Working With Midlevel Providers: Dentists' Perspectives

Midlevel dental providers perform preventive care and routine restorative duties, such as filling cavities, in a variety of settings. Often called dental therapists, they already work as part of the dental team in Alaska, Minnesota, and more than 50 countries. In addition, Maine authorized them in 2014. Eight dentists share their perspectives on these practitioners, who are similar to physician’s assistants or nurse practitioners in the medical field.

Dr. Leon Assael, Dean of the University of Minnesota School of Dentistry, details how using dental therapists can help “reduce the unit cost of care to increase access.” He also notes the University’s goal to have “one educational standard and one practice standard,” training dental therapists alongside dentists, and discusses a dentist in a low-income community who has changed his mind about midlevel practitioners.

Dr. Frank Catalanotto, a pediatric dentist and professor at the University of Florida, explains what dental therapists are and how they can help dentists in traditional office settings serve Medicaid patients. He also explains how two rural Kansas dentists are leading the effort to authorize dental therapists in that state. 

Dr. Mary Williard, who directs the dental therapist training program for the Alaska Native Tribal Health Consortium, provides an overview of their education, how they can be utilized in a dental office, and how using remote supervision by a dentist allows these practitioners to reach more people in rural areas—including the elderly in their homes. 

Dr. David Gesko, dental director for a nonprofit integrated health care system in Minnesota, refers to dental therapists as “dentist extenders” that that help lower costs and increase access to care for low-income populations.  He urges dentists to be early adopters.

Dr. Mark Kelso, dental director at Norton Sound Health Corporation in Nome, AK, describes how he supervises dental therapists -- including using telehealth technology. Kelso notes that it's helpful to have someone with an ethnic background similar to patients when educating them about oral health and that he's much busier with referrals for advanced care since dental therapists started.

Dr. Michael Helgeson, CEO of a nonprofit dental organization in Minnesota, describes two advanced dental therapists that work in rural and urban settings and addresses concerns he's heard about midlevel practitioners. He notes that dentists have a better work scenario by using dental therapists and says more states are likely to adopt these practitioners. He urges the dental community to take the lead in shaping these efforts to ensure an integrated team.

Dr. John Powers, who owns a private dental practice in the rural town of Montevideo, MN, describes how a dental therapist is working -- and helping families "get turned around in terms of their oral health." Dental therapists in Minnesota are required to spend at least 50 percent of their time treating patients whose income or insurance status creates difficulty finding dental care.

Dr. Shiraz Asif describes the positive impact a dental therapist has made at Family Dental Care, a community clinic in Minneapolis that primarily serves disadvantaged people. According to Dr. Asif, having a dental therapist on his team allows him to focus on more sophisticated procedures that only a dentist is trained to perform.