CHICAGO, Sept. 26, 2024 — The American Dental Association (ADA) supports cost-effective workforce innovations that advance access to quality oral health care for all. Unfortunately, model legislation recently adopted by the American Legislative Exchange Council (ALEC) to authorize dental therapy falls short of those goals. Put simply, dental therapy does not increase access to care in an appropriate, timely, and economically feasible way.
The ADA examined the initial proposal and addressed the underlying policy shortcomings in a letter to the ALEC Board of Directors on August 19th, noting that the proposed approach does not create a viable member of the dental team, nor does it meaningfully improve access to care or provide adequate protection of the public’s health. Despite the ADA’s strong statement of opposition, ALEC officially adopted its model on August 30th. The ADA will continue to advocate against the model legislation both at ALEC and, cooperatively, in states where the model bill may be proposed.
The ADA recognizes that dentists are ultimately responsible, ethically, and legally, for patient care. Central to this belief is the conviction that in the best interests of the public, only dentists, equipped with comprehensive education and training, are the only qualified professionals to properly diagnose dental disease, identify oral pathology such as oral cancer, perform surgical and irreversible procedures and supervise procedures by allied dental team members. The ADA believes that any delegated treatment tasks must be at the discretion of a licensed dentist.
“Although the model places the ‘responsibility of all services performed by a dental therapist’ on the dentist, it allows the therapist to diagnose dental disease while lacking the appropriate training and education required to perform services and identify oral pathology such as cancer and determine an individualized treatment plan,” said Linda J. Edgar, D.D.S., president of the American Dental Association.
ALEC’s model legislation as written would allow for procedures to be performed by a dental therapist with insufficient support from the dentist to diagnose, treat or supervise other allied personnel if it defines ‘general supervision’ with the lack of definition required to ensure patient care.
“The dentist is the qualified professional to diagnose dental disease, and written standing orders are not a substitute for obtaining a diagnosis,” Dr. Edgar said.
The model’s failure to specify that dental therapists must graduate from a program accredited by the Commission on Dental Accreditation (CODA), the only body in the United States tasked with evaluating dental education programs, which includes dental therapy; and failure to assure that the patient first become a patient of record examined by the dentist raise significant concerns for the ADA. The ADA believes that the development of any new member of the dental team be based upon determination of need, a CODA-accredited dental school or advanced dental education program, and a scope of practice that ensures the protection of the public’s oral health.
Finally, and perhaps most important for conservative lawmakers at ALEC, dental therapy education programs have struggled to maintain viability unless they are heavily subsidized by the government. This is not a position that the market demands. Enrollment at dental therapy schools has been anemic at best, with one program in Minnesota recently shuttering due to lack of continuing feasibility.
“For decades, other organizations have spent tens of millions of dollars to implement and expand dental therapy throughout America with very little impact. Sadly, now ALEC has chosen to promote the same costly, failed model instead of working cooperatively with the ADA to meaningfully increase the dental workforce and access to care. The ADA stands ready and willing to work with any organization to advance proven success models in workforce and increasing access to care that are less costly, more effective, and can be brought to the market faster,” said Dr. Edgar.
Because of these major flaws the ADA opposes this model and will encourage the state societies and other organizations to oppose it. A better and faster approach to address dental workforce shortages is to fund initiatives for existing dental education programs whose members function efficiently in the current dental team model.