Dental Therapists Could Provide Cost-Efficient Care in Veterans’ Nursing Homes

Heather Luebben, a dental therapist from Apple Tree Dental performs dental treatments through their mobile clinic at Options, Inc. in Big Lake, Minn., on April 13, 2017.

© The Pew Charitable Trusts

The number of senior citizens (ages 65 and older) in the United States is expected to double to more than 98 million by 2060. The Census Bureau predicts that by 2030 the U.S. will be home to about 9 million people age 85 and older, many of whom will face mobility challenges. Compared with earlier decades, more seniors are expected to still have their teeth and will need continuing dental care. These trends require an examination of the current dental delivery system and whether it is equipped to meet the needs of this growing population.

A case study conducted by Apple Tree Dental, a Minnesota-based nonprofit, and sponsored by The Pew Charitable Trusts found that most of the oral health needs of residents in the Minnesota Veterans Home could be met by a dental therapist providing on-site care. An even greater portion of need could be met by an advanced dental therapist (dually licensed in therapy, including restorative procedures, and dental hygiene). Dental therapists, akin to nurse practitioners on the medical team, are trained to deliver preventive and routine restorative care, such as placing fillings and performing simple tooth extractions. They receive the same training as dentists to provide a smaller number of procedures. Dental therapists work under the supervision of a dentist and have been practicing in Minnesota since 2011.

Because of the difference in salaries, deploying an advanced dental therapist instead of a dentist saved Apple Tree an estimated $52,000 a year.

 Apple Tree’s dental therapists expand care options via an on-site care approach that is better able to reach elderly people living in long-term care. This flexibility removes the cost of transporting patients to traditional dental offices—including nursing staff time and use of special transportation services—which can more than double the cost of the needed dental services.

The study found that most of the charges for procedures (71-79 percent) performed at the Minnesota Veterans Home were within the scope of a dental therapist trained to a Commission on Dental Accreditation standard (CODA). Eighty-two to 87 percent were within the scope of an advanced dental therapist in Minnesota, as shown in the chart below.

Among other major findings of the case study:

• About 60 percent of the procedures performed by the advanced dental therapist, who was the focus of the study, were restorative, highlighting the need for a provider trained in restorative care.
• Total billing fees generated by the advanced dental therapist each day were not significantly lower than that of the dentist on the team—$3,003 for the advanced dental therapist compared with $3,618 for the dentist. Because of the difference in salaries, however, deploying an advanced dental therapist instead of a dentist saved Apple Tree an estimated $52,000 a year.

Jane Koppelman directs research for The Pew Charitable Trusts’ dental campaign.