Christy Jo Fogarty, ADT, RDH, BSDH, MSOHP Advanced Dental Therapist Licensed Dental Hygienist Neither I nor members of my immediate family have any financial interests to disclose relating to the content of this presentation 1
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My Career Path History of Dental Therapy Dental Therapists/Advanced Dental Therapists (ADTs) Definition Definition of Supervision Levels DT/ADT Scope of Practice Training and Testing Entering the Workforce ADT Licensure Requirements Current Evaluation of Dental Therapy in Minnesota Ongoing Challenges Future 3
Started as a dental assistant in 1995. Graduated as a dental hygienist in 1998. Spent my first 2 years working in a practice in downtown Minneapolis. Spent the next 7 years working as an independent contractor. Moved into private practice while I completed my undergraduate and graduate degrees. Started in the first class of dental therapists in May of 2009 at Metropolitan State University, weeks before the legislation was passed. Barriers to access to dental care were first addressed nationally in the Surgeon Generals Report on Oral Health in 2000. The report identified barriers to oral health care and oral health disparities among our most vulnerable citizens- poor children, the elderly, and many members of racial and ethnic minority groups. A 2003 follow-up report, A National Call to Action to Promote Oral Health, reinforced the 2000 report and named specific actions to take place. One of the actions included increasing the oral health workforce capacity to supply dental professionals to shortage areas such as rural and urban areas with racial, ethnic, and poor populations. Minnesota Recognized these same disparities, in addition, Collaborative RDH s in Minnesota we recognizing the lack of restorative care for their patients. 4
Dr. Coleen Brickle RDH, Dean of Health Sciences at Normandale Community College, got program approval through MnSCU for educating Oral Heath Care Practitioners Legislation was drafted to create a new member to the oral health care team in Minnesota. Had over 50 organizations supporting the legislation. Had only the MDA and ADA in opposition. At the end of the 2008 legislative session it was mandated that a work group be created to find compromises and solution to be brought back. From that work group the 2 practitioners were created and put forth to the legislators in 2009 changing the title to dental therapist and advanced dental therapist. Very contentious issue-still is today? The U.S. Department of Health and Human Services released a report in July 2015, projecting an increase in demand for dentists nationally that will not be met by the increase in supply. They estimate the supply of dentists in 2025 to be 202,600, while the estimated demand for dentists by 2025 to be 218,200 a shortage of 15,600 dentists nationally. All 50 states and the District of Columbia will experience a dentist shortage by 2025 The Minnesota Department of Health (MDH) has identified similar oral health disparities in MN. 5
Dental Therapist: -Are required to complete a accredited program ending with a bachelors or masters degree and will always have indirect supervision. -The University of Minnesota trained several classes of DTs (Only about 15 with a BS), but have moved to an ADT/RDH dual track program. As a result there are currently no DTs being trained in Minnesota that aren t eligible to apply to become certified as an Advanced Dental Therapist. In addition, the University of Minnesota is offered a bridge to former graduates to allow them to become ADTs. -Most DTs work in traditional dental offices *Currently the University of Minnesota's program is 8 Semesters of training after 10 pre-requisite classes and acceptance into the program. Providing care in a traditional dental clinic Advanced Dental Therapist: -Are required to have completed a accredited program ending with a masters degree. -Metropolitan State University has only ever educated ADT eligible students and also only admits experienced RDH s -Started as a 26 month program but has been condensed to an 16 month program. -After the completion of 2,000 hours of work under indirect supervision, and completion of the certification process ADT s can work under general supervision. -This allows ADTs to work in non-traditional Providing care in schools settings. 6
Direct Supervision Procedures need to be done with knowledge and consent of a DDS in office and need to be checked by DDS before the patient is dismissed Indirect Supervision Procedures are required to be done with the knowledge and consent of a DDS and with a DDS in the office General Supervision Procedures are required to be done with the knowledge and consent of DDS but DDS is not required to be present in office and standing orders can be followed by practitioners Fillings in both primary and permanent teeth including back and front teeth, and both silver and tooth colored restorations. Stainless steel crowns on both permanent and primary teeth. Creation and placing of space maintainers. Pulpotomies. (root canals in baby teeth) Extractions of primary teeth. Soft reline of dentures. Extraction of permanent teeth that are mobile due to periodontal disease(adts only). Assessment and treatment planning(adts only). Dispensing of medications (cannot write Rx s). 7
ADT eligible students study and train for 16-26 months at Metropolitan State University or the University of Minnesota. Students are trained, in their scope of practice, to the level of a dentist. The education and training for ADT is rigorous. It includes course work in pharmacology, pediatrics, epidemiology, and research. Over 700 practicum hours are completed over the 16 months. Trained to the level of a DDS in scope. Final Capstone projects are done before graduation. I was very grateful to have had been a practicing, experienced dental hygienist. Learning new clinical skills was much more challenging than I expected. In the summer of 2015 CODA accreditation standards were passed for dental therapy Formally recognizes dental therapy as a profession Encourages career laddering Will make reciprocity a possibility in the future May allow newest states to educate therapists in other states 8
