Dental Therapist FAQs

Maryland Dental Access

What is a Dental Therapist?

Dental therapists (DTs) are oral health care professionals trained to provide preventative and basic restorative dental care, including some procedures that are beyond the scope of a dental hygienist. They are proven, cost-effective providers that can help dental practices run more efficient operations, boost revenue and meet more of the oral health needs of the underserved.

What Do Dental Therapists Do?

DTs deliver basic but critically necessary dental services, including filling cavities, placing temporary crowns, and extracting diseased baby teeth and very loose permanent teeth. Many consequences of dental disease – pain, missed school and work, unnecessary visits to the emergency department – are the result of untreated decay.1 However, in Maryland, only dentists are authorized by law to drill and fill decayed teeth.

Where Do Dental Therapists Practice?

DTs can practice in both private dental offices and public clinics. They can also bring care directly to populations who face travel or mobility challenges in locations such as schools, nursing homes, veterans facilities and rural or geographically remote settings.

Are Dental Therapists Supervised by a Dentist?

In Maryland, DTs will operate under the general supervision of a licensed dentist. This means that a supervising dentist may authorize a DT to provide specific services off-site to patients not previously examined as long as the dentist is available for consultation and supervision.

What are the National Standards for Dental Therapy Training Programs?

Programs in Maryland will need to meet standards defined by the Commission on Dental Accreditation (CODA), the national accrediting body recognized by the U.S. Department of Education that sets training standards for dental hygiene and dentistry training programs. CODA’s standards call for a minimum of three academic years of training for dental therapy. In Maryland, DTs will also be required to complete a minimum of 500 hours of training under the direct supervision of a dentist before they can practice under general supervision.

How will Dental Therapy Impact a Dentist’s Practice?

Dentists will determine how DTs will practice in Maryland. DTs will always practice under the supervision of a dentist. Research shows that DTs can enhance dentists’ earnings and allow them to treat more underserved people.2 In Minnesota, one private practice that employs a DT made an additional $24,000 in profit and increased by 50 percent (more than 200) the number of Medicaid patients served in the therapist’s first year.3

Dental Therapist Claims / Facts

Maryland Dental Access

CLAIM: Cost is the biggest driver of lack of dental care access, and dental therapists will do nothing to affect cost.

Response:

Evidence from Minnesota – and the laws of economics – proves that statement is false. The reality is that DTs command lower salaries, and are lower cost providers for dental practices. This allows dental practices to reduce the per-unit cost of delivering care to patients and more feasibly treat more patients on Medicaid. True, the dental practice itself would be reimbursed at the same rate regardless of whether the dentist or DT delivers the care. However, because the per-unit cost of care delivered by a DT is lower, a dental practice can reduce the cost of services or maintain them at existing levels (instead of charging more).

A 2014 Minnesota evaluation of these providers found that clinics employing DTs are providing more free and lower-cost care to more low-income patients.4 A 2012 analysis found that DTs in Alaska produce an estimated $127,000 in net revenue for their dental teams.5 That net revenue can be passed to patients in form of cheaper, more affordable services.

Finally, an analysis of dental therapy by the Federal Trade Commission (FTC) endorsed the potential for a positive fiscal impact stating, “FTC staff support CODA’s efforts to facilitate the creation of new dental therapy education programs and to expand the supply of dental therapists because these initiatives are likely to increase the output of basic dental services, enhance competition, reduce costs, and expand access to dental care.6

CLAIM: There is no shortage of dentists.

Response:

More than 507,000 people live in areas designated by the federal government as having a shortage of dentists.7 There are sizable parts of the state that clearly do not have an adequate number of dentists to serve the population. Additionally, only 34 percent of dentists are active Maryland Medicaid providers. Put simply, even if the number of dentists is adequate in certain areas of the state the Medicaid population is not receiving adequate dental care. Dental therapy is a strong tool to enable more people to access care.

