Overview of Canadian Dental Therapy Programs

Dr. Todd HartsfieldDirector

Dental Clinical and Prevention Support CenterInter Tribal Council of Arizona, Inc.

Canada

Large countryMany rural, isolated populationsTransportation challengesDentists concentrated in population centersAccess to dental care limited

Canadian Dental Therapy Programs

2 training schools established in 1972Response to lack of access to dental care for underserved populationsFederal school at Ft. Smith, NWT – U. of Toronto Dental FacultyProvincial school at Regina, Saskatchewan First classes graduated in 1974

Federal DT’s work in health centers and nursing stations across CanadaTrained to deliver dental care to children and adults under the general supervision of a licensed dentistProvincial DT’s worked in school clinics in SK and ManitobaTrained to deliver care to children under the general supervision of a licensed dentist

Scope of PracticeFillings on primary and permanent teethVital pulpotomies on primary teethStainless steel crowns on primary teethExtractions of primary teeth (Prov & Fed)Extractions of permanent teeth (Fed)SealantsCleaningsFluorideRadiographsEducation

Saskatchewan Dental Plan 1974 - 1987

Much opposition from organized dentistryPrivate practitioners in SK felt that dental therapists would take patients away from themJust the opposite happened – dental therapists referred patients to private practitioners when a child needed dental work that was beyond their scopeNew source of patients for private dentists

Saskatchewan Dental PlanOnce the children had their dental care completed at school, more parents started seeking dental care for themselvesSchool program had a large education component for children and parentsParents were encouraged to attend examination appointments to learn about their child’s oral healthDental IQ of the entire province was raised which raised the demand for dental care

Saskatchewan Dental Plan

By 1987, SK children’s oral health had gone from the worst to the best in CanadaToo many dental staff for the amount of dental work that needed to be doneLarge provincial deficit, conservative govtGovernment scrapped the program in 1987, except for the northern programExpanded dental hygiene schools

Northern SaskatchewanChildren’s Dental Program 1 dentist7dental therapists8 dental assistants5,200 high needs childrenEach team approx 740 patientsClinics in schools or health centerEveryone traveledEach team had satellite clinics

Northern SaskatchewanChildren’s Dental Program

Daily classroom brushingWeekly fluoride rinse programPre-brushing at every appointmentIndividual OHISealantsTopical fluoride Open house dental clinic on parent –teacher night for education of caregivers

Canada Today

282 employed dental therapistsFederal, Provincial,Territories,

First Nations, NSDT, private practice

Saskatchewan Today

181 practicing dental therapists105 in private practice Remainder work for First Nations, Federal & Provincial governments, teachingNational School of Dental Therapy is located in Prince Albert

Cost Effectiveness of Dental Therapists

Having a dental therapist living in an isolated community reduced the number of medical evacuations for dental painTransportation costs dropped dramaticallyDental therapists can successfully deal with most dental emergenciesDental therapists assure that the dentists’ visits are more productive by triaging patients and taking any needed radiographs and arranging for needed medications before the dentist arrives

Quality of Dental Therapists

Because dental therapists are limited to performing only certain clinical procedures, they focus on performing these procedures many , many times during training and become very skilled at these procedures

1976 and 1989 studies showed that restorations placed by Canadian dental therapists were of equal or better quality to those placed by dentists

Continuity of Care

People want to receive services from the same provider each time they seek careDental therapists live in the community and become part of community lifeThey are trusted by the local peopleRole models for othersPeople prefer to receive culturally appropriate care

Quality Assurance

Each dental therapist undergoes a yearly clinical evaluation by the supervising dentist

Review includes the quality of radiographs, pulpotomies, restorations, charting , consent forms, medical histories, productivity and includes interviews with parents, schools, health center staff

Safety of Dental Therapists

Since 1974 there have been no reports of serious injury to a patient who received dental treatment by a dental therapist in CanadaNo malpractice claims filed against DT’sCanadian dental therapy programs have been proven to provide safe, quality dental care