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Current Status of Adding Dental Therapists to the Oral Health Workforce in the United States


Dental therapists are members of the oral health care workforce in over 50 countries of the world. Until recently, they have not participated as members of the professional dental team in the USA. It was not until the publication of Oral Health in America: A Report of the Surgeon General in 2000, describing the significant problem of access to dental care, that the issue of dental therapists emerged in the USA in a significant manner. Details of the development of dental therapists in the workforce in the USA through 2011 were previously chronicled by Mathu-Muju. Since then, there has been a major increase in interest and licensing of dental therapists in a number of states. This article updates the dental therapist movement to the present time. The literature and activities of the movement will be reviewed by the categories of research, education, and legislation/practice, as well as analytical essays and commentaries.

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Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Nash DA, Friedman JW, Kardos TB, et al. Dental therapists: a global perspective. Int Dent J. 2008;58:61–70.

    Article  PubMed  Google Scholar 

  2. Nash, DA, Friedman JW, Mathu-Muju KR, et al. A review of the global literature on dental therapists: In the context of the movement to add dental therapists to the oral health workforce in the United States. W.K. Kellogg Accessed March 8, 2016. This monograph documents the global literature on dental therapists from their inception.

  3. Nash DA, Friedman JW, Mathu-Muju KR, et al. A review of the global literature on dental therapists. Community Dent Oral Epidemiol. 2014;41:1–10. This article summarized the above monograph for the published dental literature.

    Article  Google Scholar 

  4. Friedman JW. The New Zealand School Dental Nurse Service: a lesson in radical conservatism. J Am Dent Assoc. 1972;85(3):609–17.

    Article  CAS  PubMed  Google Scholar 

  5. Lobene RR, Kerr A. The Forsyth experiment: an alternative system for dental care. Cambridge: Harvard University Press; 1979.

  6. Spohn EE, Chiswell LR, Davison DD. University of Kentucky experimental expanded duties dental hygiene project. Lexington: College of Dentistry, University of Kentucky; 1975.

  7. Sisty NL. University of Iowa experimental program in dental hygiene. Dent Hyg. 1973;47(2):79–81.

    CAS  Google Scholar 

  8. U.S. Department of Health and Human Services. Oral health in America: a report of the Surgeon General. National Institute of Dental and Craniofacial Research. National Institutes of Health. Rockville, Maryland: U.S. Department of Health and Human Services; 2000.

  9. Nash DA, Nagel RJ. A brief history and current status of a dental therapy initiative in the United States. J Dent Educ. 2005;69:857–9.

    PubMed  Google Scholar 

  10. Nash DA. Developing a pediatric oral health therapists to help address oral disparities among children. J Dent Educ. 2004;68:7–19.

    Google Scholar 

  11. Nash DA, Nagel RJ. Confronting oral health disparities among American Indian/Alaska Native children: the pediatric oral health therapists. Am J Public Health. 2005;95(8):1325–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mathu-Muju KR. Chronicling the dental therapist movement in the United States. J Public Health Dent. 2011;71:278–88.

    Article  PubMed  Google Scholar 

  13. Mathu-Muju KR, Friedman JW, Nash DA. Oral health care for children using dental therapists in public, school-based programs, contrasted with that of the United States, using dentists in a private practice model. Am J Public Health. 2013;103(9):e7–13.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wright JT et al. A systematic review of oral health outcomes produced by dental teams incorporating midlevel providers. J Am Dent Assoc. 2013;144(1):75–91.

    Article  PubMed  Google Scholar 

  15. Wright JT et al. Do midlevel providers improve the population’s oral health? J Am Dent Assoc. 2013;144(1):92–4.

    Article  PubMed  Google Scholar 

  16. Bailit HL et al. Impact of dental therapists on productivity and finances: I. literature review. J Dent Educ. 2012;76(8):1061–7.

    PubMed  Google Scholar 

  17. Beazoglou et al. Impact of dental therapists on productivity and finances: II. Federally qualified health center. J Dent Educ. 2012;76(8):1068–76.

    PubMed  Google Scholar 

  18. Beazoglou TJ et al. Dental therapists in general dental practices: an economic evaluation. J Dent Educ. 2012;76(8):1082–91.

