11 research outputs found
Treatment of chronic non-cancer musculoskeletal pain
No full textKendra Bunker, MPH, Christina Baumann, MD, MPH, Erika Zoller, MPH, Allison Leof, PhD, Catherine Pettinari, PhD, Basmah Rahman, MPH, Heidi Kriz, MPH, RD, Valerie King, MD, MPH.This archived document is maintained by the State Library of Oregon as part of the Oregon Documents Depository Program. It is for informational purposes and may not be suitable for legal purposes.Includes bibliographical references.Mode of access: Internet from the Oregon Government Publications Collection.Text in English
Perceived Neighborhood Characteristics and Cognitive Function among Older Adults: Examining the Role of Depression
No full textPurpose: African American older adults have a greater risk of cognitive impairment compared to White older adults. While some research has established that neighborhoods are an important determinant of health, relatively little research has examined the relationship between perceived neighborhood characteristics and cognitive functioning among older adults. Moreover, little is known about how depression is implicated in the relationship between perceived neighborhood characteristics and cognitive functioning, and if racial differences exist. Thus, this thesis aims to determine the mediating and moderating role of depression in the association between perceived neighborhood characteristics and cognitive functioning in older African American and White adults.
Methods: I used data from the Health and Retirement Study and limited the sample to older Black and White adults age ≥65 years (n=7,620). Cognitive functioning was measured using the Telephone Interview for Cognitive Status (range: 0-35), with higher scores indicating better cognitive functioning. Depression was measured as a dichotomous variable using the Center for Epidemiologic Studies Depression Scale (CES-D). Depression scores ranged from 0 to 8 and the ≥3 cutoff was used to categorize adults with depression. Neighborhood perceptions of safety, cleanliness, and social cohesion were measured on a scale ranging from 0 to 7 with higher scores indicating worse perceptions. Linear regression models stratified by race were used to determine if depression played a mediating role in the relationship between perceived neighborhood characteristics (safety, social cohesion, and cleanliness) and cognitive functioning. The moderating role of depression was also examined using interaction terms with each neighborhood characteristic and depression.
Results: The results indicated that there is a negative relationship between perceived neighborhood characteristics and cognitive functioning among White older adults. Depression moderates the relationship between neighborhood characteristics (cleanliness, discohension) and cognitive functioning among White older adults. However, there was no moderating effect of depression among African American older adults. However, after controlling for neighborhood characteristics and other covariates, depression was associated with worse cognitive functioning.
Discussion/Conclusion: Depression is associated with worse cognitive functioning for both African American and White adults. Among White older adults with depression, there was a more pronounced negative association between neighborhood perceptions and cognitive functioning compared to those without depression. However, depression in African Americans was associated with worse cognitive functioning after controlling for neighborhood characteristics and other covariates. Therefore, depression is directly related to worse cognitive functioning in older adults
Limited usefulness of neurocognitive functioning indices as predictive markers for treatment response to methylphenidate or neurofeedback@home in children and adolescents with ADHD
No full textIntroduction
Earlier studies exploring the value of executive functioning (EF) indices for assessing treatment effectiveness and predicting treatment response in attention-deficit/hyperactivity disorder (ADHD) mainly focused on pharmacological treatment options and revealed rather heterogeneous results. Envisioning the long-term goal of personalized treatment selection and intervention planning, this study comparing methylphenidate treatment (MPH) and a home-based neurofeedback intervention (NF@Home) aimed to expand previous findings by assessing objective as well as subjectively reported EF indices and by analyzing their value as treatment and predictive markers.
Methods
Children and adolescents (n = 146 in the per protocol sample) aged 7–13 years with a formal diagnosis of an inattentive or combined presentation of ADHD were examined. We explored the EF performance profile using the Conners Continuous Performance Task (CPT) and the BRIEF self-report questionnaire within our prospective, multicenter, randomized, reference drug-controlled NEWROFEED study with sites in five European countries (France, Spain, Switzerland, Germany, and Belgium). As primary outcome for treatment response, the clinician-rated ADHD Rating Scale-IV was used. Patients participating in this non-inferiority trial were randomized to either NF@home (34–40 sessions of TBR or SMR NF depending on the pre-assessed individual alpha peak frequency) or MPH treatment (ratio: 3:2). Within a mixed-effects model framework, analyses of change were calculated to explore the predictive value of neurocognitive indices for ADHD symptom-related treatment response.
Results
For a variety of neurocognitive indices, we found a significant pre-post change during treatment, mainly in the MPH group. However, the results of the current study reveal a rather limited prognostic value of neurocognitive indices for treatment response to either NF@Home or MPH treatment. Some significant effects emerged for parent-ratings only.
