities statewide.
This policy option would require action from state lawmakers and collaboration with tribal entities in Oklahoma.
Dental therapy expansion and utilization requires state approval. Currently, the Oklahoma Dental Board recognizes only dentists and dental hygienists as oral health care providers. In the upcoming legislative session, Oklahoma lawmakers can create a framework for licensing dental therapists. To ensure that expansion of dental therapy is most effective at answering the needs of one of the state’s largest underserved communities, the development process for this new dental provider group would require close collaboration with Tribes and Indian health organizations (Indian health service, tribal health, and urban Indian health).
Moving forward, state and tribal leaders, dental providers, and everyday Oklahomans can work together to improve oral health in Oklahoma by :
- Learning about Oklahoma’s oral health needs and how dental therapy can be expanded in the state.
- Expanding tribal-state partnerships to increase outreach and education on how dental therapy can create cost savings, revenue streams and improved access to care for those that need it.
- Increasing awareness about the rigor and requirements of CODA educational standards for dental therapy programs that ensures safety of the public.
- Providing culturally appropriate education and support for state-led efforts for the addition of dental therapists.
- Supporting tribal dental therapy programs and implementing training programs, licensing, and regulation.
Conclusion
Oklahoma has a severe shortage of dental providers, and authorizing dental therapists to work in the state would expand access to necessary oral health care. Further, dental coverage and oral health are vitally important for overall health and well-being. This means that dental therapists can bring more than just dental care to communities; they can also provide a culturally responsible, trusted community member to support desperately needed mental health needs. Creating a new, mid-level community-based dental provider option will shore up Oklahoma’s dental workforce and make care more accessible for everyone.
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To learn more about dental therapy and the oral health status of Oklahoma, check out the resource from our partners at the Native Oral Health Network and Southern Plains Tribal Health Board, “Expanding the Oral Health Workforce – A Dental Therapy Toolkit for Oklahoma” and the extended Policy Brief: Oral Health Policy and Improvement Strategies in Oklahoma.
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About the Authors
Michelle Dennison, PhD, RD/LD, BC-ADM, CDE // michelle.d@okcic.com
Michelle Dennison is the Vice President of Policies and Prevention at the Oklahoma City Indian Clinic. She is responsible for developing effective relationships that lead to health policies benefiting the American Indian population. Michelle also oversees diabetes and prevention operations for the Oklahoma City Indian Clinic. Dr. Dennison is a previous Robert Wood Johnson Foundation Health Policy Fellow and served in the office of the U.S. Surgeon General.
Julie Seward, RDH, MEd (Cherokee) // jseward@spthb.org
Julie Seward is the Oral Health Programs Manager at the Southern Plains Tribal Health Board. She manages all oral health activities through the Native Oral Health Network that provides a platform for resource sharing, peer support, and community engagement. As a registered dental hygienist, Julie has practiced in general and periodontal practices. She previously served as the Dental Hygiene Liaison for Oklahoma, the Vice-Chair for the Oklahoma Oral Health Coalition, and Public Health Chair for the Oklahoma Dental Hygienists Association. Cumulatively, she has over 20 years of oral health experience in clinical, academic, and public health sectors. She lives in Tulsa with her husband and two children.
