Overview of Canadian Dental Therapy Programs

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Overview of Canadian Dental Therapy Programs

• Dr. Todd Hartsfield
• Director
• Dental Clinical and Prevention Support Center
• Inter Tribal Council of Arizona, Inc.

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Canada

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

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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

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• Federal DTs 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 DTs worked in school clinics in SK
  and Manitoba
• Trained to deliver care to children under the
  general supervision of a licensed dentist

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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

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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

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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 childs oral
  health
• Dental IQ of the entire province was raised which
  raised the demand for dental care

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Saskatchewan Dental Plan

• By 1987, SK childrens 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

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Northern SaskatchewanChildrens 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

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Northern SaskatchewanChildrens 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

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Canada Today

• 282 employed dental therapists
• Federal, Provincial,Territories,
• First Nations, NSDT, private practice

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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

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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

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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

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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

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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

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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 DTs
• Canadian dental therapy programs have been proven
  to provide safe, quality dental care