Transcript Canadian Dental Therapy Program

Overview of Canadian Dental
Therapy Programs
Dr. Todd Hartsfield
Director
Dental Clinical and Prevention Support Center
Inter Tribal Council of Arizona, Inc.
Canada
Large country
Many rural, isolated populations
Transportation challenges
Dentists concentrated in population centers
Access to dental care limited
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
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
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
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
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
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
Northern Saskatchewan
Children’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
Northern Saskatchewan
Children’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
Canada Today
282 employed dental therapists
Federal, Provincial,Territories,
First Nations, NSDT, private practice
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
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
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
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
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
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