Oral Health Care for Children: Dental Therapists vs Dentists
Oral Health Care for Children: Dental Therapists vs Dentists
Extensive studies have been undertaken to evaluate the technical competence of dental therapists when performing restorative and minor surgical procedures.
In 1950, John T. Fulton, the dental services advisor to the US Children's Bureau, studied New Zealand's school dental nurse program for the World Health Organization. He concluded that school dental nurses were capable of placing excellent silver amalgam restorations, 82% of which he judged to be superior. In1972, a team of dentists from the 2 California dental associations, led by Dale Redig, dean of the University of the Pacific School of Dentistry, determined that more than 97% of the silver amalgam restorations placed were of satisfactory quality and concluded, "There is little doubt that dental treatment needs related to caries for most New Zealand children age 2 1/2 to 15 have been met."
Roder evaluated teeth restored by school dental nurses and dentists in South Australia in 1973. Only 1.8% of dental nurses' restorations were defective, compared with 2.6% of dentists'. In 1983, David Barmes, chief dental officer of the World Health Organization, conducted a review of the School Dental Service in South Australia. The quality of care provided by the school dental nurses was excellent. A 2009 study in Australia evaluated dental therapists' restorations in adults. More than 94% were judged to be successful, a rating as good as that for those placed by dentists.
In 1966, the General Dental Council of the United Kingdom appointed 28 dentists to assess the quality of restorations placed by the New Cross dental auxiliaries (dental therapists); 91% were rated satisfactory.
In 1972, the Saskatchewan government launched a 2-year training program for dental nurses and therapists in Regina to develop a school-based dental care program. In 1976, 3 Canadian academic dentists—E. R. Ambrose, dean and former chair of restorative dentistry at McGill University in Montreal; A. B. Hord, chair of restorative dentistry at the University of Toronto; and W. J. Simpson, chair of pediatric dentistry at the University of Alberta— conducted blinded clinical examinations of children in the program who had received care from the newly trained dental therapists as well as from dentists. They were evaluated by the criteria developed by Ryge. The dental therapists had more restorations rated as superior and fewer rated as unsatisfactory than did the dentists. Additionally, no difference was found in the quality of stainless steel crowns placed by dentists or dental therapists. The concluding summary stated,
Aside from the high standard of treatment services, there is little doubt that the personnel of the Saskatchewan Dental Plan place a good deal of emphasis on the preventive aspects of dental care…. There is no question that the children's dental program functioning in Saskatchewan is providing much needed dental care to large numbers of children who otherwise would not be receiving it.
In 1989, the Canadian government requested 2 former presidents of the Canadian Dental Association to assess and evaluate dental treatment provided by dentists and dental therapists practicing among aboriginal populations. Their findings paralleled those of Ambrose et al., with more restorations placed by dental therapists being evaluated as superior and fewer being evaluated as unsatisfactory in comparison with dentists.
No comparable studies have been done on the quality of care provided by dentists in the United States. However, studies were conducted in the United States in the 1970s at the Forsyth Institute, the University of Kentucky, and the University of Iowa demonstrating the ability of dental hygienists with additional training to provide quality restorative care for children comparable to that of US dentists and dental therapists internationally. In addition, the recent introduction of dental therapists in Alaska has resulted in studies demonstrating that these individuals are providing technically competent dental care that is equal to the level of care provided by a dentist.
Quality of Care
Extensive studies have been undertaken to evaluate the technical competence of dental therapists when performing restorative and minor surgical procedures.
In 1950, John T. Fulton, the dental services advisor to the US Children's Bureau, studied New Zealand's school dental nurse program for the World Health Organization. He concluded that school dental nurses were capable of placing excellent silver amalgam restorations, 82% of which he judged to be superior. In1972, a team of dentists from the 2 California dental associations, led by Dale Redig, dean of the University of the Pacific School of Dentistry, determined that more than 97% of the silver amalgam restorations placed were of satisfactory quality and concluded, "There is little doubt that dental treatment needs related to caries for most New Zealand children age 2 1/2 to 15 have been met."
Roder evaluated teeth restored by school dental nurses and dentists in South Australia in 1973. Only 1.8% of dental nurses' restorations were defective, compared with 2.6% of dentists'. In 1983, David Barmes, chief dental officer of the World Health Organization, conducted a review of the School Dental Service in South Australia. The quality of care provided by the school dental nurses was excellent. A 2009 study in Australia evaluated dental therapists' restorations in adults. More than 94% were judged to be successful, a rating as good as that for those placed by dentists.
In 1966, the General Dental Council of the United Kingdom appointed 28 dentists to assess the quality of restorations placed by the New Cross dental auxiliaries (dental therapists); 91% were rated satisfactory.
In 1972, the Saskatchewan government launched a 2-year training program for dental nurses and therapists in Regina to develop a school-based dental care program. In 1976, 3 Canadian academic dentists—E. R. Ambrose, dean and former chair of restorative dentistry at McGill University in Montreal; A. B. Hord, chair of restorative dentistry at the University of Toronto; and W. J. Simpson, chair of pediatric dentistry at the University of Alberta— conducted blinded clinical examinations of children in the program who had received care from the newly trained dental therapists as well as from dentists. They were evaluated by the criteria developed by Ryge. The dental therapists had more restorations rated as superior and fewer rated as unsatisfactory than did the dentists. Additionally, no difference was found in the quality of stainless steel crowns placed by dentists or dental therapists. The concluding summary stated,
Aside from the high standard of treatment services, there is little doubt that the personnel of the Saskatchewan Dental Plan place a good deal of emphasis on the preventive aspects of dental care…. There is no question that the children's dental program functioning in Saskatchewan is providing much needed dental care to large numbers of children who otherwise would not be receiving it.
In 1989, the Canadian government requested 2 former presidents of the Canadian Dental Association to assess and evaluate dental treatment provided by dentists and dental therapists practicing among aboriginal populations. Their findings paralleled those of Ambrose et al., with more restorations placed by dental therapists being evaluated as superior and fewer being evaluated as unsatisfactory in comparison with dentists.
No comparable studies have been done on the quality of care provided by dentists in the United States. However, studies were conducted in the United States in the 1970s at the Forsyth Institute, the University of Kentucky, and the University of Iowa demonstrating the ability of dental hygienists with additional training to provide quality restorative care for children comparable to that of US dentists and dental therapists internationally. In addition, the recent introduction of dental therapists in Alaska has resulted in studies demonstrating that these individuals are providing technically competent dental care that is equal to the level of care provided by a dentist.