Dental therapists are members of the oral health workforce in over 50 countries in the world typically caring for children in publically funded school-based programs. A movement has developed in the United States to introduce dental therapists to the oral health workforce in an attempt to improve access to care and to reduce disparities in oral health. This article critiques trends in the United States movement in the context of the history and success of dental therapists practicing internationally. While supporting the dental therapist movement, we challenge: a) the use of dental therapists treating adults, versus focusing on children; b) the use of dental therapists in the private versus the public/not-for-profit sector; and c) requirements that a dental therapist must also be credentialed as a dental hygienist.

To examine the literature on dental reimbursement methods, with emphasis on paying for value (e.g., health care outcomes) rather than procedure. To make recommendations that would facilitate the expansion of access to dental care for those most in need and improve the oral health of the US population.

The Virtual Dental Home is a concept of the Pacific Center for Special Care of the Arthur A. Dugoni School of Dentistry in San Francisco. It is designed to improve access to dental care for underserved populations, specifically children and institutionalized adults. This article describes the development and implementation of the Virtual Dental Home, subsequently critiquing the concept. The criteria for a dental home are not met by the program. It is the equivalent of a traditional public oral health prevention and screening program, with the additional dimension of allowing dental hygienists and assistants to place interim glass ionomer restorations in dental cavities. The critique questions the need to insert a cloud dentist into the process. The routine utilization of radiographs is also challenged. The VDH not only lacks the attributes of a dental home, it has not been shown to be as efficient and effective as traditional programs staffed by dental hygienists and dental therapists. The article concludes by describing how programs utilizing dental therapists could address the deficiencies of the Virtual Dental Home, effectively improving access to oral health care for underserved populations.

OBJECTIVES:The poor oral health of Saskatchewan's children, in concert with a significant shortage of dentists, prompted the province in the early 1970s to seek an alternative method of addressing the oral health care needs of children. The result was the Saskatchewan Health Dental Plan (SHDP), which trained and employed dental therapists in school-based clinics to provide basic dental care to all children. The program was initiated over the opposition of Saskatchewan's dentists. The purpose of this research was to provide information and data previously not documented in the refereed dental literature regarding the only school-based program staffed by dental therapists to ever exist in North America.METHODS:This case study reviews the program's planning, opposition, implementation, and achievements based on a comprehensive review of published articles as well as a search of the grey literature. Additionally, Saskatchewan Health provided annual reports for each year of the program's existence.RESULTS:During its thirteen years of existence, the school-based program proved popular with parents and achieved significant success in providing necessary dental care for children. It was terminated in 1987 by the newly elected provincial Conservative government, which was not supportive of such social programs.CONCLUSIONS:The SHDP serves as a successful model of school-based dental care for children. However, the termination of the plan demonstrates the vulnerability of publicly funded dental health programs to conflicting political ideologies and special interest groups.

This article discusses the debate surrounding the supposed negative health implications for community water fluoridation (CWF).

Dental therapists are members of the oral health care workforce in over 50 countries of the world. Until recently, they have not participated as members of the professional dental team in the USA. It was not until the publication of Oral Health in America: A Report of the Surgeon General in 2000, describing the significant problem of access to dental care, that the issue of dental therapists emerged in the USA in a significant manner. Details of the development of dental therapists in the workforce in the USA through 2011 were previously chronicled by Mathu-Muju. Since then, there has been a major increase in interest and licensing of dental therapists in a number of states. This article updates the dental therapist movement to the present time. The literature and activities of the movement will be reviewed by the categories of research, education, and legislation/practice, as well as analytical essays and commentaries.