Active Dentists and Dentists Participating with Maryland’s Medicaid Dental Program8(2015)
Region Total Active Dentists Dentists Enrolled with Healthy Smiles Dental Program
Baltimore Metro9 1,757 459 (26% of dentists in Baltimore Metro)
Montgomery/Prince George’s 1,646 504 (31% of dentists in Montgomery/Prince George’s)
Southern Maryland10 155 59 (38% of dentists in Southern Maryland)
Western Maryland11 261 114 (44% of dentists in Western Maryland)
Eastern Shore12 203 67 (33% of dentists in the Eastern Shore)
Out of State13   182
Total 4,022 1,38514 (34% of total active dentists in Maryland)

Source: Maryland Department of Health and Mental Hygiene (DHMH), “Maryland’s 2015 Annual Oral Health Legislative Report,” (2015).

CLAIM: This is a reimbursement problem, not a provider problem.

Response:

In 2015, only 1 in 3 dentists participated in Maryland’s Medicaid dental program.15 While increasing Medicaid reimbursement rates is an important goal, it is insufficient to solve the access problem. There will still be sizeable areas of the state with few or no providers and there will always be populations that find it difficult to travel to a dentist’s office. Raising reimbursement rates, like so many other initiatives, is not a silver bullet to solving dental access challenges. It does nothing for those living in dentist shortage areas or for those who find it hard to travel to an office for care.

CLAIM: We want qualified people delivering this care. It just isn’t safe enough.

Response:

There are 1,100 studies reiterating the quality of these providers in Minnesota, Alaska, and more than 50 countries including the United Kingdom, Australia, and Canada.16 This position runs counter to the findings of a review conducted by the American Dental Association: “The results of a variety of studies indicate that appropriately trained midlevel providers are capable of providing high-quality services, including irreversible procedures such as restorative care and dental extractions.17 The ADA says these providers can deliver safe, effective care when trained appropriately.

CLAIM: This type of provider is not needed. We don’t have an access problem in Maryland.

Response:

More than forty percent of kids on Medicaid didn’t see a dentist last year. The percentage of pregnant women on Medicaid who received dental services continues to fall—from 32.5 percent in 2011 to 27.0 percent in 2014.18 Something clearly isn’t working. Oral health stakeholders also refute this argument based on their own knowledge and the experiences of their constituents. There is never one silver bullet to improving oral health; a range of approaches, including water fluoridation, oral health education and community health workers can help make a difference. DTs are a critical component because they can help dentists address the untreated decay of tens of thousands of residents.

CLAIM: Their bill allows a therapist to be 100 miles away from the supervising dentist. What happens if there is a critical emergency? That’s why we need a dentist right there on-site.

Response:

I know this concern comes from a good place. However, it’s just not based in fact. A DT has a close working relationship with his or her supervising dentist. It is highly unlikely a dentist would allow a DT to treat a patient with existing significant medical conditions. If there is an emergency, the therapist will do the same thing a dentist will do – call 911! Finally, look at Minnesota and Alaska – similar providers have delivered safe and quality care for more than a decade. These are important questions, but it’s important to remember we know the answers from states already implementing this. And when DTs cannot practice in community settings, like schools and nursing homes, they cannot bring care directly to kids, seniors, and people with disabilities who cannot travel to a dentist’s office for care. These are precisely the people in greatest need of better dental care access .

CLAIM: They say their goal is to treat people on MassHealth. Then let’s make sure the dental therapists only treat people on Medicaid. Let’s get at the problem!

Response:

Doing so would prohibit dentists from having their DTs treat uninsured patients or patients paying out-of-pocket. It also nullifies the economic incentive for dentists to employ these providers. All dentists should have the right to hire DTs to expand access to the underserved.

CLAIM: Surveys of people on Medicaid often list reasons other than an inability to find a dentist for not getting care.

Response:

There are many barriers to care other than being able to locate a dentist. This includes available transportation options, work and family needs and cost, all of which could be addressed with a DT.

