Kavita R. Mathu-Muju

Dental Therapists: Improving Access to Oral Health Care for Underserved Children

Disparities in dental health care that characterize poor populations are well known. Children suffer disproportionately and most severely from dental diseases. Many countries have school-based dental therapist programs to meet childrens primary oral health care needs. Although dental therapists in the United States face opposition from national and state dental associations, many state governments are considering funding the training and deployment of dental therapists to care for underserved populations. Dental therapists care for American Indians/Alaska Natives in Alaska, and Minnesota became the first state to legislate dental therapist training. Children should receive priority preference; therefore, the most effective and economical utilization of dental therapists will be as salaried employees in school-based programs, beginning in underserved rural areas and inner cities.

The Children's Oral Health Initiative: An intervention to address the challenges of dental caries in early childhood in Canada's First Nation and Inuit communities

OBJECTIVE: The objective of the Children’s Oral Health Initiative (COHI) is to increase access to preventive oral health services provided to First Nations and Inuit (FN/I) children living on federal reserves and in remote communities.PARTICIPANTS: COHI targets preschool children; 5–7-year-olds; pregnant women; and parents/caregivers in FN/I communities.SETTING: The program was piloted in 2004 by Health Canada and is potentially available to all FN/I communities. However, the community must consent to the program’s implementation and agree to support a community member to be trained as a COHI aide.INTERVENTION: Dental therapists and hygienists screen eligible children, apply fluoride varnish and sealants to children’s teeth, and stabilize active dental caries with glass ionomer. An innovation was the development of a community oral health worker, the COHI Aide. The COHI Aide is a community member who serves as an advocate for preventive oral health in the community and provides instruction to children, parent/caregivers and expectant mothers in preventing dental caries.RESULTS: COHI was piloted in 41 communities in 2004. By 2014, the program had expanded to 320 FN/I communities, which represents 55% of all eligible FN/I communities. In 2012, 23,085 children had received COHI preventive oral health services.CONCLUSION: The results demonstrate COHI’s success as a preventive oral health care delivery model in remote communities. Implementation and delivery of preventive oral health services has been enhanced by the sustained presence of a community-based COHI Aide.RésuméOBJECTIF: L’Initiative en santé buccodentaire des enfants (ISBE) vise à élargir l’accès aux services de santé buccodentaire préventifs offerts aux enfants inuits et des Premières Nations (IPN) vivant dans les réserves fédérales et les communautés éloignées.PARTICIPANTS: L’ISBE cible les enfants d’âge préscolaire, les enfants de 5 à 7 ans, les femmes enceintes, et les parents et aidants vivant dans les communautés IPN.LIEU: Mis à l’essai par Santé Canada en 2004, le programme est potentiellement disponible dans toutes les communautés IPN. Toutefois, la communauté doit consentir à la mise en œuvre du programme et accepter de soutenir la formation d’un membre de la communauté comme représentant ou représentante en santé dentaire pour l’ISBE.INTERVENTION: Des thérapeutes et des hygiénistes dentaires filtrent les enfants admissibles, appliquent un vernis fluoré et un scellant sur les dents des enfants et stabilisent les caries dentaires actives avec du verre ionomère. L’une des innovations du programme a été la création du poste de représentant ou représentante en santé dentaire pour l’ISBE. Cette personne plaide en faveur de la santé buccodentaire préventive dans la communauté et donne des instructions aux enfants, aux parents ou aidants et aux femmes enceintes sur la prévention de la carie dentaire.RÉSULTATS: L’ISBE a été mise à l’essai dans 41 communautés en 2004. Dix ans plus tard, l’initiative était présente dans 320 communautés IPN, soit 55% des communautés IPN admissibles. En 2012, 23 085 enfants avaient reçu des services de santé buccodentaire préventifs de l’ISBE.CONCLUSION: Ces résultats indiquent que l’ISBE est un modèle efficace de prestation de soins buccodentaires préventifs dans les communautés éloignées. La mise en œuvre et la prestation des services de santé buccodentaire préventifs sont rehaussées par la présence continue d’un représentant ou d’une représentante en santé dentaire pour l’ISBE.

