CTSI-supported researchers help shape a national model for dental care aimed at underserved communities

Published by CTSI on April 24, 2017

Dental therapist treats a patient

Dental therapists handle procedures like filling cavities at a lower cost than dentists, even though they take many of the same courses. Minnesota clinics have credited the profession with helping them cut costs while serving patients who otherwise couldn’t afford the procedures they need.

Two University of Minnesota School of Dentistry researchers are at the forefront of an emerging profession that is extending dental care access to rural, underserved Minnesota communities.

In 2009, Minnesota became the first state to pass legislation allowing dental therapists -- mid-level professionals similar to physicians assistants and nurse practitioners on the medical side -- to care for patients.

The law aimed to improve access to dental care in rural communities and other underserved populations, and that’s exactly what has happened since. In fact, today nearly 85 percent of individuals receiving care from dental therapists are enrolled in a publicly funded insurance program, according to a Minnesota Department of Health survey.

CTSI created an opportunity to conduct research that is moving the dental therapy profession forward.

—Dr. Christine Blue

Shortly after the law change, the University of Minnesota became the first and only U.S. dental school to offer a Dental Therapy degree with the launch of a three-year program that educates individuals to provide preventive and restorative care.

Dental therapy students learning alongside dental and dental hygiene students

The University’s School of Dentistry has a team-based approach to care and education. Dental therapists learn alongside the dental and dental hygiene students with whom they will practice (Seen here are dental therapy students in black scrubs with dental hygiene students in maroon scrubs).

This unique combination of firsts placed Minnesota at the forefront of this budding profession, a position that University of Minnesota researchers are helping to bolster. Researchers have been studying various aspects of the profession to better understand the effect of dental therapists, which can help inform and influence policymakers across the nation.

CTSI is helping lead the way through two projects supported through its Office of Community Engagement to Advance Research and Community Health (CEARCH), which provides funding and guidance to enable teams of University researchers and members of the public to address health issues.

Studying dental therapists’ impact

Soon after Minnesota began allowing dental therapists to practice, CTSI awarded a $34,000 grant to the School of Dentistry’s Christine Blue, BSDH, MS, DHSc, so she could study dental therapy students’ impact on patients’ oral care behaviors.

Dr. Christine Blue, an Associate Professor at the University of MinnesotaDr. Christine Blue is an Associate Professor at the University who was part of a legislative work group that ultimately led to a new law allowing dental therapists to practice in Minnesota.

Dr. Blue -- who was part of a legislative work group that ultimately led to the Minnesota law passage -- teamed up with Lydia Caros of the Native American Community Clinic to investigate the topic. The Minneapolis clinic would become the setting for the study, in which dental therapists counseled participating pregnant women and mothers with newborns about cavity prevention. 

Because bacteria can be transmitted from mother to child through pregnancy and breastfeeding, improving a mother’s oral health behaviors could help reduce cavities among infants. Moms and moms-to-be took a test to assess their oral bacteria load, and completed two questionnaires pertaining to risk behaviors and disease indicators.

CTSI biostatisticians crunched the numbers, as part of a contract that the School of Dentistry has with CTSI’s Biostatistical Design and Analysis Center. This enables researchers across the school to receive ongoing support from CTSI biostatisticians.  

“Our CTSI biostatistician is incredibly easy to work with and is the ‘go-to’ for all research happening in our department, from student thesis projects to extramural faculty grants,” says Dr. Blue.

Study data suggests the dental therapist was effective in reducing mothers’ oral bacterial load. It’s currently one of the only studies that investigates the effectiveness of dental therapists, and is being used across the country by groups advocating to allow dental therapists to practice. 

CTSI’s support of our research has been an important part of our overarching efforts to influence policy decisions, advance the dental therapist profession, and better serve the communities who can benefit the most from these practitioners.

—Dr. Karl Self

“CTSI created an opportunity to conduct research that is moving the dental therapy profession forward,” says Dr. Blue. “You can anecdotally talk about the advantages of dental therapists, but unless you have facts, it’s not as meaningful.”

Assessing attitudes toward dental therapists

The willingness of the public to accept care from dental therapists had been another unknown until School of Dentistry researcher Karl Self, DDS, MBA, released findings from a CTSI-supported study.

Dr. Karl SelfResearch by University Associate Professor Karl Self, DDS, MBA, is helping to advance the dental therapist profession, and better serve the communities that can benefit the most from these practitioners.

Understanding how socioeconomic factors and oral health status impact the acceptability of care provided by a dental therapist is important, as dental therapy was authorized to help low-income and underserved people who disproportionately suffer poor oral health.

Dr. Self received a $7,500 Driven to Discover Community Health Research grant, which supports pilot projects that address important Minnesota human health issues and enable Minnesota State Fair attendees to participate. 

A survey of fairgoers gauged whether they felt it would be appropriate to have a dental therapist provide care, and received a screening from a dental therapist. Having dental therapists interact with patients also served to educate the public and increase awareness of the profession.

To conduct the study, Dr. Self partnered with the newly created Minnesota Dental Therapy Association (MDTA), an organization devoted to promoting the profession and generating awareness. The association helped design the data collection approach, recruited therapists to staff the study, and have strongly supported efforts to interpret the data.

Dr. Self and team assessed the attitudes of a broad population, and correlated those attitudes with the individual’s risk for dental decay. Results showed the public is generally accepting of the new provider type, with the majority of participants saying they would accept care from a dental therapist or did not have a strong preference or enough information.

Dental therapists may trigger a paradigm shift for the way dental care is delivered, and CTSI’s support of research on this topic is helping to make that a reality.

—Dr. Christine Blue

Dr. Louis B. Sullivan (second from right), former Secretary of the U.S. Dept. of Health and Human Services, visits the School of Dentistry to meet with dental therapy students and educators and tour the school's team care clinic.

Dr. Louis B. Sullivan (second from right), former Secretary of the U.S. Dept. of Health and Human Services, visits the School of Dentistry to meet with dental therapy students and educators and tour the school's team care clinic. The visit followed his testimony before the North Dakota interim Health Services Committee about the dentist workforce shortages and the licensure of dental therapists to enhance access to care.

Influencing legislation across the country

A few additional states have begun allowing dental therapists to practice, though Minnesota continues to lead the way in education, care, and research.

Minnesota’s program is considered a national model due to the way it incorporates dental therapists into the delivery of care, and researchers like Drs. Self and Blue are continuing to advance the profession and influence legislation. 

For example, findings from Dr. Self’s CTSI-supported study were used in documentation provided to the Commission on Dental Accreditation (CODA), which ultimately voted to accredit dental therapy education in the U.S.

Additionally, Dr. Self has testified on behalf of proposals to modify licensing laws pertaining to dental care practitioners.

“CTSI’s support of our research has been an important part of our overarching efforts to influence policy decisions, advance the dental therapist profession, and better serve the communities who can benefit the most from these practitioners,” says Dr. Self.  “If states remove the barriers that prevent dental therapists from practicing, they can better serve those who lack access to dental care.”

Blue agreed adding, “Dental therapists may trigger a paradigm shift for the way dental care is delivered, and CTSI’s support of research on this topic is helping to make that a reality.”

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