Discussion
Current findings indicate a potential value of self-report (BRIEF global score) and some objectively measured neurocognitive indices (CPT commission errors and hit reaction time variability) as treatment markers (of change) for MPH. However, we found a rather limited prognostic value with regard to predicting treatment response not (yet) allowing recommendation for clinical use. Baseline symptom severity was revealed as the most relevant predictor, replicating robust findings from previous studies
Artificial intelligence in gastrointestinal endoscopy
No full textBackground and Aims: Artificial intelligence (AI)-based applications have transformed several industries and are widely used in various consumer products and services. In medicine, AI is primarily being used for image classification and natural language processing and has great potential to affect image-based specialties such as radiology, pathology, and gastroenterology (GE). This document reviews the reported applications of AI in GE, focusing on endoscopic image analysis. Methods: The MEDLINE database was searched through May 2020 for relevant articles by using key words such as machine learning, deep learning, artificial intelligence, computer-aided diagnosis, convolutional neural networks, GI endoscopy, and endoscopic image analysis. References and citations of the retrieved articles were also evaluated to identify pertinent studies. The manuscript was drafted by 2 authors and reviewed in person by members of the American Society for Gastrointestinal Endoscopy Technology Committee and subsequently by the American Society for Gastrointestinal Endoscopy Governing Board. Results: Deep learning techniques such as convolutional neural networks have been used in several areas of GI endoscopy, including colorectal polyp detection and classification, analysis of endoscopic images for diagnosis of Helicobacter pylori infection, detection and depth assessment of early gastric cancer, dysplasia in Barrett’s esophagus, and detection of various abnormalities in wireless capsule endoscopy images. Conclusions: The implementation of AI technologies across multiple GI endoscopic applications has the potential to transform clinical practice favorably and improve the efficiency and accuracy of current diagnostic methods
Attention deficit hyperactivity disorder (ADHD) within a South Indian (Keralian) mainstream school context
No full textAttention Deficit Hyperactivity Disorder (ADHD) is a widely discussed special educational issue in Western contexts and developed countries. By contrast, limited information is available about ADHD in Eastern contexts and developing countries. In India in particular, the only available information is about the medical perspective of ADHD; little or no attention is given to social or educational perspectives. DSM IV criteria are the most commonly used standard assessment procedures. However, limited research is reported to discuss the potential cultural influences of this North American model. The present study examines the incidence and interpretation of ADHD within the context of five mainstream schools in Trivandrum, South India. It also explored cultural influences impact upon the cultural validity and reliability of DSM IV criteria when introduced into a South Indian context. In order to identify children with ADHD characteristics, culturally valid assessment tools such as behaviour checklist and behaviour rating scales, were developed from DSM IV (TR) symptoms criteria. Qualitative data was gathered from the five sample schools during the academic year of 2006-07 using a variety of methods including in-depth interviews (with 21 teachers), classroom observations (of 26 children), rating scale and document scrutiny. The case study method was adopted to gain in-depth information about the identified children. Informal interviews with parents (24) were also utilised to triangulate the information gathered from the school contexts. Qualitative data analysis techniques such as open coding and case analysis were used to assess children's behavioural characteristics and difficulties. The findings indicate that three percent of children (21) had ADHD characteristics within the sample schools. Some of the findings are consistent with the studies reported in Western contexts. There are also some contrasting results: a) most of the identified children had inattention rather than hyperactivity characteristics, b) a higher number of children with ADHD characteristics were from lower socio-economic backgrounds, c) teachers used coercive methods of physical punishments and sanctions as they interpreted the children's ADHD characteristics as a result of their lack of interest in learning. Most importantly, though DSM IV (TR) criteria are useful in identifying ADHD, two items of the 'symptoms' criteria were not identifiable within the present context of the sample schools. The findings suggest that socio-cultural factors do influence the validity and reliability of DSM IV criteria. The study has implications not only for further research but also for planning and policy making in the field of education for all. The conclusions suggest that an educational provision should be considered with regards to the varied and complex needs of children with special educational needs such as ADHD. Teacher education programmes should be enhanced with positive intervention strategies
Outer suburban/interface services and development committee inquiry into liveability options in outer suburban Melbourne
No full textThis report presents a range of options for enhancing the liveability of Melbourne’s outer suburbs. Melbourne has an international reputation as one of the world’s most liveable cities. However, many areas within Melbourne’s outer suburbs currently lag behind the rest of Greater Melbourne on a range of liveability measures. On a number of those measures, the gap is growing.
This situation is primarily due to the rapid pace at which Melbourne’s outer suburbs have expanded in recent years. There are a range of options for preserving and enhancing the liveability of Melbourne’s outer suburbs, many of which are increasingly being adopted by residents, community groups and local governments.
The Government of Victoria has also indicated that preserving and enhancing the liveability of Greater Melbourne will be a major priority for the new Melbourne Metropolitan Planning Strategy
UND lists names of students eligible to graduate at 2015 Spring Commencement ceremonies held May 9 and 16
No full textUND lists names of students eligible to graduate at 2015 Spring Commencement ceremonies held May 9 and 16
More than 2,000 University of North Dakota students were eligible to receive degrees during this year’s Spring Commencement ceremonies held on May 9 and 16 in Grand Forks.
Nearly 600 of those students were eligible to receive post-graduate and professional degrees for law and medicine. Fifty-five UND students graduated with their medical degrees from the School of Medicine and Health Sciences at a ceremony on May 9. A separate event was held for 59 students, who received their law degrees from the School of Law, also on May 9.
