Improving Access to Oral Health Care Services Among Underserved Populations in the U.S.: Is There a Role for Mid-Level Dental Providers?

Headnote

Abstract: Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers. This article examines the case for and against one possible solution to address these barriers to oral health care: the introduction of a mid-level dental provider (MDP) position within the dental field.

Key words: Oral health, access to care, disparities, dental care, dental therapists.

Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers.1

One proposal to address these barriers to oral health care is the introduction of a mid-level dental provider (MDP, also referred to as an alternative dental provider) position within the dental field. Mid-level dental providers are generally permitted to perform basic preventive and basic restorative dental procedures under the direct, indirect, or general (depending on the model) supervision of a dentist, with the goal of extending access to care to underserved populations. The ability to provide basic restorative care such as fillings and simple extractions is the main feature differentiating MDPs from programs in some states that allow dental hygienists to provide dental hygiene and preventive care outside of a dental office or clinic. Mid-level dental providers now practice in a variety of capacities in more than 50 countries, including Great Britain, New Zealand, Australia, and Canada. Alaska and Minnesota are the only two U.S. states that have approved MDP providers, but policymakers in a number of other states are seriously considering such proposals.

In a recent report prepared for the W.K. Kellogg Foundation, Professor Burton Edelstein of Columbia University concluded that a majority of dental procedures could be delegated to properly trained MDPs.2 Implementation of MDPs within the U.S. dental team framework holds the potential not only to increase access to care, but also to create new jobs and allow dentists to devote more time to advanced oral procedures, which they are best trained to address.

In 2003, the Alaskan Native Tribal Health Consortium began an initiative to train dental health aid therapists (DHAT) to care for Alaska's...