Currently there is no written board that is given to gain licensure for dental therapy The CRDTS/(CDCA) exam is given over two days. First day is done on a mankin and requires four different components including a pulpotomy, a SSC, and crown preps for both an anterior and posterior teeth. The second day is clinical testing. The testing done by DT s/adt s through CRDTS/(CDCA) is the exact same testing DDS s take and consist of doing one class III filling and one Class II filling. DTs must enter into a collaborative management agreement with a licensed dentist in Minnesota. A collaborating dentist must be licensed and practicing in Minnesota. The collaborating dentist accepts responsibility for all services authorized and performed by the dental therapist/advanced dental therapist pursuant to the management agreement. 9
First DT s Graduated in June 2011 Started with CDS in August of 2011 as a dental hygienist Worked with several DDS s helping them to understand my experience in dentistry and the education I received for dental therapy While I was issued a dental therapy license in August of 2011, I was not allowed to practice until I had a signed CMA with the Board of Dentistry Signed my first CMA s in December of 2011 Started full-time as a dental therapist in January of 2012 Started slowly with DDS s checking every step of the way While I was a DT I had 9 CMA s signed and currently as a ADT I have 1 CMA. The requirement by law is that they know what type of procedures I am doing and need to approve and new or changes in treatment plans 10
The Minnesota Board of Dentistry Requires the following: Proof of 2,000 hours of clinical work Proof of ADT Education Proof of CRDTS/(CDCA) Exam Passage Then ADT Candidates are required to complete a 3 Part Process that includes: 1.Records Review 2.A multiple-choice patient assessment exam 3.An oral interview with the boards licensing and credentialing committee Current Evaluation of Dental Therapy in Minnesota As of April 2018, there were 86 licensed dental therapists in Minnesota who work at 54 different sites. 34 (39%) are dually licensed in both dental hygiene and dental therapy. 48 (55%) have achieved certification as ADTs. Minnesota dental therapists are relatively young, with 55 percent age 34 and younger. 11
Current Evaluation of Dental Therapy in Minnesota Dental therapists are more diverse than other oral health professions in Minnesota; 12% of dental therapists are Asian, 3% are Hispanic, 2% are American Indian, and 9 percent are of multiple races. Dental therapists are geographically distributed in proportion to the state s population: *55% of the state s population lives in the 7-county Greater Twin Cities metro area, where 59% of working dental therapists are employed. *45% of Minnesotans live outside the Metro area, where 41% of working dental therapists are employed. Current Evaluation of Dental Therapy in Minnesota The primary practice setting for 49% of dental therapists in 2017 was a dental clinic; 47% work in community-based nonprofit organizations, Community Health Centers (CHC), Federally Qualified health Centers (FQHCs), hospitals, and schools, and mobile clinics. The remaining 4 percent reported working in academic settings. Dental therapists also provide services in community and rural settings at more than 370 mobile dental sites throughout the state in schools, Head Start programs, community centers, VA facilities and nursing homes. 12
Current Evaluation of Dental Therapy in Minnesota Dental therapists report a high levels of career satisfaction 98% indicate career satisfaction in the last 12 months, and 96 percent are satisfied with their careers overall; 84% plan to practice for 10 years or more. In 2017, 93% of licensed dental therapists reported being employed as compared to 74% in 2014. This increase indicates greater integration of these providers in Minnesota 13
Ongoing Challenges Credentialing and reimbursement No clear, consistent policy for credentialing and paying DTs by insurance companies and claims administrators Currently in many offices, DT services are billed through the CMA dentists Services provided to patients with MA coverage can be billed under the DT In Minnesota, reimbursement rates are the same for DTs as for dentists Ongoing Challenges New = Confusing Still misinformation about the purpose and intent of dental therapy Patient demographics Scope of practice-can be confusing Differences in educational programs in Minnesota Problems with separating DT and ADT It takes approximately a year for a DT to obtain the 2000 hours needed for ADT certification Constraints with indirect supervision of DTs Initial concern within the profession has decreased 14
I plan on continuing to work as an ADT for Children s Dental Services. I will continue to work to educate other states creating dental therapy providers. Currently Minnesota and Alaska have practicing midlevel providers with ME, VT and AZ having passed enacting legislation Currently about 20 states are looking at legislation. http://www.pewcenteronthestates.org/report_detail.aspx?id=61628 http://www.normandale.mnscu.edu/academics/deans/pdfs/adeapresentation1.pdf https://www.revisor.mn.gov/statutes/?id=150a.105 http://www.dentalboard.state.mn.us/portals/3/ Licensing/Dental%20Therapist/ADT CMA%2012 4 10approved.pdf https://www.revisor.mn.gov/statutes/?id=150a.105 http://www.normandale.mnscu.edu/academics/deans/pdfs/adeapresentation1.pdf http://www.dentalboard.state.mn.us/portals/3/licensing/dental%20therapist/adt-cma%2012-410approved.pdf 15
Any questions? Christy Jo Fogarty Dental Therapist Children s Dental Services 612-867-8875 cfogarty@childrensdentalservices.org 16