Have you ever met a dental therapist from the United States? BDJ Team Editor Kate Quinlan spoke to Laura (Hale) Brannon, project manager for Community Catalyst's Dental Therapy Project, who oversees efforts to support the authorisation and implementation of dental therapists across the USA, to find out how American and British dental therapists compare and why dental therapists are important in the US.

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What are the duties of a US dental therapist?

The specific duties of a dental therapist have some small variations state by state but generally dental therapists can perform preventive procedures (eg cleanings, sealants, fluoride varnish), evaluative procedures (eg exams, treatment planning) and routine restorative procedures (eg preparing and placing fillings, extracting primary teeth, placing preformed crowns, pulp capping, simple extractions of permanent teeth under limited circumstances). This chart1 is a few years old so lacks several recent states that have authorised dental therapists but compares the scope across state.

Most dental therapists work 35-40 hours a week.

How does the UK dental therapist's scope of practice compare with that of the US one?

Editor's note: The scope of practice for dental therapists in the UK can be found here: https://www.nature.com/articles/bdjteam201889.

The scope of practice of British and American dental therapists is very similar. The national standards for dental therapy education in the US do not require dental therapists to also be trained as dental hygienists (although some states do include that requirement), so more advanced periodontal procedures like root planing can generally not be performed by dental therapists.

In the US dental hygienists must complete degrees of at least two academic years at the post-secondary level. Some states require dental therapists to also hold dental hygiene degrees so some education programmes for dental therapists in the US combine the training for the two professions.

Do US dental therapists usually start out as dental assistants [dental nurses]?

Some dental therapists previously worked as dental assistants but it's not a requirement to become a dental therapist.

What qualifications are required in the US to become a dental therapist?

Dental therapists are required to complete an accredited dental therapy education programme at the post-secondary level of at least three academic years. Some states set a specific degree requirement for dental therapists (ie bachelor's or master's) but the national accreditation standards for education programmes do not mandate a specific degree level so the degree awarded (associate's, bachelor's or master's) varies by school. Notably, the duties of dental therapists generally do not vary based on the level of degree they hold.

How many dental therapists are there across the US?

At present, there are roughly 200 dental therapists working in the US. We expect this number to grow sharply as two new education programmes have opened in the last two years (for a current total of five education programmes) and there are a number of schools working on opening dental therapy education programmes.

What are dental therapists' career prospects and what sort of workplaces might they be employed in?

There is a great demand to hire dental therapists in the US with the number of jobs currently greatly outnumbering the number of dental therapists. Dental therapists can work in a variety of settings: private dental offices, community health centres (these are safety-net clinics that receive public funding to serve low-income communities), tribal clinics, and hospitals. Using portable equipment, many dental therapists are also delivering care in community settings like schools and nursing homes. Most states require dental therapists to work in a public health setting, an area without enough dental providers or for a significant portion of a dental therapist's patients be uninsured or covered by Medicaid (the public insurance programme for people with low-incomes or disabilities).

Is this a regulated profession?

Yes, dental therapists have to be licensed or certified by the applicable state or tribal licensing entity. Dental therapists have to complete continuing education and regularly renew their licenses/certifications.

Is there a great need for dental therapists in the US?

Dental therapists are an effective means of expanding access to dental care for those who lack it and there is a great need for that in the US. Almost 70 million Americans live in areas without enough dental providers and almost one-third of adults report having skipped dental care due to cost. Finding dental care can be a particular challenge for families with Medicaid coverage (public insurance for people with low-incomes or disabilities) as most dentists don't accept it.

While dental therapists can work in a variety of settings, they are specifically trained to extend routine care into chronic shortage areas.

While dental therapists can work in a variety of settings, they are specifically trained to extend routine care into chronic shortage areas. Working under the off-site supervision of a dentist and collaborating via telehealth, dental therapists can bring care to people where they are, whether that's schools, nursing homes or rural communities. Because their employment cost is one-third to one-half the amount of a dentist, hiring dental therapists has proven to be a cost-effective way for a range of dental care settings to treat more low-income and uninsured patients with the same budget.

Many rural and low-income communities struggle to recruit and retain dentists and the dental providers in those communities often do not share the language or culture of the community they treat. Dental therapy focuses instead on building a dental workforce from communities. Because dental therapists do a narrow set of commonly needed procedures, they can be trained in far less time and at far less cost than a dentist. This allows local colleges to build an accessible workforce pipeline, creating both good paying jobs and better oral health.

Can you tell us more about Community Catalyst's Dental Therapy Project and the National Partnership for Dental Therapy?

Community Catalyst's Dental Therapy Project is part of our broader Dental Access Project, which works to address inequitable access and other barriers to care. We partner with community advocates to identify and implement community-based solutions. This includes supporting state and tribal partners in creating policy change that helps people get quality, affordable dental care where and when they need it, in their own communities, with particular attention to communities of colour, tribal communities and low-income populations, as well as other groups who have been ignored by or intentionally excluded from the current oral health delivery system. Learn more at: https://communitycatalyst.org/work/projects/dental-access-project/.

The National Partnership for Dental Therapy is co-chaired by Community Catalyst, the National Indian Health Board and the National Coalition of Dentists for Health Equity, and the American Dental Therapy Association with the goal of elevating the visibility and broad, multi-sectorial support for dental therapy as an evidence-based way to improve access to oral health. Learn more at https://www.dentaltherapy.org/about/about-the-partnership.