I will definitely agree that the evidence is not conclusive, but there is evidence that they are successful in some ways, and there is a lack of evidence to the contrary. A freer market in dental care (note, I am not advocating a completely deregulated or unlicensed market) would help bring down the cost of care and raise oral health standards.

Unfortunately, there is not a whole lot of research on the subject, because it is a burgeoning field. More research needs to be done though, because there is definite potential. If, as you believe, dental therapists cannot provide proper surgical care, then that shall be quickly evident. (The early research though seems to indicate the opposite.) Evidence-based dentistry only comes about though with an accumulation of studies and research. I definitely agree that there needs to be more research, but I also maintain that the early body of research is quite hopeful as a manner to improve the oral health of the population by expanding affordable access.

And although I agree with Dr. Nash’s treaty on protecting the profession of dentistry from unscrupulous business practices and the very serious need to keep patient care at the highest level possible, the fact is we are still blessed with a free market system of providing dental care and thus must operate our offices by sound business principles. Dr Nash’s works are really no more than an academic trying to “publish or perish” and “push or pull” his liberal agenda onto the practice dentistry.

The article from New Zealand in its conclusion actually questions if the dental therapists has been used effectively or if it even has fulfilled its original objectives in “forestalling disease” and “prevention”. The article from Australia is thin support of your position at best. It evaluated only seven therapists working under the supervision of dentists in the Royal Hospital of Melbourne and merely studied if a therapist could place a filling on someone over the age of 25 instead of under the age of 25. The study you have sighted from the UK was a review of patient charts to determine the amount of time therapists spend doing various procedures and does not draw any conclusion on quality of care.

Finally the article by Dr Bolin on Alaska. This pilot study of the new therapist set up by the Alaska Tribal Council in cooperation with the ADA again simply reviewed patient charts to determine if the types of procedures performed by a therapist were consistent with the type of procedure which was performed by a dentist for a similar diagnosis. The article sites a 95% consistency between a therapist and dentist; however the study reviewed the chart entries of the therapists while they were in training and under the direct or indirect supervision of the control group dentists. Dr Bolin does not comment nor was his study designed to evaluate quality of any treatment but was rather the accumulation of data and the treatment planning process of the therapist in a very controlled teaching environment.

If one carefully and objectively evaluates the sources you have used to support your position, or really understands the methodology in scientific literature or even has a passing familiarity with research—your conclusions or perhaps more accurately your “editorial spin” on this issue is completely without merit. None of these sources look at anything approaching an evaluation of the safety of a dental therapist or even remotley speeks of your proposal, which seems to be an independent dental healthcare provider performing diagnostic and surgical care outside the traditional dental setting and for a population which many times is more complicated than average.

Your statement:
Dental therapists only provide a limited range of services — which does not include surgical procedures. All of the published research shows that, for the limited range of services that dental therapists provide, patient outcomes are not significantly different from that of patients who have been treated by dentists instead.With that clearcut body of evidence, it should be a matter for consumers to decide whether they want to pay a premium to have a full-fledged dentist treat them for basic services, or whether they’re willing to trust the lesser training of a dental therapist who will also charge less for that similar range of basic work.

This statement is either simple fabrication or a sloppy interpretation of your own sources. I do not necessarily believe you have intentionally been dishonest with the readership in your previous posts and op ed pieces but I would hope just rather inexperienced in your research and understanding of such a complex issue. Which is it? Do you stand behind these “studies” or are you willing to do some real research into ALL sides of this idea?

Oh and by the way—the MDA did not initiate the bleaching legislation—it was forwarded to the capital by two very bright and concerned dental students—the legislation was filed and first read before the dental association ever knew anything about it!!!!!!!!!!!!!!!

Dental therapists only provide a limited range of services — which does not include surgical procedures. All of the published research shows that, for the limited range of services that dental therapists provide, patient outcomes are not significantly different from that of patients who have been treated by dentists instead.

With that clearcut body of evidence, it should be a matter for consumers to decide whether they want to pay a premium to have a full-fledged dentist treat them for basic services, or whether they’re willing to trust the lesser training of a dental therapist who will also charge less for that similar range of basic work.

If, as you suggest, an increase in the number of practicing dental therapists would reduce safety for that basic range of services, those therapists will soon find themselves without paying customers. Markets are very efficient tools at sorting out the optimal equilibrium between risk, cost, and benefit.

There’s no reason to continue to subsidize dentists through the regulatory capture of exclusive licensing when dental therapists have a comparative advantage at providing basic dental services.