CLAIM: It is out-of-state interests who are advocating for this.

Response:

Pew Charitable Trusts is a nonprofit that is advocating for expanding dental care access for children, seniors and people with disabilities. If you think the people of Maryland should be opposed to that, I’m eager to hear why. Our proposal is also supported by nearly a dozen Maryland advocacy organizations. I’m confident they have our citizens’ best interest in mind.

Expanding Dental Access in Maryland

Maryland Dental Access

(SB 1013/HB 1214) – Sen. Joan Carter Conway & Delegate Bonnie Cullison

Despite recent progress on expanding access to health care, many Maryland residents still struggle to get dental care.19 Some cannot find a dentist who accepts public insurance, while others cannot get to a dental office due to mobility or transportation challenges.20 And many people, regardless of insurance status, are unable to afford the costly prices of dental services.21

  • Oral health is a critical component of overall health affects nutrition and quality of life.22
  • Tooth decay remains the most common chronic condition among children in the U.S.23
  • 42% of Maryland children on Medicaid (ages 1-20) – 274,000 children – did not receive any dental services in 2015.24
  • More than 507,000 Maryland residents live in areas designated by the federal government as having a shortage of dentists.25
  • There were approximately 48,000 dental visits to Emergency Department (ED) in Maryland in 2014, nearly 60% of which were paid for by Medicaid.26 These visits cost Maryland’s Medicaid program close to $11 million.27
  • In 2015, only 1 in 3 dentists participated in the Maryland Healthy Smiles Dental Program (Maryland’s Medicaid dental program for children, pregnant women, and adults with certain high-cost chronic conditions).28

One effective, common sense solution to increase access to dental care and improve the overall health of Maryland residents is legislation sponsored by Senator Joan Carter Conway and Delegate Bonnie Cullison to authorize a type of midlevel dental professional known as a dental therapist.

Working under the supervision of dentists, dental therapists are providers who would be able to deliver basic but critically necessary care such as filling cavities, placing temporary crowns and extracting baby teeth and badly diseased permanent teeth. Dental therapists can be used by private practices and public clinics to extend office hours and treat more underserved patients. They are being used in other states to bring care directly to patients in schools, day care centers and nursing homes to care for people unable to receive care in a clinic or office.

Dental therapists began serving Native Alaskans in 2004, Minnesota residents in 2011, have been authorized in Vermont and Maine. They have effectively helped clinics decrease travel and wait times and improved patient satisfaction.29 Savings from the lower costs of dental therapists allowed private dentists and public health clinics to treat more Medicaid or uninsured patients.30

For more information, contact Anna Davis at adavis@acy.org or (410) 547-9200 x3032

