New York Times Examines Debate Over ‘Dental Therapists’ Providing Care to Alaska Natives

The New York Times on Monday examined the debate over a program in Alaska that uses "dental therapists" to provide care to Alaska Natives who lack access to dentists. Under the program, after dental therapists receive two years of "intensive training" at the University of Alaska-Anchorage, they can perform routine tooth extractions and fill cavities. Patients who need root canals and complex extractions must be referred to dentists. Dental therapists must be supervised by a dentist, either onsite or offsite through documents and X-rays.

The therapists, who are allowed to practice only in Alaska and only on Alaska Natives, are paid about $60,000 annually -- one-half to one-third dentists' typical incomes -- through a federally funded program that provides dental care to 136,000 Alaska Natives throughout the state. The program, which aims to have 100 fully trained dentists on staff, has so far only 75 participants and "the number of vacancies is growing," according to the Times. According to Ron Nagel, a dentist and a consultant for the Alaska Native Tribal Health Consortium, dental therapists are a less-expensive option to provide dental care for people who otherwise might not have access to it.

The Alaska program currently has fewer than 12 dental therapists practicing. Some dentists who specialize in public health said the program should be offered nationwide to provide dental care to the about 100 million U.S. residents who cannot afford treatment, according to the Times. The American Dental Association and Alaska Dental Society oppose the program, saying dentists -- who receive four years of postcollegiate training -- should be the only providers allowed to perform fillings and extractions. The two groups filed a lawsuit to block the program but dropped the suit last summer after a state court judge issued a ruling critical of the dentists. According to the Times, ADA officials say that they do not want patients to receive substandard care and note that dental therapists might not be able to handle emergencies such as uncontrolled bleeding that sometimes occur in routine procedures.

The Times reports that some dentists in public health programs say the groups are actually concerned about dental therapists becoming low-cost competition. According to a 2006 study by the Baylor College of Dentistry that compared the quality of about 600 procedures in more than 400 patients, the quality of procedures performed by dental therapists was no different from that provided by dentists (Berenson, New York Times, 4/28).