The 2015 Spring General Commencement ceremony took place on May 16 at the Alerus Center. At that ceremony, two UND faculty members, Sharon Carson and Cindy Juntunen, were officially named Chester Fritz Distinguished Professors. The professorship is the school’s highest academic honor. Also, Honorary Doctor of Letters degree were given to Bill Gross, an aviator and founder of the nonprofit known as Farm Rescue; and North Dakota Chief Justice of the Supreme Court Gerald Vandewalle. Both men are North Dakota natives and UND alums.
The following is a list of the newest UND graduates, sorted alphabetically by hometown and name:
NORTH DAKOTA:
Alexander -- Aaron Weber (JD); Ambrose -- Coltyn Johnson (BSN); Anamoose -- Dustin Rudnick (BSEE & BSME, Cum Laude) Arthur -- Kelly Sagen (BSFWB, Cum Laude); Arvilla -- Jacob Petsinger (BBA, Summa Cum Laude); Belcourt -- Shyleen Hall (MPH), Shane Martin (PHD), Duran Parisien (BSCJS), Janie Schroeder (JD), Ronette Vandal (BA); Beulah -- Brendan Boe (MD), Karlie Hoherz (BSKIN), Megan Muscha (BBA), Joseph Roberson-Kitzman (MPA), Kasey Schmidt (BSKIN), Lucas Schnaidt (BS, Summa Cum Laude); Bismarck -- Jordan Adolf (BGS, Summa Cum Laude), Jessica Albert (BSN), Annemarie Assel (BGS, Summa Cum Laude), Alyssa Backes (MS), Jody Bauer (MPAS), Gannon Becker (BA), Kirk Bjella (MD), Jasmin Boger (BSN), Amber Bouret (BA), Steven Brunner (BBA), Madison Buck (BBA), Jean Canham (MD), Kristin Canham (BACC, Summa Cum Laude), Andrew Carman (BS), Meghan Conlin (BSGDT), Nathan Curry (BS, Summa Cum Laude), Ashley Dockter (BS), Chelsea Ensz (BS, Summa Cum Laude), Jordan Ensz (BSCE, Magna Cum Laude), Nicole Evans (BA), Kristin Faris (BSSW), Daniel Field (MD), Aaron Frenette (MD), Macy Gunderson (BS), Jessica Hansen (BS, Summa Cum Laude), Sarah Hansen (BS, Summa Cum Laude), Jenifer Hardy (BGS, Cum Laude), Erin Haugen (BGS, Summa Cum Laude), Nicholas Henes (JD), Shane Hersch (MS), Nathan Hoaglund (MD), Caitlin Hochhalter (JD), Skylar Hoyt (BSSW, Cum Laude), Jacqueline Huber (MD), Kirby Huber (BS), Timothy Jacobs (BSCE, Summa Cum Laude), Isaac Jensen (BS, Magna Cum Laude), Mathew Jensen (JD), Alexandra Johnson (BS), Brian Johnson (JD), Ciara Johnson (MD), Kayla Johnson (BA), Kamela Kelsch (BGS, Cum Laude), Jessica Keys (BSED, Summa Cum Laude), Zachary Klabo (BSChE), Jace Kusler (BS, Summa Cum Laude), Aaron LaMontagne (BSMLS), Hannah Loesch (MS), Kathryn Lundberg (MS), Jacqueline Maddock (DPT), Jesse Maier (JD), Alyssa Martin (PHD), Alyssa Mastel (BBA), Alexandra Mathern (MD), Hana Mattern (BGS), Johnathan Metz (BSATSC, Summa Cum Laude), Brittany Mildenberger (BA, Summa Cum Laude) Jacob Miller (BACC), Joshua Morrell (MD), Dakota Noot (BFA, Summa Cum Laude), Kayla Owens (BSED, Cum Laude), Christopher Pansegrau (BS, Magna Cum Laude), Dillon Parker (BM, Summa Cum Laude), Sara Paulson (BS, Summa Cum Laude), Annah Preszler (MD), Tyler Przybylski (BSEE, Summa Cum Laude), Morgan Reese (MPAS), Cullen Reiser (BSCJS, Magna Cum Laude), Sherris Richards (MS), Dylan Roness (BS), Amanda Sather (BBA), Joshua Schumaker (BS, Cum Laude), Kyle Seidler (BSCE), Zachary Selzler (BS, Summa Cum Laude), Tiffany Shiu (BA, Magna Cum Laude), Tiffany Shiu (BACC, Magna Cum Laude), Michelle Steiner (MS), Kelly Streckert (BSME), Frank Swiontek (BBA), Alexie Traiser (MOT), Tessa Vaagen (JD), Nolan Wagner (BSChE), Tyler Weichel (BS), Katie Weigel (BACC); Bottineau -- Abbey Aide (BA), Austin Cote (BSME), Kelsie Grenier (BS, Magna Cum Laude), Bianca Lamb (MD), Andrew Mills (MD), Lindsey Siemens (MPAS), Kyle Thorson (MPA); Bowbells -- Molly Aufforth (BSATSC, Magna Cum Laude); Bowman -- Craig Bucholz (BSChE); Burlington -- Caleb Kester (BSME);