    PubMed  Google Scholar 

  19. Bailit HL et al. Impact of dental therapists on productivity and finances: III. FQHC-run, school-based dental care programs in Connecticut. J Dent Educ. 2012;76(8):1077–81.

    PubMed  Google Scholar 

  20. Phillips E, Shaefer HL. Dental therapists: evidence of technical competence. J Dent Res. 2013;92(suppl):115–9.

    Google Scholar 

  21. Bader JD et al. Clinical technical performance of dental therapists in Alaska. J Am Dent Assoc. 2011;142(3):322–6. First major evaluation of the clinical performance of dental therapists in Alaska.

    Article  PubMed  Google Scholar 

  22. Wetterhall S et al. Cultural context in the effort to improve oral health among Alaska native people: the dental health aide therapist model. Am J Public Health. 2011;101(10):1836–40.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Williard ME, Fauteux N. Dentists provide effective supervision of Alaska’s dental health aide therapists in a variety of settings. J Public Health Dent. 2011;71:S27–33.

    Article  PubMed  Google Scholar 

  24. Lamster IR, Formicola A. A summary of the 2010 dunning symposium: the practice of dentistry for the 21st century. J Public Health Dent. 2011;71:S34–7.

    Article  PubMed  Google Scholar 

  25. Blue CM et al. Utilization of nondentist providers and attitudes toward new provider models: finding from the National Dental Practice-based Research Network. J Public Health Dent. 2013;73(3):237–44.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gehshan S, et al. Expanding the dental team: studies of two private practices. A report from the Pew Charitable Trusts. 2014; February: 20 pages.

  27. Minnesota Board of Dentistry. Early impacts of dental therapists in Minnesota: report to the Minnesota Legislature. 2014; February: 38 pages.

  28. Evans C. Guest editorial—introduction to the special issue. J Public Health Dent. 2011;71:S1–2.

    Article  PubMed  Google Scholar 

  29. Evans C. The principles, competencies, and curriculum for educating dental therapists: a report of the American Association of Public Health Dentistry Panel. J Public Health Dent. 2011;71:S9–19.

    Article  PubMed  Google Scholar 

  30. Licari FW, Evans CA. Recommended standards for dental therapy education programs in the United States: a summary of critical issues. J Public Health Dent. 2014;74(3):257–60.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Edelstein BL. Training new dental health providers in the United States. J Public Health Dent. 2011;71:S3–8.

    Article  PubMed  Google Scholar 

  32. Yoder K. Navigating career pathways—dental therapists in the workforce: a report of the career path subcommittee. J Public Health Dent. 2011;71:S38–41.

    Article  PubMed  Google Scholar 

  33. Community Catalyst. Recommended standards for dental therapy education programs in the United States: advisory panel report and recommendations. October, 2013. 19 pages.

  34. American Dental Association. CODA votes to establish accreditation process for dental therapy education. Chicago: American Dental Association News; 2015.

    Google Scholar 

  35. Commission of Dental Accreditation. Accreditation Standards for Dental Therapy Education Programs. Chicago, 2015. Accessed March 8, 2016. Initial accreditation standards for dental therapists in the United States.

  36. American Dental Education Association. Governor of Maine signs dental hygiene therapy bill into law. May 5, 2014. American Dental Association. Washington, D.C. Accessed March 8, 2016.

  37. Children’s Health Alliance. Voices for access to dental care. January 29, 2016. Children’s Health Alliance, Seattle, Washington. Accessed March 8, 2016.

  38. Indian Country. Swinomish hires dental aide therapist in Washington state, ADA objects. January 7, 2016. Indian Country; Today Media Accessed March 8, 2016.

  39. Batliner TS. American Indian and Alaska Native access to oral health care: a potential solution. J Health Care Poor Underserved. 2016;27:1–10.

    Article  Google Scholar 

  40. Indian Country. Oregon approves Coos Bay tribes to integrate mid-level native dental therapists. February 10, 2016. Indian Country; Today Media Accessed March 8, 2016.