Saskatchewan's school‐based dental program staffed by dental therapists: a retrospective case study

OBJECTIVES The poor oral health of Saskatchewans children, in concert with a significant shortage of dentists, prompted the province in the early 1970s to seek an alternative method of addressing the oral health care needs of children. The result was the Saskatchewan Health Dental Plan (SHDP), which trained and employed dental therapists in school-based clinics to provide basic dental care to all children. The program was initiated over the opposition of Saskatchewans dentists. The purpose of this research was to provide information and data previously not documented in the refereed dental literature regarding the only school-based program staffed by dental therapists to ever exist in North America. METHODS This case study reviews the programs planning, opposition, implementation, and achievements based on a comprehensive review of published articles as well as a search of the grey literature. Additionally, Saskatchewan Health provided annual reports for each year of the programs existence. RESULTS During its thirteen years of existence, the school-based program proved popular with parents and achieved significant success in providing necessary dental care for children. It was terminated in 1987 by the newly elected provincial Conservative government, which was not supportive of such social programs. CONCLUSIONS The SHDP serves as a successful model of school-based dental care for children. However, the termination of the plan demonstrates the vulnerability of publicly funded dental health programs to conflicting political ideologies and special interest groups.

Current Status of Adding Dental Therapists to the Oral Health Workforce in the United States

Dental therapists are members of the oral health care workforce in over 50 countries of the world. Until recently, they have not participated as members of the professional dental team in the USA. It was not until the publication of Oral Health in America: A Report of the Surgeon General in 2000, describing the significant problem of access to dental care, that the issue of dental therapists emerged in the USA in a significant manner. Details of the development of dental therapists in the workforce in the USA through 2011 were previously chronicled by Mathu-Muju. Since then, there has been a major increase in interest and licensing of dental therapists in a number of states. This article updates the dental therapist movement to the present time. The literature and activities of the movement will be reviewed by the categories of research, education, and legislation/practice, as well as analytical essays and commentaries.

Confronting dental uncertainty in old age

OBJECTIVE To provide an overview of the literature about uncertainty in health care and how it relates to the oral health care of older people. BACKGROUND The medical literature describes uncertainty in health care from the initial informed-consent to its impact on a patients ability to cope with undesirable outcomes. METHODS A narrative review of the medical, dental and psychological literature was conducted to identify pertinent information on the theory and implications of uncertainty in healthcare. The findings are infused into a case-report illustrating the recurrence of uncertainty experienced by an older woman who had multiple treatments over several years to restore her dentition damaged severely by dental caries. RESULTS Uncertainty originates from inadequate understanding, incomplete information and undifferentiated alternatives leading to unnecessary diagnostic tests and healthcare costs. A conceptual taxonomy clarifies the characteristics of uncertainty in the context of scientific, practical or personal sources and offers management possibilities through effective communications to identify choices and probabilities that help patients to adapt and cope with adverse events. CONCLUSIONS Uncertainty pervades healthcare. It can lead patients to self-blame, anger and withdrawal from care unless it is communicated effectively so that they can adapt and cope with the disappointment of adversity and continue with alternative approaches to care.