Journal of School HealthVolume 85, Issue 10 p. 659-662 COMMENTARY Ensuring Access to Oral Health Care for Children: School-Based Care by Dental Therapists — A Commentary David A. Nash DMD, MS, EdD, Corresponding Author David A. Nash DMD, MS, EdD William R. Willard Professor of Dental Education, Professor of Pediatric Dentistry [email protected] College of Dentistry, University of Kentucky, Lexington, KY 40536-0297Address correspondence to: David A. Nash, William R. Willard Professor of Dental Education, Professor of Pediatric Dentistry, ([email protected]), Department of Pediatric Dentistry, College of Dentistry, University of Kentucky, Lexington, KY 40536-0297.Search for more papers by this authorKavita R. Mathu-Muju DMD, MPH, Kavita R. Mathu-Muju DMD, MPH Assistant Professor of Pediatric Dentistry [email protected] Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, CanadaSearch for more papers by this authorJay W. Friedman DDS, MPH, Jay W. Friedman DDS, MPH Public Health Dental Consultant [email protected] Los Angeles, CASearch for more papers by this author David A. Nash DMD, MS, EdD, Corresponding Author David A. Nash DMD, MS, EdD William R. Willard Professor of Dental Education, Professor of Pediatric Dentistry [email protected] College of Dentistry, University of Kentucky, Lexington, KY 40536-0297Address correspondence to: David A. Nash, William R. Willard Professor of Dental Education, Professor of Pediatric Dentistry, ([email protected]), Department of Pediatric Dentistry, College of Dentistry, University of Kentucky, Lexington, KY 40536-0297.Search for more papers by this authorKavita R. Mathu-Muju DMD, MPH, Kavita R. Mathu-Muju DMD, MPH Assistant Professor of Pediatric Dentistry [email protected] Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, CanadaSearch for more papers by this authorJay W. Friedman DDS, MPH, Jay W. Friedman DDS, MPH Public Health Dental Consultant [email protected] Los Angeles, CASearch for more papers by this author First published: 02 September 2015 https://doi.org/10.1111/josh.12297Citations: 8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL REFERENCES 1 US Department of Health and Human Services (USDHHS). Oral Health in America: A Report of the Surgeon General. Rockville, MD: USDHHS, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. 2Dye BA, Tan S, Smith V. Trends in Oral Health Status: United States, 1988-1994 and 1999-2004. Vital and Health Statistics, Series 11, Number 248. Washington, DC: National Center for Health Statistics; 2007. 3Gehshan S, Straw T. Access to Oral Health Services for Low Income People: Policy Barriers and Opportunities for Intervention by the Robert Wood Johnson Foundation. Forum for State Health Policy Leadership. Washington, DC: National Conference of State Legislatures; 2002. 4 General Accounting Office (GAO). Oral Health: Factors Contributing to Low Use of Dental Services by Low-Income Populations. Washington, DC: General Accounting Office; 2000. 5Nash DA. Developing a pediatric oral health therapist to help address oral health disparities among children. J Dent Educ. 2004; 68(1): 8- 20. 6Nash DA, Friedman JW, Mathu-Muju KR, et al. A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States. Battle Creek, MI: The W. K. Kellogg Foundation; 2012. 7Nash DA, Friedman JW, Mathu-Muju KR, et al. A review of the global literature on dental therapists. Community Dent Oral Epidemiol. 2014; 42: 1- 10. 8Mathu-Muju KR, Friedman JW, Nash DA. Oral health care for children in countries using dental therapists in public, school-based programs, contrasted with that of the United States. Am J Public Health. 2013; 103(9): e7. 9Friedman JW. The international dental therapist: history and current status. J Calif Dent Assoc. 2011; 39(1): 23- 29. 10 Canadian Center for Policy Alternatives. Putting Our Money Where Our Mouth Is: The Future of Dental Care in Canada. Ottawa, ON: Canadian Center for Policy Alternatives; 2011. 11New Zealand Ministry of Health. Internal Data. Wellington, New Zealand: New Zealand Ministry of Health; 2012. 12 US Department of Health and Human Services (USDHHS). National Call to Action to Promote Oral Health: A Public-Private Partnership Under the Leadership of the Office of the Surgeon General. Rockville, MD: USDHHS, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2003. 13Newacheck PW, Hughes DC, Hung YY. The unmet health needs of America's children. Pediatrics. 2000; 105(4 Pt 2): 989- 997. 14Kaste LM, Selwitz RH, Oldakowski RJ. Coronal caries in the primary and permanent dentitions of children and adolescents 1-17 years of age (1988-91): United States. J Dent Res. 1996; 75: 631- 641. 15Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health. 1992; 82(12): 1663- 1668. 16Seirawan H, Faust S, Mulligan R. The impact of oral health on the academic performance of disadvantaged children. Am J Public Health. 2012; 102(9): 1729- 1734. 17Improving the Oral Health Status of All Americans: Roles and Responsibilities of Academic Dental Institutions. Washington, DC: American Dental Education Association; 2003. 