Advocates and experts from across the country working to improve access to dental care for underserved populations came together recently at the Dental Access Project Convening in Portland, Oregon. 

Ohio’s delegation included three distinguished dental professionals: Dr. Ed Sterling. who recently retired as the dental director of the Nisonger Center, where he spent the majority of his career treating children and adults who are developmentally challenged; Ann Naber, a dental hygienist, faculty member at Sinclair’s hygiene program, and former member of the Ohio State Dental Board; and Dr. Larry Hill, a public health dental consultant and retired dental director of the Cincinnati Health Department.

The Convening, conducted by the WK Kellogg Foundation and Community Catalyst, provides an opportunity for participants to share information on progress and strategies towards creating a more cost-effective and farther-reaching dental workforce that can improve the oral health of the nation. Topics ranged from enabling legislation efforts in various states, varied strategies being employed in the states of Washington and Oregon, financing, and communications. 

Each participant returned to Ohio with renewed energy and new learnings. Ms. Naber came away with an even stronger belief that our focus should be “on providing care to the Ohio population with the highest disease rates and least access to dental care.”

She noted that “Fifty-four countries already utilize dental therapists. In Alaska, twenty-five dental therapists (DHATs) provided care to 45,000 people and created 76 full time jobs. Currently there are three funded and proposed dental therapist pilot programs in Oregon and the state of Washington. The Commission on Dental Accreditation (CODA) has adopted national standards for educating dental therapists.”

Ohio representatives learned that there are several states going through the legislative process or planning to introduce legislation to add dental therapists to the oral health team. Momentum in the lower 48 states is increasing in favor of this additional dental personnel. An important component of decreasing health disparities is empowering people to make better choices and getting communities to demand health care services.

Dr. Sterling found that the biggest change from previous convenings was the progress that is occurring in the dental therapy movement. He noted that with the recognition by CODA, there is real progress in the “lower 48.” Dr. Sterling said that while “the presentations were very positive, there are still obstacles to overcome, but they seem more manageable. The reports from the states all showed progress in the establishment and acceptance of the dental therapist as a recognized member of the oral health care team.” He concluded, “It seems that efforts to make public and oral health care providers aware of dental therapy now should be more positive. Utilizing social media to a greater extent to promote the positive side of dental therapy – e.g. what therapists are doing, their commitment to oral health, and the people they serve – should be the message, rather than what is lacking in the oral health care system. With data from Minnesota, New Mexico, and the Oregon programs, along with CODA recognition, a brighter day is dawning for oral health care.”

Dr. Hill was especially impressed with the creativity in some states to create dental therapy demonstration projects. New clinical trials are beginning in Oregon; there are 3 so far and possibly more to follow. Oregon has a statute that has been on the books for some time that allows for health care workforce demonstrations but that had not previously been applied to dentistry. That law is now the foundation for developing a dental therapy demonstration, in which, over 5 years, dental therapists will be trained and deployed to communities to expand access. Almost simultaneously, the Northwest Portland Area Indian Health Board will be gearing up pilot projects in Oregon and Washington, targeting Native Americans, under the rights of Indian sovereignty. 

Also of interest was a presentation by Shelly Geshen, a policy consultant and former director of the Pew Children’s Dental campaign. Ms. Geshen spoke about the workings of state workforce boards. Every state receives federal funds to create a Workforce Board. Those funds are then distributed to local workforce agencies to help underemployed populations receive training and then assistance for employment. Populations include disconnected young folks ages 16-24, people living in low-income areas, dislocated workers, adults with low literacy, unemployed veterans, etc. It was recommended that in our efforts we become acquainted with state workforce board members and even work to get a sympathetic person on the board and then to get dental therapists into the state’s workforce plan. Currently Alaska is the only state to have done so. 

Finally, Dr. Hill said that he was impressed by the suggestions of Roxanne Fulcher representing the American Association of Community Colleges. Ms. Fulcher “recommended that advocates for dental therapists work not only with dental hygiene programs within community colleges, but also with the workforce development departments. Community colleges are currently facing concerns over degree inflation which is requiring nurses to get baccalaureate degrees and therefore essentially removing those programs from community colleges. Those colleges will be looking for programs and students to replace the loss of their nursing students, which may create an opportunity for dental therapy training programs.”