What does the national dental workforce look like?
Most typically, dental care is provided by the Dental Team, comprised of dentists, dental hygienists, dental assistants, and support personnel including dental technicians, administrators, and receptionists.
- According to the federal Bureau of Labor Statistics (BLS) there are about 150,000 practicing dentists in the US of whom 85% are general dentists. About 6000 are specialists in the care of children.
- BLS reports about 175,000 dental hygienists in the US who provide preventive services and 295,000 dental assistants who support care provided by dentists and hygienists.
The particular services provided by dental personnel are governed by state practice acts which vary from state to state. As of early 2011, only Alaska’s Native Tribal Health Consortium and Minnesota’s statute authorize an additional type of dental provider, the Dental Therapist who provides basic preventive and reparative dental services.
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Who are the individuals working in the field?
- Dentists: The dentist provides or is responsible for all patient care services including those that are performed by other provider.
- Registered Dental Hygienists (RDH – all states): RDHs provide preventive services including cleanings (above and below the gum line), application of preventive agents, and oral health counseling typically under the direct or indirect supervision of a dentist.
- RDH in Public Health Settings (many states): A number of states authorize dental hygienists to practice in public health or safety net settings under the general supervision of a dentist. Examples include the OR Limited Access Permit that authorizes the hygienist to practice dental hygiene services, without the supervision of a dentist, on limited access patients and the NV and ME Special Endorsements to hygienists’ licenses that allow practice in specified settings.
- Registered Dental Hygienist in Alternative Practice (RDHAP) (CA): The RDHAP provides a specified range of hygiene services for up to 18 months for patients without a prescription from, or examination by, a dentist or physician.
- Independent Practice (CO, ME): Dental hygienists can practice independently of dentists, providing preventive services directly to the public.
- Expanded Function Dental Assistant (EFDA): The EFDA, working chair-side with the dentist, provides a range of restorative services that are more typically delivered by the dentist and increase the dentist’s productivity. Examples include placement of restorations in teeth prepared by the dentist, fabrication of temporary crowns and bridges, and a variety of other technical procedures. They do not provide any “irreversible” procedure such as preparing a tooth for a filling (“drilling”) or extractions.
- Dental Assistants: Dental assistants assist other providers in the direct delivery of services. Depending upon state law, their authority may extend to such responsibilities as exposing radiographs (x-rays) and cleaning teeth above the gum line as well as maintaining operatories and assisting the dentist or hygienist.
- Alternative providers:
- Alaska model: Dental Health Aide Therapists (DHATs) provide education and routine dental services including “irreversible” drilling, filling, and extraction of teeth for targeted high-risk patients in rural villages without the direct supervision of a dentist.
- Minnesota model: Dental Therapists (DT) and Advanced Dental Therapists (ADT) provide a specified range of dental repair and other “irreversible” procedures.
- Community Dental health Coordinator: An advocate who assists in enrolling community members in health programs, provides information on access to care, provides oral health counseling, and conducts risk assessments as well as a limited range of preventive procedures.
- Proposed model - Advanced Dental Hygiene Practitioner (ADHP): Designed to provide diagnostic, preventive, therapeutic, and restorative services to underserved populations as well as conduct research and engage on oral health advocacy.
- Proposed model - Pediatric Oral Health Educator: Receives advanced training and certification in oral disease management and works directly with patients and families to individualize disease control.
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What are the workforce numbers?
The Bureau of Labor Statistics projects that the number of dentists will increase to 164,000 by 2018. However, anticipated population growth will result in a reduced dentist-to-population ratio. There is a widely recognized maldistribution of dentists with relative paucities of dentists serving rural and low-income inner city populations. The federal Health Resources and Services Administration projects that more than 7000 dentists would be needed to provide care in the 4230 designated Dental Health Profession Shortage Areas across the US.
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What Education and Training is required?
Dentists are trained in four-year post-baccalaureate graduate programs. As of 2009, there are 58 accredited dental schools and at least five additional schools in development. Only New York and Delaware require an additional one-year post-doctoral residency or fellowship to acquire a license.
Most hygienists obtain training in two-year certificate or associate degree programs or four-year baccalaureate programs that are typically collocate with dental schools.
Dental assistants most often receive training on the job or in formal programs associated with accredited high schools, technical/vocational schools or junior/community colleges.
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Do dental professionals coordinate with each other and with medical providers?
State practice acts determine the relationship among dental providers based on scope of service, licensure, and supervision requirements. Integration of dental services with primary medical care is modeled in programs such as “Bright Futures” and holds promise, in particular, to address oral health disparities among young children.
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Are there federal programs to increase dental workforce in states?
Federal “Grants to Support Oral Health Workforce Activities” were authorized in 2002 as part of the Safety Net Improvement Act to provide matching funds (40% state dollars; 60% federal dollars) for a variety of activities that improve access in rural areas through workforce fixes. By 2010, this program grew to $17 million in federal funds and provided grants in 34 states to support any of 13 strategies.
ACA (healthcare reform) expands Health Professions Training (Title VII) funding for pre- and post-doctoral dentist training, hygienist training, practitioner education, faculty support and curriculum development. ACA also establishes demonstration project grants to “train or employ” alternative new dental professional and a National Health Workforce Commission and training programs
The American Recovery and Reinvestment Act (ARRA) includes funding for health workforce programs and scholarship, loans and load repayment to support programs that expand and improve health professions training.
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Do state oral health plans and best practices address workforce?
State oral health plans often identify workforce needs and establish goals. ASTDD best practices specifically address Workforce.
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Where can I get more information?