Cando -- Brennen Bergdahl (BBA, Cum Laude); Carrington -- Devin Barton (BBA), Brett Harmon (BA); Casselton -- Dennis Bolda (MS), Angela Lee (MS), Kirsten Marschke (BGS), Skyler Moderow (BS, Summa Cum Laude); Cavalier -- Samantha Stegman (DPT), Garret Thorlakson (BS); Center -- Rebecca Hovey (BSChE, Magna Cum Laude); Colfax -- Kathleen Breuer (DPT); Colgate -- Elizabeth Erickson (BBA); Conway -- Taylor Schlenk (BS, Magna Cum Laude); Cooperstown -- Kaitlin College (BSCLS); Crary -- Megan Anderson (BBA); Crosby -- Tanner Simonson (BS, Cum Laude); Davenport -- Sadie Skarloken (MD); Deering -- Jory Miller (BBA); Devils Lake -- David Allard (BSAT, Magna Cum Laude), Calvin Crawford (DPT), Chelsea de Bruto (BGS, Cum Laude), Sawyer Diseth (BBA), Darren Eckes (BSN), James Goulding (BA), Taylor Hoffart (BACC), Tanner Hoffmeyer (BSMLS), Heather Howatt (BSCLS, Magna Cum Laude), Sara Kurtz (BS), Maren Lysne (BSN, Cum Laude), Travis Nelson (MS), William Otis (BBA), Teri Paine (BSN, Cum Laude), Tiffany Peterson (BSMLS), Heather Schwan (MS), Shelby Turck (BA, Summa Cum Laude), Ian Whitney (DPT), Timothy Whitney (BSCSCI, Summa Cum Laude); Dickinson -- Christina Becker (BGS, Summa Cum Laude); Daniel Berg (BSME, Cum Laude), Paige Biederstedt (BACC, Summa Cum Laude), Amanda Blanchard (MD), Nikolaus Butz (PHD), Angela Casale (BSGEOL), Marissa Cerkoney (BS), Amanda Engelstad (JD), Katie Hewson (BSN, Summa Cum Laude), Natalie Taylor (BA), Lane Thompson (JD), Ty Thompson (MA), Whitney Wilhelmi (BGS, Cum Laude); Donnybrook -- Jennifer Nelson (MD); Drayton -- Grace Oberg (BS, Cum Laude); Dunseith -- Seth DeMontigny (BSCE ); Edinburg -- Stefanie Brandvold (BGS), Kassandra Kertz (DPT); Edmore -- Katerina Hoime (BS, Summa Cum Laude); Emerado -- Erica Cerda (BSSW, Magna Cum Laude), Andrew Hammen (BBA, Cum Laude), Erica Leake (BSED, Magna Cum Laude); Enderlin -- Darbie Claus (BGS ); Fairmount -- Jessica Rydell (JD); Fargo -- Tyler Almquist (BS), Logan Anderson (BA), Hannah Andrist (BM, Cum Laude), Amanda Berg (JD), Brittney Bolstad (BSN, Cum Laude), Colin Brown (BBA), Allison Buchholtz (MS), Siri Burck (BS, Magna Cum Laude), Jaford Burgad (BS, Magna Cum Laude), Stephanie Carlson (BGS), Brandi Claus (MS), Brittany Cwikla (BSN, Cum Laude), Lucas Demarais (BA), Keri DeSutter (PHD), Elizabeth Donner (MD), Clark Everson (BSPA), Taylor Fontaine (MPAS), Stephanie Gartner (BA), Paul German (MD), Casey Goodyear (BA, Cum Laude), Molly Goughnour (BSKIN, Cum Laude), Elizabeth Gray (MD), Andrew Grettum (BACC), Brayden Harwood (JD), Trevor Hausauer (MS), Casey Hepper (BA, Cum Laude), Casey Hepper (BS, Cum Laude), Amy Honzay (MS), Samantha Hoy (MOT), Kalli Hutchison (JD), Jacob Hvidston (MD), Anneli Johnson (JD), Michael Jordan (MD), John Kennelly (JD), Matthew Kirschenmann (JD), Grant Kraft (BA & BS, Magna Cum Laude), Brooke Kranzler (MA), Jacob Labernik (BSCE), Brady Larson (BSN, Cum Laude), Jason Lee (BBA), Joseph Leggio (PHD), Alysa Lerud (BS, Summa Cum Laude), Kari Losee (JD), Alyssa Mairs (BGS), Katelyn Mari (MOT), Taylor Martin (BA), Anne Mayer (BSME, Summa Cum Laude), Shantell Mayer (MS), Patrick McClellan (BACC, Cum Laude), Kirsten McCullough (BS, Magna Cum Laude), Brittany Michels (MPAS), John Mitzel (BBA, Summa Cum Laude), Michael Moos (BBA), Kendra Olson (JD), Adam Overvold (BSA), Anna Peinovich (BGS), Shayla Pierce (BA), Jesse Plambeck (BA), Cal Potter (BSFWB), Haley Reinholz (BSN, Magna Cum Laude), Jacob Reopelle (BACC), Sadie Rivard (BSN, Summa Cum Laude), Ebonee Ronningen (MSW), Joseph Schaefbauer (BA, Magna Cum Laude), Kelly Schempp (BSED, Magna Cum Laude), McKayla Schmitt (MD), Lisa Schock (MD), Samuel Schultz (MFA), Andrew Smith (JD), Mathew Strom (BA), Clark Swanson (BSIT), Joshua Teigen (BBA), Lucas Teske (MD); Fessenden -- Kayla Hotakainen (MS); Forman -- Shirin Nour (BS, Summa Cum Laude); Gackle -- Andrew Owen (BSCHEM, Summa Cum Laude);