18 US General Accounting Office. Oral Health: Factors Contributing to Low Use of Dental Services by Low-income Populations. Washington, DC: US General Accounting Office; 2000. 19Department of Health and Human Services. Center for Medicaid and Medicare Services. Connecting Kids to Coverage National Campaign to Insure Care. Washington, DC. Available at: www.insurekidsnow.gov. Accessed May 1, 2013. 20Gehshan S, Hauck P, Scales J. Increasing Dentists' Participation in Medicaid and SCHIP. Forum for State Health Policy Leadership. Denver, CO and Washington, DC: National Conference of State Legislatures; 2001. Available at: http://mchoralhealth.org/PDFs/IncreasingDentistParticipation.pdf. Accessed June 30, 2015. 21DeVoe JE, Baez A, Angier BA, Krois L, Edlund C, Carney PA. Insurance + access does not equal health care: typology of barriers to health care access for low-income families. Ann Fam Med. 2007; 5(6): 511- 518. 22Brooking TWH. A History of Dentistry in New Zealand. Dunedin, New Zealand: New Zealand Dental Association; 1980. 23Nash DA. Developing and deploying a new member of the dental team: a pediatric oral health therapist. J Public Health Dent. 2005; 65(1): 48- 55. 24 New Zealand Ministry of Health. Our Oral Health: Key Findings of the 2009 New Zealand Oral Health Survey. Wellington, New Zealand: Ministry of Health; 2010. 25 Malaysia Ministry of Health. Annual Report 2004: Health Management Information System (Oral Health Subsystem). Kuala Lumpur, Malaysia: Ministry of Health; 2004. 26 Singapore Ministry of Health. Dentistry in Singapore 1819-1996. Singapore: Singapore Ministry of Health; 1996. 27Board SHP. A-Z of Health; Annual Report, 2008-2009. Singapore: Health Promotion Board; 2009. 28 Singapore Ministry of health. Information Sheet of Dental Therapists in the Singapore Dental Service. Singapore: Singapore Ministry of Health; 2007. 29Wong SPY. Training and utilization of dental therapists in the school dental care service. J Hong Kong Soc Community Med. 1981; 12(1): 17- 20. 30Government of Hong Kong. Department of Health. Available at: www.budget.gov.hk/2012/eng/pdf/head037.pdf. Accessed August 20, 2012. 31 Hong Kong Department of Health. Oral Health Survey 2001. Hong Kong: Government Printer; 2002. 32Lewis MH. Dental care delivery in Saskatchewan, Canada. In: JII Ingle, P Blair, eds. International Dental Care Delivery Systems. Cambridge, MA: Ballinger; 1977. 33Lewis DW. Performance of the Saskatchewan Health Dental Plan, 1974-1980. Toronto, Canada: Faculty of Dentistry, University of Toronto; 1981. 34 Saskatchewan Health. Statistical Report of the Saskatchewan Health Dental Plan. September 1, 1987 to August 31, 1988. Saskatoon, Canada: Saskatchewan Health; 1988. 35National Assembly of School-Based Health Care. The raising of America. Washington, DC: National Assembly of School-Based Health Care. Available at: http://www.raisingofamerica.org/?q=advocacy/national‐assembly‐school‐based‐health‐care‐nasbhc. Accessed June 30, 2015. 36Seen Magazine. School-based health care: why it is common sense. Seen Magazine, March 31, 2010. Available at: http://www.seenmagazine.us/articles/article‐detail/articleid/582/school‐based‐healthcare.aspx. Accessed May 1, 2013. 37New York City Department of Education. School based health centers. Available at: http://schools.nyc.gov/Offices/Health/SBHC/SBHC.htm. Accessed May 1, 2013. 38Nash DA, Nagel R. A brief history and current status of a dental therapy initiative in the United States. J Dent Educ. 2005; 69(8): 857- 859. 39Nash DA, Nagel R. Confronting oral health disparities among American Indian/Alaska Native children: the pediatric oral health therapist. Am J Public Health. 2005; 95(8): 1325- 1329. 40Wettterhall S, Bader JD, Burrus BB. Evaluation of the Dental Health Aide Therapist Workforce Model in Alaska: Final Report. Durham, NC: RTI International; 2010. 41Anchorage Daily News. Dental therapist training program opens in Alaska. Accessed January 16, 2007. 42Glasrud PE, Ebetson C, Day T, Diercks R. A History of Minnesota's Dental Therapist Legislation: Or…What the Heck Happened Up There? Minneapolis, MN: Minnesota Dental Association; 2009. 43 American Dental Association. House of Delegates Proceedings. Chicago, IL: ADA Annual Session; 2000. 44To'olo G, Nash DA, Mathu-Muju KR. Pediatric dentists' knowledge and opinions about pediatric oral health therapists. Pediatr Dent. 2010; 32(6): 505- 512. 45 American Association of Public Health Dentistry. Resolution on the Need for Formal Demonstration Projects to Improve Access to Preventive and Therapeutic Oral Health Services. Springfield, IL: American Public Health Dentistry Association; 2006. 46 American Association of Public Health. Resolution on Dental Therapists in Alaska. Washington, DC: American Public Health Association; 2006. 47 US Department of Health and Human Services. National Call to Action to Promote Oral Health: A Public-Private Partnership Under the Leadership of the Office of the Surgeon General. Rockville, MD: Agency for Health care Research and Quality; 2009. Citing Literature Volume85, Issue10October 2015Pages 659-662 ReferencesRelatedInformation

