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| Title |
Differences in Attitudes and Beliefs Among Dental Hygienists and Dentists on the Introduction of Dental Therapy Programs in Community Colleges |
| Clinical Question |
Will there be difference in attitude and beliefs among dental hygienists and dentists on the proposal of introducing dental therapy program in community colleges to increase the number of available dental therapists at the local community? |
| Clinical Bottom Line |
The proposal of introducing a dental therapy program in community colleges is linked to differences in attitudes and beliefs among dental hygienists and dentists. Evidence from two cross-sectional reviews reveals the existence of significant differences in opinions regarding the involvement of dental therapists in the workforce as dental service providers. However, there is a need for additional clinical evidence regarding the role played by dental therapists at the local community level to address access to dental care services. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 31182564 | Ly (2019) | 220 dentists and 187 dental hygienists employed by a regional dental group (RDG) | Cross-sectional | | Key results | The study involved 187 dental hygienists and 84 dentists from a regional dental group (RDG) in the Pacific Northwest. These responded to an electronic survey, with the response rates being 46% for dental hygienists and 38% for dentists. Collectively, 6% practiced in Idaho, 32% of the participants practiced in Washington state, and 60% in Oregon. The results from the study showed significant statistical differences in the opinions of dental hygienists and dentists in various areas. On the question of whether there was a need for having dental therapists in the community, 65% of the dental hygienists were in support, with only 38% of dentists supporting, representing (p<0.001). Also, the study revealed that dental hygienists were more likely to believe that dental therapists should play a significant role in the dental team (p<0.001). On whether dental therapists should be dental hygienists, 90% of the dental hygienists were in support, with only 56% of dentists supporting this (p<0.001). The study also showed that 76% of dental hygienists were open to the idea of having dental therapists as part of their team in their current work setting, while only 56% of the dentists supported this. On the levels of agreement of dental hygienists regarding the scope of practice definition as compared to dentists, the p-value was represented as p<0.001. There were significant differences regarding perception of a dental therapist’s level of supervision, with 57% of the dental hygienists supporting direct and indirect supervision, while 48% of the dentists supported direct supervision (p<0.001). On the appropriate level of training, most of the respondents believed that either a bachelor's or master’s degree was ideal for dental therapists provided they were already dental hygienists (p=.160). On the level of tuition and fees that was ideal for a program for dental therapists, there was a significant difference between the respondents with dentists supporting higher tuition and fees (p<0.001). On the question of appropriate remuneration for dental therapists, there were significant differences in the average salaries as stated by the participants with dentists opining that an annual salary of $78,767 was sufficient while dental hygienists noted that $108,434 was sufficient (p<0.001). The study had selection bias, considering that the participants were from a specific regional dental group (RDG), meaning that the opinions of the participants would have likely differed if they were self-employed, private practitioners. | | #2) 36241553 | Hill (2022) | 27,459 electronic health record transactions between 2006 and 2015 collected from the Yukon-Kuskokwim Health Corporation | Cross-sectional | | Key results | Over the 10-year period of the study, 722,272 dental services were provided to the residents of Yukon-Kuskokwim Delta. During that period, the number of diagnostic, preventative, and restorative services provided to the residents increased. The number of patients seeking oral surgery and other types of dental services remained constant. However, the number of endodontic services decreased over the study period. The percentage of diagnostic services provided by dentists decreased by 3.50% while those provided by dental therapists increased by 4.07% representing (p<.001). Similar results were observed for preventative services. Although there was no change for dentists (p=.89), a 4.77% annual increase was noted for dental therapists representing (p<.001). Restorative and oral surgery services recorded a similar trend with the percentage of services provided by dentists decreasing while those provided by dental therapists increasing. There was also an increase in preventative oral health care over the period of the study. Dental therapists were more likely to provide preventative services at the population level compared to dentists. On average, dental therapists provided 41.5% of all preventative services while dentists provided 29.7% of these services. Bias in the study is linked to the study’s reliance on electronic health record data, which was not intended to be used for research purposes. It indicates that the information is susceptible to problems in its quality and accuracy due to the presence of data quality issues and measurement errors. The overall conclusion of the study was that dental therapists have significantly contributed to enhancing the delivery of dental services in native communities found in Alaska. Specifically, they have provided population-based preventive care to these communities. | |
| Evidence Search |
“Dental therapists” AND “Dentists” “Dental” AND “Access” [MeSH] |
Comments on
The Evidence |
Ly et al. (2019) assessed the opinions of dentists and dental hygienists on dental therapists using cross-sectional surveys with Likert scale items and open and close-ended questions. The study revealed significant differences in opinions between dental hygienists and dentists regarding the need for a dental therapist in their community, with 65% of the dental hygienists compared to 38% of the dentists supporting it. Despite the validity of the results, there was no randomization of the participants as they were all from a specific regional dental group (RDG) in the Pacific Northwest, which may have led to limitations in opinions. Hill et al. (2022) examine secular trends regarding the delivery of dental services between dentists and dental therapists. The study revealed a significant overall increase in dental services, including restorative, diagnostic, and preventive services. For instance, there was a 4.8% increase in preventive services provided by dental therapists, and no change in the case of those provided by dentists. The evidence is valid, considering that the study found that dental therapists play a significant role in the provision of preventive care. Overall, the studies present reliable and valid evidence on the role played by dental therapists. The results presented confirm an increase in the acceptability of the role of dental therapists, despite some differences in opinions. |
| Applicability |
The studies focused on dental therapists and dentists, meaning that they can be generalizable to the population being studied, as the results are broadly applicable to these different groups. They can be utilized to understand attitudes and beliefs about dental therapists and dentists; however, there is a need for more emphasis on dentists to help understand their opinions regarding dental therapists, which is significantly becoming a popular profession. A good aspect about this contrast in findings is that it allows for the application of different viewpoints to help answer the PICO question. Therefore, such evidence may lead to better findings regarding opinions and attitudes on the proposal of introducing dental therapy programs in community colleges. The addition of dental therapists will help in addressing issues with access to dental care and workforce problems in that their education programs are less costly and they have lower salaries than dentists, which means that focusing on them is a less costly way of expanding the capacity of a dental working staff. On issues with access to dental care, dental therapists often practice in settings dominated by underserved and low-income communities, which means they will be ideal in improving access to dental care in such communities countrywide. |
| Specialty/Discipline |
(Public Health) (General Dentistry) |
| Keywords |
Dentists, dental therapists, dental workforce, access to oral health.
|
| ID# |
3551 |
| Date of submission: |
11/02/2023 |
| E-mail |
gillp@uthscsa.edu |
| Author |
Puneet Gill |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Dr. Sohini Dhar |
| Faculty mentor/Co-author e-mail |
dhar@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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