AAPD skeptical of Alaska midlevel provider report

Oct 26, 2010

After reviewing the recent positive evaluation of U.S. dental therapists in Alaska, the American Academy of Pediatric Dentistry (AAPD) is questioning the report's findings.

In a position that mirrors that of the ADA, the AAPD said it doubts that dental health aide therapists (DHATs) with two years of intensive training could provide "safe, competent, and appropriate dental care."

The report was conducted by RTI International and funded by the W.K. Kellogg Foundation, the Rasmuson Foundation, and the Bethel Community Services Foundation.

While the AAPD welcomes dialogue and participation from organizations that seek to improve oral health for at-risk children, the organization feels the report fails to offer a reliable quantitative assessment of whether the program had any impact on dental care access in Alaska.

"This evaluation is not a randomized trial of quality assessment that compares the outcomes of licensed dentists with those of therapists," said John Liu, D.D.S., AAPD president, in a press release. "In our opinion, this report clearly demonstrates that the question of effectiveness has not been adequately addressed or answered. There is absolutely no indication that the oral health status of these populations has improved, and the report itself states that it did not attempt to quantify changes in access to care; rather it provided only anecdotal/testimonial comments from individuals."

The study evaluated only five dental health aide therapists in five sites over a period of two-and-a-half years, he added.

"The evaluation lacked performance standards for measures of quality of individual care or practice procedures, and the results couldn't be generated beyond the grounds included in the study, as it only sampled children over the age of 6 years old," he said. "Sadly, in preschool-aged children, where dental disease rates are quickly increasing, this demographic wasn't even examined."

The AAPD acknowledged Alaska's unique challenges that stem from harsh winters in highly remote locations where many of its tribes reside.

Studies of this nature require more evidence-based analysis, Dr. Liu concluded.