An out-of-state foundation wants more children to receive dental care. I share their goal.
However, the Pew Foundation’s proposal (“Dental therapist proposal remains controversial,” Sept. 1 Daily Sun) would create a new layer of health professionals, add regulations and require a new curriculum that’s yet to be written. A better way exists. I know from experience.
The foundation wants Arizona to create a new mid-level position, a dental therapist, who with just three years of training could drill and remove teeth. I wouldn’t want my children having their mouths irreversibly altered by someone with scant training, and I can’t imagine many other parents would either.
Especially when there is a better alternative: tele-dentistry.
I started using it about seven years ago to better serve children in the White Mountains. Families were driving to Flagstaff to see me for their initial intake and assessment. We would plan their treatment and schedule a second appointment, requiring another six to eight hours of driving.
That wasn’t efficient, and it increased the chances the family would miss the second appointment. The child’s dental issues would just get worse.
That’s when David Leard, who was then at Head Start, suggested tele-dentistry to break down barriers to care.
We did our intake and initial assessment via the Internet. I remained in Flagstaff while a hygienist or dental assistant visited a Head Start center in the White Mountains. Using digital radiography, photographs and digital cavities detection, I could diagnose a child remotely.
We would create a treatment plan (always involving the parent), directing the child to either come to Flagstaff or handle the issue with counseling closer to home. Follow-up care could be done off site.
After three years, I recruited a pediatric dentist and opened a satellite office in Show Low, later moving it to Lakeside. It’s like a hub and wheels, with spokes of the practice giving every child a dental home with a dentist, dental hygienists and health coordinators.
Creating a dental therapist position does no more than roughly patch a hole. It drops the team approach of a dentist, hygienist and coordinator working together. Rural areas shouldn’t be restricted on care. With technology, there’s no reason dentists can’t reach out to those areas.
Community health clinics are established throughout the state. Coordinators can provide education, work with a dentist in creating a treatment plan and provide follow-up care.
State regulations changed to make tele-dentistry possible, but more can be done to remove barriers. And AHCCCS plans need to be more transparent. I’ve had dentists tell me they were turned down for participation, when it’s clear we need more dentists available to treat children. The Legislature should also consider adding preventive dental care to AHCCCS, connecting adults to dentists and all the benefits that brings.
Creating a mid-level position just waters down the system, making it more complex, convoluted and costly. Coordination of care becomes more difficult, increasing the potential for at-risk children to drop through the cracks. Rather than closing the gap, adding dental therapists creates the opportunity for more of them.
Besides incorporating tele-dentistry, Arizona recently made changes to expand the scope of dental services. Hygienists and dental assistants can fill cavities on teeth prepared by the dentist, increasing productivity and efficiency. This hasn’t yet come to fruition. Let’s give it a chance before suggesting that rural Arizona should be happy with second-tier care.