The missing link in dental care: who are dental therapists and why they are indispensable

For many years, underserved communities in northern Michigan have faced a severe shortage of dental care. Public dental clinics struggle daily with high rates of caries and chronic periodontal disease, while resources for timely patient treatment are critically insufficient. In some cases, waiting times for appointments exceed one year, leading to disease progression, pain, and deterioration in patients’ overall health.

The public dental care system in the United States is in crisis and unable to meet the needs of the population. In this context, the integration of dental therapists into care teams is gaining increasing attention, particularly in regions with high risks of dental diseases. This approach is seen as an effective and economically viable way to expand access to quality care without compromising treatment standards.

Who are dental therapists and what role do they play

Dental therapists fall under the category of mid-level providers. They operate under a collaborative practice agreement with the supervision of a dentist and are comparable to nurse practitioners in the general healthcare system. Within their scope of practice, dental therapists provide preventive and restorative care, including fillings and non-surgical tooth extractions.

This division of responsibilities allows dentists to focus on more complex procedures—endodontic treatment, prosthodontics, and surgical interventions. In addition to clinical work, dental therapists are trained in preventive counseling and culturally sensitive care, often spending more time with patients than is possible under the high workload faced by dentists.

In many cases, dental therapists are residents of the communities they serve. This fosters trust-based relationships with patients and enhances treatment adherence. The study *Dental Therapists: A Solution to a Shortage of Dentists in Underserved Communities*, published in the journal *Public Health Reports*, found that the integration of dental therapists leads to improved access to care, reduced prevalence of dental diseases, and lower treatment costs.

Social and economic factors of dental diseases

Underserved communities often face high poverty rates and lower education levels, which are directly linked to increased prevalence of caries and periodontal diseases. Unbalanced diets, high sugar consumption, tobacco use, and limited access to preventive education further exacerbate the situation.

Even with government insurance coverage, patients often have to travel long distances to access dental care due to a shortage of specialists accepting such programs. As a result, over 40% of low-income individuals have untreated carious lesions, compared to about 9% among higher-income groups. Such disparities highlight the need for systemic solutions aimed at expanding the accessibility of care.

Cost-effectiveness and quality of care

Dental therapists represent a cost-effective solution. Their training requires fewer resources compared to the education of dentists, which reduces the burden of educational debt and makes these professionals more accessible for hiring.

Despite a narrower scope of practice, dental therapists demonstrate comparable quality in performing procedures such as restorations and tooth extractions. A systematic review conducted by the American Dental Association in 2013 found that patients receiving restorative care from mid-level providers had a reduction in untreated carious lesions, with no significant differences in treatment quality compared to care provided by dentists.

Thus, dental therapists are a crucial component of the dental team and effectively complement the work of dentists and hygienists, particularly in the context of persistent inequalities in access to care.

Professional motivation and development of the field

For many professionals working in the public healthcare system, expanding the role of dental therapists is linked to a desire to provide a broader range of care to patients and reduce the burden on dentists. Pursuing this profession enables mid-level providers to participate in restorative treatment, increase clinic throughput, and improve the quality of services for the population.

Furthermore, dental therapy offers the opportunity to continue patient-centered practice, focusing on restoring function and smile aesthetics, which is particularly important for socially vulnerable groups.

Educational pathways and licensing

The pathway to becoming a dental therapist is often accompanied by misconceptions. A common belief is that a hygienist diploma or dual licensure is mandatory. However, in Michigan and several other states, this is not a strict requirement. There are both dual training programs and direct educational pathways for applicants meeting established criteria.

However, licensing requirements vary significantly from state to state, making it essential to study regulatory conditions beforehand. Dental assistants and professionals with expanded duties often possess a suitable knowledge base and practical skills for transitioning into dental therapy.

Prospects for a team-based model of dental care

Collaborative work among dentists, dental therapists, hygienists, and assistants can significantly expand patient reach and enhance the efficiency of the system as a whole. A team-based approach creates the conditions for providing comprehensive, high-quality, and equitable dental care, regardless of a patient’s socio-economic status, race, culture, or place of residence.

Развитие института дентальной терапии рассматривается как важный шаг к формированию более справедливой и устойчивой системы стоматологической помощи, способной удовлетворять потребности всех слоёв населения.