Igniting a Movement in a Dual Licensed Dental Workforce: The Minnesota Model.

Increased awareness of oral health disparities in the United States has highlighted the need to expand the workforce and access to both primary and preventive dental care. Achieving oral health equity will require new dental team members with appropriate clinical skills dedicated to reaching historically marginalized populations through intra and interprofessional practice. Collective efforts by health care advocates in Minnesota led to legislation that created a dental hygiene-based workforce model inspired by the vision and foresight of the American Dental Hygienists' Association's "Advanced Dental Hygiene Practitioner." In July 2023, there were 141 licensed dental therapists and 99 certified advanced dental therapists, with the majority being dual-licensed dental hygienists/dental therapists, providing primary care services in a variety of settings throughout the state. Current data confirm their contributions to increasing access to primary oral health care services for Minnesotans across the lifespan. While surmountable challenges remain, new opportunities are emerging for dental therapists within Minnesota's transforming health care system. The purpose of this paper is to describe the implementation of this new workforce model in Minnesota, its challenges and successes to assist other states in developing new models for intraprofessional dental team members.

Igniting a movement in a dual-licensed dental workforce: The Minnesota model.

AIMS: Increased awareness of oral health disparities in the United States has highlighted the need to expand the workforce and access to both primary and preventive dental care. Achieving the goal of oral health equity will require dental team members with appropriate clinical skills dedicated to reaching historically marginalized populations through intra- and interprofessional practice. MATERIALS AND METHODS: Collective efforts by healthcare advocates in Minnesota led to legislation that created a dental hygiene-based workforce model inspired by the vision and foresight of the American Dental Hygienists' Association's 'Advanced Dental Hygiene Practitioner'. RESULTS: In July 2023, there were 141 licensed dental therapists and 99 certified advanced dental therapists, the majority dually licensed as dental hygienists/dental therapists, providing primary care services in a variety of settings throughout the state. Current data confirm the contributions of this workforce model to increasing access to primary oral health care for Minnesotans across the lifespan. CONCLUSIONS: While challenges remain, new opportunities are emerging for dual-licensed dental hygienists/dental therapists to reach intended populations. Minnesota's challenges and successes with the authorization and implementation of a dental hygiene-based workforce model can serve to assist others in developing their own intra- and interprofessional oral health care practitioners.

DENTAL THERAPY AND DENTAL PATIENT-REPORTED OUTCOMES (dPROs).

Dental therapy was introduced into the dental team as an advanced practice provider with the intention to increase access to care while providing high quality care in a cost-effective manner. It is essential that the dental therapist is able to provide patient-centered care to minimize patients' suffering. In order to assess patients' suffering, it is critical to understand the impact of care and dental patient-reported outcomes (dPROs). The use of dPROs in evidence-based clinical practice can assess the impact that the advanced practice provider has in dentistry. The presence of dPROs in evidence-based clinical practice will show the equivalence and differences in impact of the dental therapist and dentist. Currently, there is limited research regarding the use of dPROs in dental therapy. A roadmap in this paper demonstrates possible ways to collect dPROs in dental therapy and advance evidence-based dental practice. Recommendations in ways to achieve the roadmap, possible research designs, and expansion in knowledge of dental therapy and dPROs are provided. It is important to explore the advanced practice provider and the possibilities in evidence-based dentistry with the usage of dPROs.

Dental Therapists as New Oral Health Practitioners: Increasing Access for Underserved Populations.

The development of dental therapy in the U.S. grew from a desire to find a workforce solution for increasing access to oral health care. Worldwide, the research that supports the value of dental therapy is considerable. Introduction of educational programs in the U.S. drew on the experiences of programs in New Zealand, Australia, Canada, and the United Kingdom, with Alaska tribal communities introducing dental health aide therapists in 2003 and Minnesota authorizing dental therapy in 2009. Currently, two additional states have authorized dental therapy, and two additional tribal communities are pursuing the use of dental therapists. In all cases, the care provided by dental therapists is focused on communities and populations who experience oral health care disparities and have historically had difficulties in accessing care. This article examines the development and implementation of the dental therapy profession in the U.S. An in-depth look at dental therapy programs in Minnesota and the practice of dental therapy in Minnesota provides insight into the early implementation of this emerging profession. Initial results indicate that the addition of dental therapists to the oral health care team is increasing access to quality oral health care for underserved populations. As evidence of dental therapy's success continues to grow, mid-level dental workforce legislation is likely to be introduced by oral health advocates in other states. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Minnesota Extends Oral Healthcare Delivery to Impact Population Health.

UNLABELLED: Collaborative leadership and stakeholder engagement have created the concept of dental therapist intraprofessional dental team members who are expanding and extending the reach of oral health care to help meet the public need in Minnesota. BACKGROUND AND PURPOSE: Partially owing to inadequate access to affordable oral health care, health disparities exist within Minnesota's population with significant numbers of residents lacking access to basic oral health care. Policymakers, advocacy organizations, and dental professionals recommended action to address these issues. In 2009, Minnesota became the first state government in the United States to license 2 levels of practitioners, the dental therapist and the advanced dental therapist to primarily treat underserved patients. The purpose of this article is to explain the evolution of the dental therapist and guide other constituencies toward innovative dental hygiene-based workforce models. METHODS: The evolution and educational preparation of the dental therapist and advanced dental therapist are explained in the context of a unique working relationship between educators, legislators, educational institutions, and the Minnesota Department of Health. Pivotal societal, public health, and legislative issues are described from the initial stages in 2005 until 2014 when early data are emerging regarding the impact of dental therapists. CONCLUSIONS: Dental therapist oral health care providers are working in a variety of settings in Minnesota including community clinics, hospitals, and private practices. As of early February 2014, there were 32 licensed dental therapists, and 6 of whom also held certifications as advanced dental therapists. Initial public health impacts are positive; research regarding the benefits to the public is in its infancy. Further evaluation of outcomes will ascertain the viability of this new professional.

Development and status of the advanced dental hygiene practitioner.

PURPOSE: Advanced dental hygiene practitioners (ADHPs), members of the oral health care team, bring care to persons disenfranchised from adequate dental services. ADHPs are licensed and provide the traditional educational, preventive and therapeutic dental hygiene services, plus diagnostic, prescriptive and minimally invasive restorative services. ADHPs work in collaboration with all members of the dental team, referring patients in need of services outside of their scope directly to dentists or other health care providers.

Legislative initiatives of the developing advanced dental hygiene practitioner.

PURPOSE: Today there is a heightened awareness to address access issues and unmet oral needs. The current private practice system of delivering oral health care is failing many Americans. Healthcare advocates and policy makers are taking a greater interest in addressing access problems and have begun to explore new approaches to eliminate oral health care disparities. One solution is the introduction of a new member of the dental team, which is creating a power paradigm shift within the dental profession. As the Advanced Dental Hygiene Practitioner (ADHP) becomes a reality it will be necessary to advocate for change in state dental practice acts to allow this new provider access to populations that are currently unserved or underserved. The National Call to Action to Promote Oral Health report that was published in 2003 called for flexibility in licensure laws that would permit alternative models of delivery of oral healthcare services to vulnerable populations. The American Dental Hygienists' Association responded to the Call to Action by proposing a mid-level provider, the ADHP. Six years later extensive work has led to curricula and one program that accepted applicants for the fall of 2009. This short report will outline steps necessary for changing the practice act along with an example of one state's experience at planning and implementing creative solutions to increase access and eliminate disparities in oral healthcare in a socially responsible and cost-effective approach.