Statement by American Dental Association President Raymond Gist, DDS: WK Kellogg Foundation Dental Health Aide Therapist Program
“The ADA welcomes the Kellogg Foundation to the fight to improve the oral health of the millions who suffer from its lack. Unfortunately, the foundation’s recent efforts to address this complex issue focus exclusively on expanding a single provider model, the controversial Alaska Dental Health Aide Therapist. The limited research evaluation conducted by Kellogg did not provide the robust examination or projectable metrics on which to base such important policy and public health decisions.
“No matter where you stand on the issue of non-dentists performing dental surgery—and we stand firmly against it—limiting the approach to overcoming the many access barriers to promoting this one workforce model ignores numerous, and we believe much greater, barriers to care. Frankly, these energies and resources would be better directed toward improving existing programs.
“Chief among these is the lack of adequate funding for public assistance dental programs. No matter who provides the care, someone must pay for it. The positive effects of adequate funding for dental care through programs like Medicaid and SCHIP—along with much-needed administrative reforms—dwarf any ostensible benefits brought about by allowing non-dentists to perform surgical procedures.
“Geographic and other practical barriers also present challenges. But here again, we believe that assisting patients with such issues as transportation, securing time off from work, translation services or child care are simply better solutions to these barriers than continuing to isolate the patients who most need care from fully trained dentists.
“Prevention is the ultimate solution to the epidemic of untreated oral disease. The nation will never drill and fill its way out of this health crisis. Yes, we must bring millions more into the system to receive restorative care from dentists. But almost all of this disease is entirely preventable.
“The ADA supports workforce innovations that address prevention and providing care to those with the most urgent needs, without putting patient safety or the quality of care at risk. In 2009, the association launched the Community Dental Health Coordinator pilot project. The CDHC model is based on community health workers, who have proven extraordinarily successful on the medical side. The CDHC focuses primarily on prevention, through oral health education, and the application of preventive measures like sealants and fluoride varnishes.
“CDHCs also act as patient navigators, identifying those patients in greatest need of care and helping them get to dentists. This can involve not only securing the dental appointment, but also helping the patient overcome such related barriers as the maze of bureaucracy that afflicts many public assistance programs, and the need to secure transportation, child care or even permission to take time from work to keep an appointment. CDHCs are trained to help patients comply with post-operative instructions and instruct them in ways to prevent recurrences.
“The first class of CDHCs completed their training in October. They now are working in clinics and other public health settings.
“The degree and severity of disease among underserved communities, whether they are in inner cities, remote rural communities, or on Tribal lands, demand comprehensive solutions. As America’s leading advocate for oral health, the ADA welcomes input from and dialogue with all stakeholders who are dedicated to overcoming the barriers to dental care that too many in this country face. It is our sincere hope that we all agree on the need to address all of the barriers to care, not just a single one. A concerted effort that reflects a long term, evidence-based approach will enable the dental profession to implement a sustainable system that delivers high-quality, dental care to those Americans who currently lack it.”