Alternative Workforce ModelsBen Youel, Illinois ‘13, Vice PresidentTim Calnon, Buffalo ‘13, Leadership Development Work Group, Chair

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“there are profound and consequential disparities in the oral health of our citizens”

“silent epidemic”

http://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm

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“Programming has taken a multi-pronged approach including:

http://www.wkkf.org/what-we-support/healthy-kids/dental-therapy.aspx

Funding mobile dental vans to reach rural populations,

Improving public health dental education,Increasing the number of underrepresented minorities enrolled in dental school, and

Supporting community-led projects for new workforce models.”

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“The Pew children's dental campaign works on four efficient, cost-effective solutions:

http://www.pewtrusts.org/our_work_detail.aspx?id=574

1. Ensure that Medicaid and the Children’s Health Insurance Program – the programs that serve  low-income children – work better for kids and for providers so that insurance coverage translates into real access to needed care

2. Expand sealant programs for kids who need them most

3. Help expand access to optimally fluoridated water

4. Expand the number of professionals who can provide dental care to low-income children”

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Dental Health Aide Therapist (DHAT)

http://depts.washington.edu/dentexak/

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Advanced Dental Hygiene Practitioner (ADHP)

http://www.adha.org/workforce-models-apdh

“In response to the access crisis, state policymakers, consumer advocates and oral health coalitions are pioneering innovations to extend the reach of the oral health care delivery system and improve oral health infrastructure.

Among these innovations is the creation of a mid-level oral health provider to provide much needed restorative dental care to underserved populations.”

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“Unsupervised private dental hygiene practice has not had a notable effect on access to care in Colorado.”

http://www.ada.org/sections/professionalResources/pdfs/report_hygiene.pdf

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“New Zealand’s program in the schools has been in place a long time, and thus it may be surprising to learn that Baltimore adolescents had … the lowest number of DMF teeth and the second- or third-lowest number of decayed teeth.”http://www.ncbi.nlm.nih.gov/pubmed/16674756

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Community Dental Health Coordinator (CDHC)

http://www.ada.org/cdhc.aspx

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Dental Therapists / Advanced Dental Therapists (DT/ADT)

First State to License a Dental Midlevel Provider

http://www.dentalboard.state.mn.us/Default.aspx?tabid=1165

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“Nearly 9,500 new dental providers are needed to meet the country’s current oral health needs.

However, there are more dentists retiring each year than there are dental school graduates to replace them.”

http://www.sanders.senate.gov/imo/media/doc/DENTALCRISIS.REPORT.pdf

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Four MLP Programs

DHAT

ADHP

CDHC

DT/ADT

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DHAT = Alaska (trained in University of Washington)CDHC = University of Oklahoma, Temple University, & A.T. Still University Arizona School of Dentistry; New MexicoADHP = Nowhere Dental Therapist / Advanced Dental Therapist = Minnesota

Locations

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All can do:Collect information (photographs, radiographs)ScreeningsFluoride treatmentsSealantsTemporary fillings (IRM)

What can each program do?

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What can each program do?CDHC DT DHAT ADHPTriageDevelop and implement community education programs

Direct RestorationsPre-formed crownsPrimary teeth extractionPerio-involved perm teeth extraction (ADT)Pulp cappingPulpotomiesLocal/NitrousProvide & administer analgesics, anti-inflammatories and antibiotics (ADT)Dx & Tx Planning (ADT)Repair removable prosRe-cement fixed prosSpace maintainersSplinting

Full hygiene scopeDirect RestorationsPre-formed crownsPrimary tooth extractionNon-surgical perm teeth extractionPulpotomiesLocal

Full hygiene scopeDirect RestorationsPre-formed crowns“Uncomplicated extractions”Repair removable prosRe-cement fixed pros

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REVERSIBLE

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REVERSIBLEIR

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What do WE think?

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C1 Expanded Functions of Dental Assistants and Dental Hygienists

• The American Student Dental Association endorses expanded functions for dental auxiliaries only when each has received the appropriate education and training to guarantee competence, and when such functions fall within the laws established by their respective state of employment.

• It is incumbent on the profession to assure that expanded functions for dental auxiliaries will not adversely affect the health and well-being of the public.

• The practice of dentistry entails more than the simple performance of routine technical procedures. A dentist must possess a wide range of knowledge of the biological, anatomical, and physiological sciences in order to successfully and safely perform such procedures. A dentist must also be able to process and apply both the knowledge and the skills acquired in dental school in order to successfully and safely perform these tasks.

• Thus, only the dentist should perform the following functions. These functions include but are not limited to:

a. Examination, diagnosis and treatment planning

b. Prescribing work authorizations

c. Performing irreversible dental procedures

d. Prescribing drugs and/or other medications

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C2 Independent Practice

• The American Student Dental

Association is strongly opposed to

independent dental hygiene practice,

and favors the team approach for

providing comprehensive dental care.

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Opposition to Pilot Programs Which Allow Nondentists to Diagnose Dental Needs or Perform

Irreversible Procedures

• Resolved, that the American Dental Association opposes pilot programs that are in violation of the ADA policy stated in Resolution 24H-2004 (stating that, “The ADA is opposed to non-dentists making diagnoses, developing treatment plans or performing irreversible procedures.”)

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Diagnosis or Performance of Irreversible Dental Procedures by Nondentists

• Resolved, that the American Dental Association by all appropriate federal legislative and judicial means resist any effort compromising the quality of dental health care services by allowing any nondentist to diagnose or perform irreversible dental procedures except as otherwise authorized by state law with reference to physicians.

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What is the root of the debate over

Alternative Workforce models?

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“Breaking down Barriers to Oral Health for All Americans”

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…“must guard against focusing on any one barrier to the exclusion of others that are equally critical.”

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“Everyone deserves a Dentist.” - Dr. Ray Gist, 2010-2011 ADA President

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- 82 million underserved- 27.8% visit dentist

-System with 7-8 Million capacity

“Coordination is critical”

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Underserved populations =

Unserved individuals

1 million/ 1%

$2.16 Billion Charity

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- Internal understanding

- 34 Graduates practicing

- 7 Core Competencies

- Sunset evaluation

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SYSTEMATIC REVIEW

“In populations where nondentists conduct diagnostic, treatment planning, and/or irreversible/surgical dental procedures, is there a change in disease increment, untreated dental disease, and/or cost-effectiveness of dental care?”

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The Journal of the American Dental Association January 1, 2013 vol. 144 no. 1 75-91

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• 18 Observational studies from 7,701 citations

• Conclusion: Poor quality evidence– Decease in caries with MLP, but same as

with dentist treated pop.– Select pop. Treated by MLP show greater

decrease– *Results should be applied with caution*

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What about our future...?

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JOIN TODAY!

$5 = Your Future

In Washington, if you’re not at the table, you’re on the menu.

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ADVOCACY

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Don’t let the tail wag the dog!

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Thank you!• Ben Youel

– bcyouel@gmail.com

• Tim Calnon – t.calnon@gmail.com

PACE Verification Code: AS1304