  41. Vermont General Assembly. S. 20: An act relating to establishing and regulating dental therapists. Vermont General Assembly, Montpelier, Vermont. Accessed March 8, 2016.

  42. New Mexico Legislature. HB 191: Dental health act changes & therapists. New Mexico Legislature, Santa Fe, New Mexico. Accessed March 8, 2016.

  43. Kansas Legislature. SB 413: Licensure of dental therapists. Kansas Legislature, Topeka, Kansas. Accessed March 8, 2016.

  44. Public News Service—Ohio. Poll puts some teeth into efforts to expand Ohio’s dental team. March 2, 2016. Public News Service—Ohio. Accessed March 8, 2016.

  45. U.S. Congress. S.B. 1522: Comprehensive dental reform act of 2013. Accessed March 8, 2016.

  46. U.S. Congress. H.B. 1055. Comprehensive dental reform act of 2015. Accessed March 8, 2016.

  47. Blue CM, Lopez N. Towards building the oral health care workforce: who are the new dental therapists? J Dent Educ. 2011;75(10):36–45.

    PubMed  Google Scholar 

  48. Blue CM et al. Beginning the socialization to a new workforce model: dental students’ preliminary knowledge of and attitudes about the role of the dental therapists. J Dent Educ. 2011;75(11):1465–75.

    PubMed  Google Scholar 

  49. Lopez N et al. Dental school faculty perceptions and attitudes toward the new dental therapy model. J Dent Educ. 2012;76(4):383–94.

    PubMed  Google Scholar 

  50. Shaefer HL, Miller M. Improving access to oral health care services among underserved populations in the U.S.: is there a role for mid-level providers? J Health Care Poor Underserved. 2011;22:740–4.

    Article  PubMed  Google Scholar 

  51. Rodriguez TE, Galka AL, Lacy ES, Pellegrini AD, Sweier DG, Romito LM. Can mid-level providers be a benefit to the American public? J Health Care Poor Underserved. 2013;24(2):892–906.

    Article  PubMed  Google Scholar 

  52. Stolberg RL, Brickle CM, Barby MM. Development and status of the advanced dental hygiene practitioner. J Dent Hyg. 2011;85(2):83–91.

    PubMed  Google Scholar 

  53. Nagel RJ. The development and implementation of dental health aide therapists in Alaska. J Calif Dent. 2011;39(1):31.

    Google Scholar 

  54. Friedman JW. The international dental therapist: history and current status. J Calif Dent Assoc. 2011;39(1):23–9.

    PubMed  Google Scholar 

  55. Murat C. In Alaska, reaching into remote corners to provide dental care. Health Aff. 2013;32(11):2047–50.

    Article  Google Scholar 

  56. Edelstein BE. Examining whether dental therapists constitute a disruptive innovation in US dentistry. Am J Public Health. 2011;101(10):1831–5.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Friedman JW. Dental therapists are a positive innovation. Am J Public Health. 2012; 102(3).

  58. Bertolami CN. Access to care: is there a problem? Am J Public Health. 2011;101(10):1817.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Nash DA. A professional imperative: caring for the oral health of America’s children. Nexus: a publication of the College of Dentistry; New York University. Summer, 2011:35–39

  60. Friedman JW, Mathu-Muju KR. Dental therapists; improving access to oral health care for underserved children. Am J Public Health. 2014;104(6):1005–9.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Nash DA, Mathu-Muju KR, Friedman JW. Ensuring access to oral health care for children: school-based care by dental therapists—a commentary. J Sch Health. 2015;85(10):659–62. This article describes the advantages of a school-based model of care utilizing dental therapists.

    Article  PubMed  Google Scholar 

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Correspondence to Kavita R. Mathu-Muju.

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Kavita R. Mathu-Muju, Jay W. Friedman, and David A. Nash declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Dental Public Health

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Mathu-Muju, K.R., Friedman, J.W. & Nash, D.A. Current Status of Adding Dental Therapists to the Oral Health Workforce in the United States. Curr Oral Health Rep 3, 147–154 (2016).

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  • Dental therapists
  • Advocacy
  • Access to care
  • Education
  • Legislation