Galesburg -- Cindy Olstad (BSSW); Garrison -- Katarzyna Belisle (MS), Daniel Fetzer (MD); Gilby -- Randi Hulst (BSN), Nathan Yon (BA); Glen Ullin -- Brian Herz (BS); Glenburn -- Zachary Lee (MA); Grafton -- Katie Collette (PHD), Dalia El Sarraf (BS, Magna Cum Laude), Lysette Lopez (BS, Cum Laude), Anna Rutherford (BACC), Kyle Wilebski (MD); Grand Foks -- David Whalen (BA), Boma Afonya (BS), DeeAnn Ahmann (BSSW), Katie Allen (MSW), Devin Aune (BSEE), Michael Badurek (BSN, Cum Laude), Lindsey Beattie (BSN), Rachel Biberdorf (BSN), Brandon Boemann (BSED), Zachary Boettner (JD), Evan Bollinger (BSATSC), Tyler Borst (BBA), Rachel Bothun (DPT), Thomas Botsford (MD), Peter Bottini (BA), Jamie Bowman (DPT), Anna Breidenbach (BSED, Summa Cum Laude), Jade Brown (MS), Joseph Brown (BGS), Joseph Bussey (MA), Angela Byzewski (BFA, Cum Laude), Alida Carlson (BS, Summa Cum Laude), Benjamin Carpenter (BSCSCI, Magna Cum Laude), Jana Carroll (BGS, Cum Laude), Mary Kissel (BGS), Blayze Clapero (BSGEOL), Amber Clark (BSN, Cum Laude), Kaitlin Clarke (BSCSCI), Ilse Coleman (MOT), Heidi Connahs (PHD), Matthew Cooley (MS), Sean Cooley (MD), Brandon Dawson (BSCJS), Kristina DeVaal (BA), Melissa DeWall (BA, Cum Laude), Sarah Doherty (MS), Matthew Duchscherer (BSCJS), William Duquette (BBA), Rachel Egstad (JD), Andrew Ellingson (BSCSCI, Magna Cum Laude), Julie Erickson (MA), Emily Evers (BBA), Rebecca Fee (BSN, Summa Cum Laude), Paige Ferguson (BS, Cum Laude), Bobbie Fleming (BSSW), Kasey Fleming (BA), Morgan Frerking (BS, Magna Cum Laude), Matthew Fuka (BSME), Krystal Gaetz (BA), Anthony Garnett (BS), Nicholas Geiger (BS, Cum Laude), Anna Giemza-Palmer (MS), Christine Gillespie (DPT), Shanna Gisvold (BSED, Summa Cum Laude), Shanna Gisvold (BA, Summa Cum Laude), Riddhiman Goswami (MS), Gabriel Gourneau (BSKIN), Colton Gowan (BS), Katelyn Greer (BA), Jessica Groseth (BS), Morgan Gruhot (BSSW, Cum Laude), Abhinav Gupta (BSME), Dawson Hahn (BSCSCI), Dawson Hahn (BS), Dawson Hahn (BS), Alexis Hanson (BA, Cum Laude), Serianna Henkel (BA), Dallas Hepper (BSFWB), Megan Hepper (BSED), Vincent Herelle (BS), Alex Hickel (BSME), Hailey Hill (BSED), Matthew Hiller (MS), Jacob Holleman (BSChE), Scott Holm (DPT), Tavia Howe (BSCE), Carlie Hughes (BA, Cum Laude), Jamie Hutchinson (BA, Cum Laude), Mohamed Jama (BSPTE), David Jamison (BBA), Philip Jensen (BACC), Adam Johnson (MS), Brady Johnson (BSED), Brooke Johnson (BGS), Joshua Johnson (BSPTE, Cum Laude), Nicole Johnson (BSCJS, Cum Laude), Peter Kampa (BSCSCI, Summa Cum Laude), Eric Kester-Mabon (BA), Joseph Kingery (MS), Anna Marie Kinney (MA), Amanda Kjeldergaard (MS), Rochelle Knudson (BGS), Caleb Kobilansky (BA, Cum Laude), Michael Krause (BS, Cum Laude), Irena Krstic (BSSW), Lalitha Kurada (PHD), Pierre-Paul Lamoureux (JD), Haley Larson (BGS, Magna Cum Laude), Kristina Larson (BSKIN), Wendy Lim (BS, Summa Cum Laude), Anna Lind (BACC, Cum Laude), Richard Lofthus (BSME), Sandra Luck (PHD), Kathryn Lund (MS), Drew MacDonald (BSFWB), Jessica Mann (BSGDT), Amy