Utilization of community health workers in Canada's Children's Oral Health Initiative for indigenous communities

OBJECTIVE The Childrens Oral Health Initiative (COHI) is a federally funded community-based preventive dental programme implemented in geographically remote Canadian Indigenous communities. The study investigated the effect of the availability of local community health workers (COHI Aides) on access to the programmes preventive dental services for children. METHODS Twenty-five communities were continuously enrolled in the COHI during the 7-year study period. Communities were categorized as having uninterrupted (all 7 years), intermittent (≥4 years) or sporadic (<4 years) service from a community health worker. Four outcome variables measured longitudinal changes in access to preventive dental services: (i) the number of enrolments; (ii) the number of enrolled children with multiple fluoride varnishes delivered; (iii) the number of enrolled children with sealants placed; and (iv) the number of enrolled children receiving ART. RESULTS The general longitudinal trend for programme enrolment and each of the preventive dental service delivery outcomes was similar. Children in communities with uninterrupted service tended to have the highest rates of enrolment and service delivery, which remained constant over time. Children in communities with sporadic service tended to have persistently low rates of enrolment and service delivery over the study period. CONCLUSIONS Community health workers were beneficial in promoting programme enrolment, as well as facilitating and augmenting the delivery of preventive dental services.

The perceptions of first nation participants in a community oral health initiative

ABSTRACT The Children’s Oral Health Initiative (COHI) is a federally funded community-based preventive dental program for children and their caregivers living in geographically isolated Canadian Aboriginal communities. The goal of the program is to improve access to preventive dental services for children of 0–7 years of age. It utilises community health workers in collaboration with dental therapists to promote and deliver the program. Almost half of the province of Manitoba’s (n=27) First Nations communities have implemented COHI since 2005. The objective of this investigation was to explore the opinions of COHI from the perspective of community members whose children had participated in the program. Purposeful selection identified caregivers of enrolled children for a semi-structured interview. The targeted caregivers had children who met at least one of the following criteria: (1) 0–2 years old; (2) 5–7 years old; (3) had two or more children either currently or formerly enrolled in COHI. Six open-ended questions guided the interview process. Content analysis was used to code transcripts and identify themes. One hundred and forty-one interviews were completed in 13 communities. Participants defined good oral health as the absence of dental cavities, which reflects a Western biomedical model of disease. The local, community-based nature of COHI was viewed as essential to its success in increasing access to preventive dental services and improving children and caregivers’ oral health knowledge and behaviours. In conclusion, a local, community-based oral health prevention programme is perceived as having a beneficial effect on children and caregivers’ oral health knowledge and behaviours. However, oral health preventive messages need to be further integrated into traditional Aboriginal holistic models of wellness.

The dental therapist movement in the United States: A critique of current trends

Dental therapists are members of the oral health workforce in over 50 countries in the world typically caring for children in publically funded school-based programs. A movement has developed in the United States to introduce dental therapists to the oral health workforce in an attempt to improve access to care and to reduce disparities in oral health. This article critiques trends in the United States movement in the context of the history and success of dental therapists practicing internationally. While supporting the dental therapist movement, we challenge: a) the use of dental therapists treating adults, versus focusing on children; b) the use of dental therapists in the private versus the public/not-for-profit sector; and c) requirements that a dental therapist must also be credentialed as a dental hygienist.

Restructuring Dental Education to Facilitate Access to Oral Health Care

Purpose of ReviewTo review recent literature evaluating how current models of dental education are contributing to reducing oral health disparities in the USA. Recent innovations in dental schools’ curricula and admissions processes will be examined, as well as how oral health disparities have driven the education and subsequent expansion of the allied dental workforce.Recent FindingsDental school curricula and admissions changes have had minimal impact on reducing oral health disparities. Subsequently, educational innovations have resulted in the traditional duties of dentists being performed by dental therapists, advanced dental hygiene practitioners, and independent dental hygienists.SummaryPublic perception is that extended employment of allied dental professionals has resulted in improved access and delivery of dental care to underserved members of the population. Development of a diversified oral health workforce that provides team-based, inter-professional care will help decrease the oral health inequities that exist in the USA.

There is high patient acceptance of care provided by dental auxiliaries and students

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION The acceptability of care provided by dental auxiliaries: A systematic review. Dyer TA, Robinson PG. J Am Dent Assoc 2016; 147(4): 244-54. SOURCE OF FUNDING Information not available TYPE OF STUDY/DESIGN: Systematic review.