Overview of Canadian Dental Therapy Programs

1. Overview of Canadian Dental Therapy Programs Dr. Todd Hartsfield Director Dental Clinical and Prevention Support Center Inter Tribal Council of Arizona, Inc.

2. Canada • Large country • Many rural, isolated populations • Transportation challenges • Dentists concentrated in population centers • Access to dental care limited

4. Canadian Dental Therapy Programs • 2 training schools established in 1972 • Response to lack of access to dental care for underserved populations • Federal school at Ft. Smith, NWT – U. of Toronto Dental Faculty • Provincial school at Regina, Saskatchewan • First classes graduated in 1974

5. Federal DT’s work in health centers and nursing stations across Canada • Trained to deliver dental care to children and adults under the general supervision of a licensed dentist • Provincial DT’s worked in school clinics in SK and Manitoba • Trained to deliver care to children under the general supervision of a licensed dentist

6. Scope of Practice • Fillings on primary and permanent teeth • Vital pulpotomies on primary teeth • Stainless steel crowns on primary teeth • Extractions of primary teeth (Prov & Fed) • Extractions of permanent teeth (Fed) • Sealants • Cleanings • Fluoride • Radiographs • Education

8. Saskatchewan Dental Plan 1974 - 1987 • Much opposition from organized dentistry • Private practitioners in SK felt that dental therapists would take patients away from them • Just the opposite happened – dental therapists referred patients to private practitioners when a child needed dental work that was beyond their scope • New source of patients for private dentists

9. Saskatchewan Dental Plan • Once the children had their dental care completed at school, more parents started seeking dental care for themselves • School program had a large education component for children and parents • Parents were encouraged to attend examination appointments to learn about their child’s oral health • Dental IQ of the entire province was raised which raised the demand for dental care

10. Saskatchewan Dental Plan • By 1987, SK children’s oral health had gone from the worst to the best in Canada • Too many dental staff for the amount of dental work that needed to be done • Large provincial deficit, conservative govt • Government scrapped the program in 1987, except for the northern program • Expanded dental hygiene schools

11. Northern SaskatchewanChildren’s Dental Program • 1 dentist • 7dental therapists • 8 dental assistants • 5,200 high needs children • Each team approx 740 patients • Clinics in schools or health center • Everyone traveled • Each team had satellite clinics

13. Northern SaskatchewanChildren’s Dental Program • Daily classroom brushing • Weekly fluoride rinse program • Pre-brushing at every appointment • Individual OHI • Sealants • Topical fluoride • Open house dental clinic on parent –teacher night for education of caregivers

14. Canada Today • 282 employed dental therapists • Federal, Provincial,Territories, First Nations, NSDT, private practice

15. Saskatchewan Today • 181 practicing dental therapists • 105 in private practice • Remainder work for First Nations, Federal & Provincial governments, teaching • National School of Dental Therapy is located in Prince Albert

16. Cost Effectiveness of Dental Therapists • Having a dental therapist living in an isolated community reduced the number of medical evacuations for dental pain • Transportation costs dropped dramatically • Dental therapists can successfully deal with most dental emergencies • Dental 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

17. 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

18. Continuity of Care • People want to receive services from the same provider each time they seek care • Dental therapists live in the community and become part of community life • They are trusted by the local people • Role models for others • People prefer to receive culturally appropriate care

19. 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

20. 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 Canada • No malpractice claims filed against DT’s • Canadian dental therapy programs have been proven to provide safe, quality dental care