Matchett Smith (MSW), Kevin Matze (MA), Kelsey McCullough (BSCN), Dana McIlwain (BSA), Betsey McIntyre (MED), Jessica McIntyre (BSSW, Magna Cum Laude), Lucas Mirera (BS), Kelsey Misialek (BACC), Martina Mlikota (BSRHS), Alexander Molstad (BSFWB), Jacqueline Mosher (BS), David Nelson (BBA), Nicholas Nelson (BA), Nichole Nelson (MSW), Tyler Newman (BSME), Heather Novak (BSMLS), Alan Oberg (BSED, Summa Cum Laude), Anders Odegaard (JD & MBA), Samuel O\u27Donnell Jr. (BA), Britney Olson (BSSW, Cum Laude), Kayla Olson (MPAS), Morgan Olson (MS), Amaka Onyeka (MS), Sean Opdahl (BSED), Jacob Ostgard (BGS), Kruse Otto (BSME), Kylie Palmiscno (DPT), Kate Paulson (MS), Rachel Perry (BFA, Cum Laude), Judd Prasnicky (BSMLS, Magna Cum Laude), Michon Pritchett (BA), Michael Ramos (BSA), John Roll (MS), Tyrell Rose (BSED), Jocelyn Rozeveld (BSD, Magna Cum Laude), April Sauve (BSRHS, Magna Cum Laude), Sarah Scholler (JD), Chelsea Schroeder (BSN), Jordan Senff (BSME, Magna Cum Laude), Clinton Senn (BSED), David Senti (BACC), Kristi Severson (MA), Anjali Sharma (BS), Alexandar Sidles (MS), Emily Smith (BGS), Makenzi Smith (BSSW), Jordan Speare (BGS), Patrick Sprague (BA), Dylan Stavens (BA), Allison Sturman (BSED, Cum Laude), Nathaniel Sweet (BGS), Brooke Swingen (BSED), Sophie Enjema Tande (BSN), Kylie Theisen (BBA), Donovan Torgerson (BSCSCI), Kevin Torkelson (MD), Leah Tunseth (DPT), Sara Tupa (BSN), Ana Velic (MD), Zachary Vodden (BA), Katlyne Weymier (BGS), Emily Whalen (MS), Tianna Wilhelmi (MS), Brooklyn Grotte (BA), Chelsey Williams (BSN), David Wiosna (MA), Brynne Wischer (MS), Samantha Wosick (BA), Shunan Xu (BSA, Cum Laude), Leslie Yellow Hammer (BS ) Yubin Zhang (BBA Cum Laude) Tyler Zielske (BSIT ) Paul Zwilling (MBA ) Grand Forks Air Force Base -- Elisa Head (BA, Magna Cum Laude);
Grandin -- Ashley Blotsky (BS, Magna Cum Laude); Halliday -- Christina Haugen (MS); Hamilton -- Robyn Kemp (BSN, Cum Laude); Hankinson -- Anthony Pohl (DPT); Harlow -- John Sears (BACC); Harwood -- Katie Fretheim (BA); Hatton -- Katie Langeliers (BSN, Cum Laude), Christina Phipps (BA, Summa Cum Laude); Hazelton -- Paul Keeney (MED); Hazen -- Kate Berg (BSEE, Cum Laude), Tristaen Bingham (MS), Conor Borud (BACC), Debra Grabow (MS), Emma Miller (BS, Cum Laude), Breaunna Oakland (BSED, Magna Cum Laude), Melissa Rothe (BS, Magna Cum Laude); Hensel -- Matthew Ashpole (BS); Hettinger -- Jessica Corean (MD), James West (MD), Hillsboro -- Amy Marriott (BA, Magna Cum Laude); Hoople -- Tiffany Hurtt (BACC); Hope -- Morgan Herz (BA, Magna Cum Laude); Horace -- Michael Haberman (BBA), Kyle Toppen (BACC); Hunter -- Alexandra Marvel (MOT); Jamestown -- Heidi Engels (BSD), Daniel Goebel (BSIT), Rodney Gross Jr. (MS), Austin Hoggarth (BS, Cum Laude), Thomas Johnson (MD), Sondra Pergotski (BA, Summa Cum Laude), Alec Redmann (BSME, Summa Cum Laude), Jennifer Schneider (MA), Justin Slusser (BS, Magna Cum Laude), Michael Soulis (MA), Brady Sullivan (MS); Killdeer -- Alyssa Walker (MS); Kindred -- Katherine Kvislen (BGS), Mary Schreiner (BBA), Dylan Torgerson (BS, Magna Cum Laude), Lakota -- Adrian Grotte (BSD, Magna Cum Laude); LaMoure -- Megan Quinlan (BS, Summa Cum Laude); Langdon -- Emily Koenig (BSSW, Summa Cum Laude); Larimore -- Alyssa Jacobson (BS), Andrew Jacobson (BSCSCI), Kaitlin Landman (BBA), Taylor Morten (BSN, Cum Laude), Derrick Parsons (BSME); Leeds -- Jessica Nelsen (MA); Lidgerwood -- Mathew Scheuring (BFA); Linton -- Margaret Burke (BS); Lisbon -- Alexis Nims (MOT), Brent Noonan (BSCE, Cum