Disparities in dental health care that characterize poor populations are well known. Children suffer disproportionately and most severely from dental diseases. Many countries have school-based dental therapist programs to meet children's primary oral health care needs.Although dental therapists in the United States face opposition from national and state dental associations, many state governments are considering funding the training and deployment of dental therapists to care for underserved populations. Dental therapists care for American Indians/Alaska Natives in Alaska, and Minnesota became the first state to legislate dental therapist training.Children should receive priority preference; therefore, the most effective and economical utilization of dental therapists will be as salaried employees in school-based programs, beginning in underserved rural areas and inner cities.

OBJECTIVE:Access to adequate oral health care is deficient in many parts of the world. Many countries are now using dental therapists to increase access, particularly for children. To inform the discussion on dental therapists in the workforce, particularly in the United States, the W.K. Kellogg Foundation funded a review of the global literature to identify as many documents as possible related to the practice of dental therapists since the establishment of the School Dental Service in New Zealand in 1921.METHODS:Consultants in each of the countries considered to have a substantive literature on dental therapists were asked to participate in the research; seventeen in total. In addition to identifying and reviewing published articles, a focus of the research was on identifying 'gray' documents. Standard databases were searched for key words associated with dental therapists. In addition, searches were conducted of the governmental and dental association websites of all countries known to have dental therapists in their oral health workforce.RESULTS:Fifty-four countries, both developing and developed, were identified where dental therapists are members of the workforce. Eleven hundred documents were identified from 26 of these countries, with over 2/3 of them cited in the published monograph. Reliable evidence from the related literature and verbal communication confirmed the utilization of dental therapists in an additional 28 countries. Thirty-three of the countries were members of the Commonwealth of Nations, suggesting a mechanism of spread from New Zealand. Variable lengths of training/education existed for dental therapists with the tradition being 2 years postsecondary. In a few countries, the training of therapists and hygienists is now being combined in a three academic year program. Historically, dental therapists have been employed by government agencies caring for children, typically in school-based programs. Initiatives in some countries allow limited care for adults by dental therapists with additional training.CONCLUSIONS:The evidence indicates that dental therapists provide effective, quality, and safe care for children in an economical manner and are generally accepted both by the public and where their use is established, by the dental profession.

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children's access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices.

With the current emphasis in dentistry being placed on clinicians to make evidence-based decisions, the management of asymptomatic and pathology free third molar teeth has been reassessed and questioned. The purpose of this paper was to evaluate past and present knowledge of third molar extractions and relate it to logical considerations relevant to science, the evidence-based decision-making process, and the individual patient. Based on suggested guidelines and current evidence, this paper endeavors to discuss the issues surrounding obtaining adequate informed consent for what is essentially an elective procedure.

Dental therapists provide preventive, restorative, and minor surgical treatment, mostly for children in government-sponsored health programs, in more than 53 countries. Their quality of care and acceptance by the public and dental profession has been well-documented. Since 2005, they have been effectively serving native Alaskans in remote communities. Not only do dental therapists provide basic dental care to underserved populations, they enable associated dentists to practice at a higher level of proficiency and efficiency.

In 1921, New Zealand began training school dental nurses, subsequently deploying them throughout the country in school-based clinics providing basic dental care for children. The concept of training dental nurses, later to be designated dental therapists, was adopted by other countries as a means of improving access to care, particularly for children. This paper profiles six countries that utilise dental therapists, with a description of the training that therapists receive in these countries, and the context in which they practice. Based on available demographic information, it also updates the number of dental therapists practising globally, as well as the countries in which they practice. In several countries, dental therapy is now being integrated with dental hygiene in training and practice to create a new type of professional complementary to a dentist. Increasingly, dental therapists are permitted to treat adults as well as children. The paper also describes the status of a current initiative to introduce dental therapy to the United States. It concludes by suggesting that dental therapists can become valued members of the dental team throughout the world, helping to improve access to care and reducing existing disparities in oral health.

Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion. In addition, more than 11 million patient days of "standard discomfort or disability"--pain, swelling, bruising, and malaise--result postoperatively, and more than 11000 people suffer permanent paresthesia--numbness of the lip, tongue, and cheek--as a consequence of nerve injury during the surgery. At least two thirds of these extractions, associated costs, and injuries are unnecessary, constituting a silent epidemic of iatrogenic injury that afflicts tens of thousands of people with lifelong discomfort and disability. Avoidance of prophylactic extraction of third molars can prevent this public health hazard.