CODA Guidelines for Dental Therapy Education: Implications for Expansion of Dental Therapy in the U.S.

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1 CODA Guidelines for Dental Therapy Education: Implications for Expansion of Dental Therapy in the U.S. Jane Koppelman, Research Director, Pew Dental Campaign Wisconsin Oral Health Conference September 26, 2018

2 Our Mission The Pew Dental Campaign strives for cost-effective policies that will mean millions more people get the basic dental care they need to lead healthy lives.

3 Overview What is CODA? What do the CODA dental therapy guidelines contain? How are the CODA DT guidelines expected to impact emergent field of dental therapy in the U.S.? How can CODA DT guidelines help state legislators craft authorizing legislation?

4 Title The Problem: Access to Care Text Mission of Mercy clinic in Cape Girardeau, Missouri on May 3, dental million lack dental insurance disproportionately low-income 63 million live in dentist shortage areas Public Clinics at of dentists do not treat publicly insured

5 ER Use for Dental Problems

6 What are Dental Therapists? Midlevel dental providers similar to physician assistants Work under the supervision of a licensed dentist Provide preventive and routine restorative care (i.e. filling cavities, nonsurgical extractions, placing temporary and preformed crowns)

7 Why Employ Dental Therapists? Improve the productivity and efficiency of dental practices Help practices serve more Medicaid patients Make community-based care models more economically sustainable

8 Dental Therapy in the U.S.

9 CODA Mission & Scope CODA: sole national accrediting agency for all dental-related education programs CODA serves the oral health care needs of the public through the development and administration of standards that foster continuous quality improvement of dental and dental therapy related educational programs.

10 Safe and High Quality Care Approved accreditation standards for DT education programs in August 2015 After extensive research, input and deliberations, CODA concluded that: There is a need for a mid-level dental provider They can be trained to provide safe and high quality care There is public and professional support for the new profession

11 CODA Membership American Dental Association 4 members; American Association of Dental Boards 4 members American Dental Education Association 4 members Postdoctoral General Dentistry 1 member Recognized Dental Specialties (one each) 9 members American Dental Assistants Association 1 member American Dental Hygienists' Association, 1 member National Association of Dental Laboratories 1 member General Public 4 members Student 1 member There will be Dental Therapist added by the time first program is considered

12 What is accreditation and why does it matter? Ultimate source of consumer protection for students and for the public In the health professions, graduation from an accredited program is almost always stipulated by state law and required for state licensure and/or certification.

13 CODA DT Guidelines: Education Degree Awarded: No degree specified. Educational programs can determine this. Program Length: At least three academic years. May be shorter for dental assistants and dental hygienists granted advanced standing for coursework already completed. Hygiene credential requirement: None

14 CODA DT Guidelines: Supervision Supervision levels will be set by states, and can include dental therapists working in locations different from their supervising dentists.

15 CODA DT Guidelines: Procedure Examples Evaluative Procedures: Comprehensive charting of the oral cavity Exposing radiographic images Preventive Procedures: oral health instruction and disease prevention education, including nutritional counseling and dietary analysis teeth cleaning and polishing, including scaling below the gums applying topical fluoride agents as well as sealants

16 CODA DT Guidelines: Procedure Examples Restorative Procedures: emergency palliative treatment of dental pain limited to CODA-listed procedures preparation and placement of direct restoration in primary and permanent teeth fabrication and placement of single-tooth temporary crowns preparation and placement of preformed crowns on primary teeth simple extraction of erupted primary teeth

17 CODA DT Guidelines: Procedure Examples Other Procedures: administering local anesthetic suture removal minor adjustments and repairs on removable prostheses

18 Impact on State Government Legislative debates less ambiguous re safety concerns for dental therapy State dental boards no longer responsible for creating educational program standards, assessing candidate schools, ensuring program quality.

19 Impact on Training Institutions Accredited programs viewed by students as more reputable and attractive. Helps schools maintain healthy enrollment levels.

20 Impact on Students Students more likely to enter field because it is accredited. National accreditation standards create ease of interstate portability

21 Implications for design of state DT laws Promote uniformity of education, procedures, supervision levels so that DT profession is easily portable

22 ALASKA Dental Health Aide Therapist MINNESOTA Dental Therapist/ Advanced Dental Therapist MAINE Dental Hygiene Therapist VERMONT Dental Therapist ARIZONA Dental Therapist Date Passed Started practice: (started practice: 2011) Education Associate degree or prior ANTHC program grad (both programs = 27 months) DT: Bachelor s (min) ADT: Masters Min of Bachelors No degree specified No degree specified Preceptorship 400 hrs. or 3 mos. (whichever is longer) DT: None ADT: 2,000 hours 2,000 hours 1,000 hours 1,000 hours Hygiene License Required No Not in law, but only available training programs are for hygiene-therapy Yes Yes Yes, but not required to maintain Supervision General DT: Indirect for restorative ADT: General Direct for restorative care General General Permanent teeth extractions Only uncomplicated, if authorized in advance by dentist DT: No ADT: Only periodontally diseased Only periodontally diseased, if authorized in advance by dentist Only periodontally diseased Only periodontally diseased, under direct supervision Restrictions on Patient Population or Practice Setting Alaska Native communities 50% underserved and/or publicly insured 50% underserved and/or publicly insured None Only practice in FQHCs, CHCs, non-profits, or private practice that serves referred CHC patients

23 Decision Points in Crafting DT Legislation Length of training? Hygiene requirement? Supervision level? Allowable procedures?

24 Schools Applying for CODA DT Accreditation Ilisagvik College (Trains Alaska DHATs) Vermont Technical College Skagit Valley College (Washington) U of Minnesota and Normandale/Metro State in Minnesota will apply by 2020

25 Questions? Jane Koppelman Research Director