Laude), Brook Rufsvold (MS), Taryn Wagner (MOT), Debbie Zabel (MS); Maddock -- Derek Engh (BSA, Magna Cum Laude); Mandan -- Lindsey Altringer (DPT), George Ellefson (PHD), Samantha Harris (BS, Magna Cum Laude), Samantha Hersch (BM, Summa Cum Laude), Samantha Hersch (BM, Summa Cum Laude), Joshua Johnson (MD), Reid Jungling (BSChE, Magna Cum Laude), Jenna Kelsch (MS), Pamela Klein (MSW), Madison Krebsbach (BM, Magna Cum Laude), Austin Lafferty (JD), Sarah Lawler (BA, Cum Laude), Jeffery Lind (EDD), Tamara Mulske (MM), Sierra Schafer (BS, Summa Cum Laude), Slade Ternes (BSEE), Kristen Urlacher (MS), Brittni Winkler (BSN, Cum Laude), Michael Wuitschick (MS), Brittaney Zander (BSN); Manvel -- Mark Bushaw (BS, Magna Cum Laude), Aaron Hatt (BBA); Mayville -- Jamie Kauffman (MOT), Kelli Odden (EDD), Maggie O\u27Keefe (BBA, Cum Laude); McGregor -- Ryan Strid (BM, Cum Laude); McVille -- Elisha Brandvold (BSED, Cum Laude), Matthew Cookman (BS, Cum Laude); Minot -- Jasper Barlich (MS), Samuel Beaudoin (BSME), Ryan Brown (BS, Cum Laude), Moneesha DeBardlabon (BGS), Aimee Duchsherer (MA), Jade Feller (MA), Lecia Hager (BSSW, Magna Cum Laude), Jordan Halseth (BA), Jacob Jenkins (MED), Anjuli Jethwa (BSED), Andrea Lang (MA), Samantha Leier (BA), Teal Leraas (MS), Kathryn Lien (BGS), Mathew Malek (MD), Robert Martin (PHD), Matthew McMahon (BS), Craig Meiers (MD), Brady Meyer (DPT), Alex Nelson (BSCJS), Austin Olson (BA, Magna Cum Laude), Matthew Schimke (BSChE, Summa Cum Laude), Kaitlyn Sivertson (BA, Magna Cum Laude), Dillon Skogen (BS), Austin Sorrells (BS), Michael Steele (MS), Yimeng Sun (BBA), Ryan Tetzloff (BBA), Ryan Tetzloff (BA), Jacob Thrailkill (BA), Travis Waswick (MD), Alex Wohl (DPT); Mott -- Kayla Norton (BSSW, Magna Cum Laude); Munich -- Trevor Schommer (BBA); Mylo -- Katie Bonn (BBA & BACC); Neche -- Matthew Thom (BBA); New England -- Kimberly Lutz (MS); New Leipzig -- Holly Gaugler (BSMLS); New Rockford -- Avolt Baumbach (MED); New Salem -- Janna Beth (MS ) New Town -- George Guimont (BS )
Newburg -- Lorea Watson (MA ) Niagara -- Craig Magnus (BSCE ) Maria Schmidt (BSN, Cum Laude); Northwood -- Haley Pratt (MOT); Oxbow -- Whitney Krabbenhoft (BS); Page -- Krista Bjerke (MS), Thomas Grindberg (MD), Karissa Lindseth (MS), Allison Vosgerau (DPT); Park River -- Dylan Berg (BBA), Kaylee Gaarder (BBA), Ian Myrdal (BBA); Pembina -- Kara Wilwand (BBA); Portland -- Darrin Winger (BSCSCI); Ray -- Kolton Jungemann (BSCE); Reeder -- Caleb Larson (BS, Magna Cum Laude); Reynolds -- Brittany Broderson (MSW), Paula Ricke (MS); Rolette -- Mason Mongeon (BA); Rolla -- Shelby Davis (MS), Brooke Lentz (BS, Magna Cum Laude), Jessica Munro (BS); Rugby -- Joshua Anderson (DPT); Rutland -- Justin Jacobson (BSED); Saint Thomas -- Andres Sanchez III (MBA); Scranton -- Chloe Krinke (BA, Summa Cum Laude); Sentinel Butte -- Lindsay Olson (BSED, Cum Laude), Ashley Wirtzfeld (JD); South Heart -- Amber Wagner (MA); St. John -- Cole Allick (BS), Lloyd Sivertson (BA); St. Michael -- Elisha Lawrence (BSN); Stanley -- Emily Mell (BA); Starkweather -- Kristina Nielsen (BACC); Steele -- Hugh Grindberg (MA); Thompson -- Zachariah Kvidt (DPT), Brian Larrabee (BA), Richard Morgan (DPT), Nicholas Nybo (BSME), Vanessa Robinson (BSN, Summa Cum Laude), Laura Slaathaug (BSD, Cum Laude), Joseph Tomanek (BSKIN), Dustin Umland (BSChE); Tioga -- Austin Lee (BSIT); Tower City -- Heather Pautz (MSW); Turtle Lake -- Joey Cherrey (BACC), Katherine Shelkey (BSSW); Valley City -- Amanda Peterson (MD), Sean Ryan (BSSW), Amanda