Dr. Donald Chi: Dental therapists
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Dental therapists—professionals with more training than assistants but less than dentists—provide basic dental care, with a focus on tribal or underserved populations. They are variously authorized to practice in 14 states, and a handful of other states have introduced legislation that would allow them to practice.
On October 3, 2024, SciLine interviewed: Dr. Donald Chi, a pediatric dentist and professor of oral health sciences at the University of Washington. See the footage and transcript from the interview below, or select ‘Contents’ on the left to skip to specific questions.
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Introduction
[0:00:20]
DONALD CHI: So my name is Donald Chi. I’m a professor and associate dean for research at the School of Dentistry at the University of Washington in Seattle, and I’m a board certified pediatric dentist. And I study lots of different things related to oral health. I study health services research, which is basically how dental care is delivered and financed and organized. I also focus on oral health inequities research related to children. So why it is that children—some children—experience higher rates of tooth decay, and more importantly, what we can do about it? So policy solutions as well as different behavioral interventions aimed at addressing tooth decay and vulnerable children.
Interview with SciLine
Which populations in the United States lack adequate access to dental care?
[0:01:19]
DONALD CHI: Categorically low-income individuals have difficulty finding and accessing dental care. So within that group, there are individuals of low income who might experience even greater difficulties accessing dental care. So that includes racial and ethnic minorities, individuals with disabilities or special health care needs, and individuals who might live a long distance away from a dental office. So when I think of that, it could be individuals who, for instance, live in rural areas where it might be difficult to get to a dentist.
What are the some of the effects of poor oral health?
[0:02:07]
DONALD CHI: Oral health is one of those things that touches every part of our lives as human beings: in order to chew, in order to socialize, in order to hold a job, in order to learn. You need your teeth. You need your teeth to be healthy. And what ends up happening is that, if you have cavities—if you have cavities that are causing pain—that can get in the way of your daily life. It can get in the way of sleeping. It can get in the way of being able to chew your food. It can get in the way of employment. So imagine if you had missing teeth in the front of your mouth because you had to have teeth removed because of large cavities. That can create difficulties in terms of holding down a job. And so we’ve had numerous studies show that individuals who are missing their front teeth can’t find jobs, can’t hold down jobs. And so really, the pain aspect as well as the aesthetic aspect of poor oral health really can create problems.
What are the dental therapists, what training do they receive, and what services do they provide?
[0:03:23]
DONALD CHI: So dental therapists are a lot like physician assistants. They’re not full-fledged dentists, but they’ve received enough training to provide a limited scope of dental care procedures. So dental therapists typically will get anywhere from two to four years of training after high school, and they’re trained to provide preventive care. So they’re able to provide cleanings and fluoride treatment as well as sealants. But they’re also able to provide a set of relatively simple procedures—simple fillings, simple tooth extractions. And what this then leads to is a system where the dentist is still providing the more complex treatment. So if you have bigger fillings, if you have complicated tooth extractions, root canals, crowns, dentures, those are still all done by dentists, but dental therapists kind of fit that set of procedures, again, that are a lot simpler. And that’s the really great thing about dental therapy is that dental therapists are not mini dentists. I think that there is a lot of language out there to suggest that dental therapists are mini dentists, and they’re not. They have a very limited scope of practice, but that scope of practice is really important because what it allows dental therapists to do is to put out small fires in a community with lots of dental care needs, and so then the dentist can come in and put out the big fires. And so really, it’s a team-based effort where dental therapists are working with dentists to make sure that all of a community’s needs are met.
Alaska was the first state to authorize dental therapists in 2006. What did your research reveal about their impact on access to care in tribal community?
[0:05:10]
DONALD CHI: DONALD CHI: What we essentially found is that Medicaid recipients, they were less likely to have teeth removed. So this is both children and adults. They were less likely to have extractions, which meant that more people were keeping their teeth longer and they were also more likely to get preventive care, so care like fluoride treatment and cleanings.
What other lessons have been learned from states that have authorized dental therapists?
[0:05:37]
DONALD CHI: What we’re essentially learning is that individuals—so people who are on Medicaid, so low-income, publicly insured individuals—that they’re more likely to get into the dentist. They’re more likely to get dental care, and it’s really surprising, given that these programs haven’t been in operation for very long. Now in Alaska, dental therapy has been around for about 20 years, so—and this is the longest, not quite 20 years—so this is the longest-running program in the U.S. So all the rest of the states have programs that have been running much less than 20 years, and to see this almost immediate impact in terms of access to dental care for vulnerable populations just has been remarkable. So we’ve seen data out of Minnesota, for instance, showing that Minnesota Medicaid enrollees are more likely to visit a dental office and get dental care after dental therapy was introduced, and we see similar types of outcomes in other states.
Besides visiting the dentist, what other ways can people promote good oral health?
[0:06:52]
DONALD CHI: The two big things have to do with healthy eating—so minimizing the amount of sugar in your diet—and then fluoride. So fluoride comes in the form of toothpaste and also water, so you can get access to fluoridated water, and that helps to protect the teeth. So while I’ve done a lot of research on dental therapists, and as I said before, I think dental care is really super important. We don’t want to forget these other contributors to oral health. And so, yeah, it’s important to get to the dentist every six months. It’s important to be seen, whether it’s by a dental therapist or by a dentist. But it’s also really, really, super important to make sure that individuals are eating healthy. That they have access to healthy foods. That they’re not giving their kids large amounts of juice and sugary beverages, and that individuals are brushing their teeth twice a day with fluoride toothpaste, and that they have access to fluoridated water. And those two things—the diet and fluoride—those are really challenging behaviors. A lot of people don’t have access to healthy foods, so it’s not just a matter of telling people, hey, just go eat healthy. It’s a lot more complicated than that.
