(BOSTON)-As more than 20 states across the country actively pursue or explore establishing a mid-level dental provider, often called a dental therapist, a panel of academic experts has developed a set of evidence-based, national standards for education programs that train dental therapists in the United States. The recommendations, which build on curriculum guidelines for dental therapist education established by the American Association of Public Health Dentistry in 2010, also come as the American Dental Association's Commission on Dental Accreditation has released proposed accreditation standards and called for public comment by December 1, 2013.

Convened in December of 2012 by Community Catalyst and chaired by Dr. Frank Licari, associate dean for academic affairs Midwestern University College of Dental Medicine Illinois, the panel is comprised of representatives from all three of the existing U.S. educational programs for dental therapists, as well as experts in dental therapy practice in the U.S. and Canada, and educational standards experts. Its standards are intended to be national in scope and, in the absence of formally adopted accreditation standards, they are intended to inform various states and tribal nations considering the addition of dental therapists to their oral health workforce in the future.

Dental therapists serve as members of a dental team.  They work under the general supervision of a dentist in a collaborative way to extend the reach of dentists, much in the same way nurse practitioners and physician assistants extend the reach of physicians.

"A set of common principles is essential to assuring that dental therapy education programs provide consistent, high-quality education," said Licari. "The recommended standards presented today by the Panel should provide the guidance states and tribes need as they explore expanding their dental care teams to include mid-level providers."

The panel researched accreditation models, standards and competencies for existing health professions to address critical issues such as curricula, faculty credentials, basic program length and the level of financial support and type of setting needed to offer quality education programs. In addition, a set of guiding principles were adopted to drive the panel's work including the recognition that their recommendations would result in minimum standards for dental therapy education and communities would likely customize their programs to meet local needs.

Some of the panel's primary recommendations include:

• Dental therapists should be trained to practice under the supervision of a dentist and to work collaboratively as part of a dental care team.

• Dental therapy curricula must include at least two calendar years of full-time instruction or its equivalent at the post-secondary level, and graduates must receive an associate degree. If a student is to be jointly trained in dental therapy and dental hygiene, the curriculum must include at least three years of full-time instruction or its equivalent.

• Graduates from dental therapy programs must be able to competently provide care within a scope of practice that includes assessing patients' oral health needs, providing preventive care and treatment for basic oral health problems, and recognizing and managing complications, while adhering to all recognized community and professional standards.

• Dental therapy education program leaders must be qualified to administer the program, but do not need to be dentists. However, if a program is not dentist-led it must employ a dental director-a licensed dentist who is continually involved in the program.

Practicing in Alaska since 2005 and in Minnesota since 2011, dental therapists are community-based oral health care professionals who help expand the reach of the dental care team and increase access to dental care for low-income adults and children, people of color, and people living in rural areas who routinely struggle to get the dental care they need. Noting that dental therapists often return to serve the communities they come from, the panel sought to create standards that would be accessible to students from underserved communities and prepare them for practice in those areas.

More than a half-dozen states have put forward legislation seeking to establish dental therapists; other states and tribes are pursuing pilot projects studying the feasibility of adding dental therapists to the dental team, and other states are seeking and sharing information on the option. 

"We're seeing persistent access problems, more dentists retiring and an overwhelming amount of untreated tooth decay in underserved communities with rapidly increasing numbers of those residents who can't get needed dental care," according to Dr. Albert Yee of Community Catalyst. "Now is the time to expand the number of dental professionals who can offer routine, preventive care to families in need. Creating these national standards for dental therapist education programs will support the growing number of efforts in states and tribes striving to make this happen."

The panel was created by Community Catalyst, with the assistance of the LPaC Alliance.  The effort is funded by the W.K. Kellogg Foundation.

Panel Members:

Chairperson: Frank Licari, DDS, MPH, MBA, Professor and Associate Dean at Midwestern University's College of Dental Medicine-Illinois Education Programs in the United States

Ruth Ballweg, MPA, PA-C, Professor in the Department of Family Medicine at the University of Washington School of Medicine.

Darren G. Berg, Dental Therapist, North Battleford, Saskatchewan, Canada

Colleen Brickle, RDH, RF, EdD., Dean of Health Sciences at Normandale Community College in Minnesota.

Caswell A. Evans, Jr., DDS, MPH, Associate Dean of Prevention and Public Health Sciences at the University of Illinois, Chicago College of Dentistry

Karl Self, DDS, MBA, Director of the University of Minnesota School of Dentistry Division of Dental Therapy

Mary Williard, DDS, Director of the Dental Health Aide Therapist Educational Program and the Department of Oral Health Promotion for the Alaska Native Tribal Health Consortium, Anchorage, Alaska.

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About Community Catalyst

Community Catalyst is a national, non-profit consumer advocacy organization founded in 1998 with the belief that affordable quality health care should be accessible to everyone. We work in partnership with national, state and local organizations, policymakers, and philanthropic foundations to ensure consumer interests are represented wherever important decisions about health and the health system are made: in communities, courtrooms, statehouses and on Capitol Hill. For more information, visit www.communitycatalyst.org.

The LpaC Alliance is a law, policy and consulting firm based in Minnesota with extensive experience working to establish dental therapists in the state.