In an effort to combat the state's rampant caries problem in rural villages, Alaska recently became the first state to utilize dental therapists. Similar to what nurse practitioners and physician's assistants are to medicine, the dental therapist position was initiated in order to improve oral health care access among Alaska Natives.
According to the April issue of AGD Impact, the newsmagazine for the Academy of General Academy (AGD), depending on whom you ask, it's a controversial subject.
Because the therapists are expected to fill cavities and extract teeth, the American Dental Association (ADA) is against the new position.
"It's considered a very big issue in the ADA," said Bernard McDermott, DDS, chair of the ADA's task force on the issue. "Part of the concept is good; the idea to give Natives training and then to send them back to their villages is great, but irreversible, surgical procedures are unsafe except by licensed dentists."
The dental therapists, who are high school graduates, spend two academic years at the University of Otago in Dunedin, New Zealand, so that they may return to Alaska to work in rural villages. The first four Native graduates of the program returned to the state in December 2004.
Dr. McDermott, along with the Alaska Dental Society, believes the dental therapists do not have the scope of training to perform drillings and fillings, especially on children.
"The problem is that while the therapists are training (in New Zealand), they are working in larger areas and often working alongside dentists," he said. "But after they finish training, they return to villages 300 miles away and are out there working alone."
Mark Kelso, DDS, who has worked in rural Alaska for 18 years, feels differently.
"My main use of the dental therapist will be to change the public opinion (in the villages) of oral health," Dr. Kelso said. "The (therapists) will be good role models because they have good teeth, are motivated and are from the community where they are trying to help. No team of dentists, volunteers or public health dentists, will be able to do that because at one time or another, they will have to leave. The dental therapist will live and stay in the community."
Access to care remains the core of the debate. The ADA wants Congress to pass legislation and contends that the answer to Alaska's access to care problem is to recruit more dentists and volunteer dentists to go there.
"We need to collaborate," Dr. McDermott said. "There is a huge access problem and we need dentists to help eradicate it because if it's runaway caries, we're never going to solve it."
"The ADA thinks you can just send someone to the village to educate people," Dr. Kelso said. "Everyone knows what causes tooth decay. We need someone there who has community respect to walk the talk and provide a continual dental presence. Itinerant dentists, including myself, are neither of the same ethnicity or residents of these small villages. We lack credibility along those lines. Do I believe the dental therapists program is the total answer? No, but it is a giant step in the right direction."
The AGD is a non-profit organization of more than 37,000 general dentists dedicated to staying up-to-date in the profession through continuing education. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.