  1. Veerasathpurush Allareddy, Sankeerth Rampa, Min Kyeong Lee, Veerajalandhar Allareddy, and Romesh P. Nalliah, “Hospital-based emergency department visits involving dental conditions: Profile and predictors of poor outcomes and resource utilization,” Journal of the American Dental Association 145, no. 4 (2014): 331-337, doi:10.14219/jada.2014.7; Stephanie L. Jackson, et al., “Impact of Poor Oral Health on Children’s School Attendance and Performance,” American Journal of Public Health 101, (2011): 1900-06. doi: 10.2105/AJPH.2010.200915.
  2. Minnesota Department of Health and Minnesota Board of Dentistry, “Early Impact of Dental Therapists in Minnesota: Report to the Minnesota Legislature 2014,” (February 2014), http://www.health.state.mn.us/divs/orhpc/workforce/dt/dtlegisrpt.pdf; The Pew Charitable Trusts, “It Takes a Team: How New Dental Providers Can Benefit Patients and Practices,” (December 2010), http://www.pewtrusts.org/~/media/legacy/uploadedfiles/pcs_assets/2010/pewittakesateampdf.pdf.
  3. The Pew Charitable Trusts, “Expanding the Dental Team: Studies of Two Private Practices,” (February 2014) http://www.pewtrusts.org/~/media/legacy/uploadedfiles/pcs_assets/2014/expandingdentalteamreportpdf.pdf.
  4. Minnesota Department of Health and Minnesota Board of Dentistry, “Early Impacts of Dental Therapists in Minnesota,” (2014), http://www.health.state.mn.us/divs/orhpc/workforce/dt/dtlegisrpt.pdf.
  5. Mary Kate Scott, “Tribal Health Organization DHAT Survey Results,” (Jan. 11, 2012). This was an analysis commissioned by the Alaska Native Tribal Health Consortium; revenues were based on a 75 percent collection rate.
  6. Letter to Sherin Tooks, Director, Commission on Dental Accreditation, from Andrew I. Gavil, Director, Office of Policy Planning, the Federal Trade Commission (November 21, 2014), https://www.ftc.gov/system/files/documents/advocacy_documents/ftc-staff-comment-commission-dental-accreditation-concerning-proposed-accreditation-standards-dental/141201codacomment.pdf.
  7. U.S. Department of Health and Human Services, Health Resources and Services Administration, Designated Health Professional Shortage Areas (HPSA) Statistics, data as of Jan. 1, 2017, http://datawarehouse.hrsa.gov/HGDWReports/RT_App.aspx?rpt=HH.
  8. Maryland’s Medicaid dental program that provides dental coverage to children up to age 21, pregnant women, and adults in the Rare and Expensive Case Management Program.
  9. Baltimore Metro includes Baltimore City and Anne Arundel, Baltimore, Carroll, Harford, and Howard Counties.
  10. Southern Maryland includes Calvert, Charles, and St. Mary’s Counties.
  11. Western Maryland includes Allegany, Frederick, Garrett, and Washington Counties.
  12. The Eastern Shore includes Caroline, Cecil, Dorchester, Kent, Queen Anne’s, Somerset, Talbot, Wicomico, and Worcester Counties.
  13. There are Healthy Smiles Program providers located in bordering Maryland states therefore they are included in the unduplicated totals.
  14. The total (1,385) includes 182 out of state dentists who are enrolled in the Healthy Smiles Program. However, the percentage (34 percent) is based on the total active dentists licensed in Maryland—not including the total active dentists in these other states.
  15. Maryland Department of Health and Mental Hygiene (DHMH), “Maryland’s 2015 Annual Oral Health Legislative Report,” (Oct. 30, 2015),
    http://phpa.dhmh.maryland.gov/oralhealth/Documents/2015LegislativeReport.pdf. Healthy Smiles Dental Program is Maryland’s Medicaid dental program for children, pregnant women, and adults with certain high-cost chronic conditions. There were 4,022 total active dentists in the state, and 1,385 dentists enrolled in the Maryland Healthy Smiles Program, including 182 out of state dentists. 34 percent (1,385/4,022) of Maryland dentists are enrolled in Healthy Smiles, however that ratio is including the out of state dentists in the numerator and just the total active dentists licensed in Maryland in the denominator.
