标题：Oral Health Care for Children in Countries Using Dental Therapists in Public, School-Based Programs, Contrasted with That of the United States, Using Dentists in a Private Practice Model
摘要：The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children’s access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, “A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States.” We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices. THE UNITED STATES’ ECO nomically disadvantaged children bear a disproportionate burden of dental disease. Although 40 million of the country’s 78 million children will be covered by public dental insurance by 2014, they will still suffer neglect because the overwhelming majority of dentists do not provide care for publicly insured children in their practices. 1–3 Interest is increasing in expanding the workforce to include the development and deployment of individuals with skills in caring for children traditionally associated with the school dental nurse/dental therapist. 4–6 Using school dental nurses/dental therapists originated in New Zealand in 1921. 7 The New Zealand model has subsequently spread to more than 50 countries. 8,9 Dental therapists are typically deployed in school-based clinics to ensure access to dental care for all children. Dental therapists are highly skilled technicians, typically with 2 to 3 years of vocational training that emphasizes technical treatment skills and individual- and community-level prevention programs. 9 Worldwide, their scope of practice includes examination, diagnosis, and treatment planning; exposing radiographs; oral health education; preventive services such as prophylaxis, fluoride therapy, fissure sealants, and dietary counseling; preparation of cavities in primary and permanent teeth and restoration with amalgam, composite, and preformed stainless steel crowns; and extraction of primary teeth. They have been successfully serving Native Americans in remote Alaskan villages since 2005. 5,6 Minnesota authorized the training of dental therapists, with the first class graduating and beginning to care for its underserved populations in 2012. 10 The development of dental therapists is supported by many US public health and philanthropic organizations, including the American Association of Public Health Dentistry 11 and the American Public Health Association 12 but opposed by the American Dental Association, 13 most constituent state dental associations, the American Academy of Pediatric Dentistry, 14 and other dental specialty organizations. It is possible that some of organized dentistry’s opposition to dental therapists is based on inadequate knowledge of their use and acceptance by the public and the dental profession in many other countries. To rectify this circumstance and provide an objective basis for consideration of introducing dental therapists in the United States, the W. K. Kellogg Foundation funded the University of Kentucky to conduct a study of the global literature on the use of dental therapists. The final report, “A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States,” was conducted by 17 international dental educators and public health officials and published online in April 2012. 9 More than 1100 documents from the 54 countries using dental therapists were identified. The 460-page monograph relied heavily on annotations of the literature, mostly direct quotes or excerpts to minimize bias. We describe oral health outcomes for children participating in international, population-centered, public, school-based programs staffed by dental therapists and contrast them with outcomes from the individual-centered, private-practice model staffed by dentists in the United States. In these programs, dental therapists are supervised by dentists, with their range of services closely restricted to their scope of training and assessed abilities. Supervision is typically indirect, with clinical dentists available for consultation or referral as needed.