  16. David A. Nash. W. K. Kellogg Foundation. A Review of the Global Literature on Dental Therapists: In Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States. April 2012. http://www.wkkf.org/~/media/pdfs/dental%20therapy/nash%20dental%20therapist%20literature%20review.ASHX; Wetterhall et.al, An Evaluation of the Dental Health Aide Workforce Model in Alaska: Final Report, RTI International, October 2010 https://www.rti.org/pubs/alaskadhatprogramevaluationfinal102510.pdf; Minnesota Department of Health and Minnesota Board of Dentistry. Early Impact of Dental Therapists in Minnesota: Report to the Minnesota Legislature 2014. February 2014. http://www.health.state.mn.us/divs/orhpc/workforce/dt/dtlegisrpt.pdf.
  17. Wright JT. Do midlevel providers improve the population’s oral health? Special Commentary, . JADA 2013;144(1):92-94
  18. Analysis of the FY 2017 Maryland Executive Budget (2016), M00Q01-DHMH-Medical Care Programs Administration, accessed at http://mgaleg.maryland.gov/2016rs/key_fiscal_documents/vol3.pdf. This figure includes pregnant women over 21 who were enrolled in Medicaid for at least 90 days and received dental services.
  19. Deborah Levy, Maryland Public Health Dental Hygiene Act: Impact Study (Baltimore: Maryland Department of Health and Mental Hygiene Office of Oral Health, 2013).
  20. C. Betley et al., “Adult Dental Coverage in Maryland Medicaid,” The Hilltop Institute (2016), http://www.hilltopinstitute.org/publications/AdultDentalCoverageInMarylandMedicaid-Feb2016.pdf; Maryland Health Care Commission, “An Evaluation of Regional Health Delivery and Health Planning in Rural Areas,” (2014), http://mhcc.maryland.gov/mhcc/pages/plr/plr/documents/lgspt_Regional_Health_Evaluation_rpt_2014.pdf.
  21. Ibid.
  22. U.S. Department of Health and Human Services, Oral Health in America: A Report of the Surgeon General (Rockville: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000), https://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/Documents/hck1ocv.@www.surgeon.fullrpt.pdf.
  23. The Centers for Disease Control and Prevention, “Dental Caries (Tooth Decay),” accessed Jan, 23, 2017 at https://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html; Regina M. Benjamin, “Oral Health: The Silent Epidemic,” Public Health Reports, 123 (2010), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821841/pdf/phr125000158.pdf.
  24. This figure counts children ages 1 to 20 who were eligible for the Early and Periodic Screening, Diagnostic and Treatment Benefit for 90 continuous days and received any dental service. See U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Annual EPSDT Participation Report, Form CMS-416 (State) Fiscal Year: 2015, as of September 7, 2016, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html.
  25. U.S. Department of Health and Human Services, Health Resources and Services Administration, Designated Health Professional Shortage Areas (HPSA) Statistics, data as of December 13, 2016, http://datawarehouse.hrsa.gov/HGDWReports/RT_App.aspx?rpt=HH).
  26. Maryland Department of Legislative Services, “Analysis of the FY 2018 Maryland Executive Budget, M00F03 Prevention and Health Promotion Administration Department of Health and Mental Hygiene” (2017), http://mgaleg.maryland.gov/pubs/budgetfiscal/2018fy-budget-docs-operating-M00F03-DHMH-Prevention-&-Health-Promotion-Administration.pdf.
  27. Ibid.
  28. Maryland Department of Health and Mental Hygiene (DHMH), “Maryland’s 2015 Annual Oral Health Legislative Report,” (Oct. 30, 2015), http://phpa.dhmh.maryland.gov/oralhealth/Documents/2015LegislativeReport.pdf. There were 4,022 total active dentists in the state, and 1,385 dentists enrolled in the Maryland Healthy Smiles Program, including 182 out of state dentists. 34% (1,385/4,022) of Maryland dentists are enrolled in Healthy Smiles, however that ratio is including the out of state dentists in the numerator and just the total active dentists licensed in Maryland in the denominator.
  29. Minnesota Department of Health and Minnesota Board of Dentistry, “Early Impact of Dental Therapists in Minnesota: Report to the Minnesota Legislature 2014,” (February 2014), http://www.health.state.mn.us/divs/orhpc/workforce/dt/dtlegisrpt.pdf.
  30. The Pew Charitable Trusts. “Expanding the Dental Team: Studies of Two Private Practices,” (February 2014), http://www.pewtrusts.org/~/media/assets/2014/02/12/dental_therapist_case_studies.pdf; The Pew Charitable Trusts, “Expanding the Dental Team: Increasing Access to Care in Public Settings,” (June 2014), http://www.pewtrusts.org/~/media/assets/2014/06/27/expanding_dental_case_studies_report.pdf.