Stevens (BSMLS, Summa Cum Laude), Bryan Tykwinski (BSCE); Velva -- Zachary Craig (BS, Cum Laude), Alex Holte (BS, Magna Cum Laude), Courtney Thingstad (BBA), Garrett Wible (BSKIN); Wahpeton -- Liesl Carlson (BA & BBA, Magna Cum Laude), Brittney Fiala (MS), André Généreux (MD), Samantha Olson (BSED, Cum Laude), Dustin Thompson (BS), Caroline Wangui (MS), Christohper Wateland (JD), Caitlyn Wolf (BSChE, Summa Cum Laude); Walhalla -- Richard Dalzell (BACC), Tara Romfo (MS); Washburn -- Christopher Gradin (BSCE, Cum Laude); Watford City -- Christopher Larsen (BBA, Cum Laude), Ty Skarda (JD); West Fargo -- Stacie Frovarp (MS), Kelsey Kloos (BS), Hannah Krause (DPT), Samir Maleki (DPT), Christian Mohan (BBA), Nathan Potter (BACC); Wheatland -- Kaylee Burgard (BSN, Magna Cum Laude), Laura Roach (BA); Williston -- Christopher Barke (BS), Jordan Braun (DPT), Aaron Dye (BSATSC), Zachary Eiken (JD), Adam Groth (BSPTE), Alissa Groth (BS), Seth Grundstad (BSME & BA, Summa Cum Laude), Lucas Imsland (BBA), Brook McFarlin (BBA, Cum Laude), Meghan Olson (MA), Casey Paradies (MA), Kolten Paryzek (BS, Magna Cum Laude), Alison Peterson (MA), John Seil (BBA), Jacob Telehey (BSME, Magna Cum Laude); Wilton -- Kerri Benning (MS), Sarah Clausen (MD);
MINNESOTA:
Ada -- Marisa Austinson (BSSW), Erica Myers (MOT), Taylor Ruebke (BACC, Summa Cum Laude), Alivia Sterton (BACC, Magna Cum Laude); Adams -- William DeHoogh (BBA); Albany -- Taylor Waletzko (BBA, Summa Cum Laude); Albert Lea -- Alycia Hall (BA), Bethany Kaemingk (MD), Jackson Knudson (BSCE), Alik Smed (BBA, Magna Cum Laude); Albertville -- Andrew Goodin (BSME, Cum Laude); Alexandria -- Dereck Buss (BSCJS), Jordan Erickson (BBA), Jordan Erickson (BSKIN), Sarah Erickson (DPT), Derek Goracke (BSKIN, Cum Laude), Emily Hoeper (BSN, Magna Cum Laude), Jenna Larson (BA, Summa Cum Laude), Brandon Ludwig (BACC), Jacquelyn Marshall (MS), Sarah Peterson (MOT), Aaron Rentschler (BACC, Cum Laude), Kristen Sjostrand (BSN, Summa Cum Laude), Brian Storhaug (DPT), Connor Sundberg (BBA), Micheal Ziegler (BSPTE); Andover -- Anthony Bodene (BA), Nicole Husfeldt (BSKIN, Cum Laude), Jeffrey Jacobs (BGS), Danielle McNallan (BSCJS, Magna Cum Laude), Pamela Nkowa (MS), Alexa Olson (BSED), Andrew Peden (BACC), Erica Turner (BACC, Cum Laude); Annandale -- Emily Triplett (BSED & BA, Summa Cum Laude); Anoka -- Baillie Fritel (BSN), Michael Olson (BSIT); Apple Valley -- Kyle Anderson (BA), Matthew Bartels (BGS), Angela Bauler (BFA), Jason Burns (BSME, Cum Laude), Heather Duehn (BSED, Magna Cum Laude), Mack Goodrich (BBA, Magna Cum Laude), Patrick Hlas (BSME), Ali Jama (JD), Mahmoud Madiboo (BSCJS), Jamie St.Marie (BS, Cum Laude), Trevor Trombley (BA & BSED); Arden Hills -- Andrew Evans (BSME); Argyle -- Alissa Haugen (MOT), Kip Thorstenson (DPT), Alison Wehri (BSN); Arlington -- Erin Dahn (MS), Ashby -- Garyt Haagenson-Buck (BSAT, Cum Laude); Audubon -- Kjerstin Swenson (BSD); Aurora -- Cynthia Burich (BSN), Cynthia Burich (BS); Badger -- Christine Hanson (MS), Abby Wicklund (MOT); Bagley -- Caleb Nelson (BSCJS), Kayla Skersick (DPT); Baudette -- Stephen Slick (BSCE); Baxter -- Ann Danielson (BSFWB), Sean Halverson (BSME, Cum Laude), Allison Reuer (BSD, Cum Laude), Tyra Taylor (MSW); Becker -- Kyle Andres (BSME), Carly Leslie (BSED), Devin Wells (BSA); Bemidji -- Jessica Bruns (DPT), Catheryne Domeier (BA), Ryan Domeier (BS), Patrick Froehle (BSEE, Summa Cum Laude), Taylor McLean (BS, Summa Cum Laude), Grant Mitchell (BGS), Christopher Nelson (BBA, Magna Cum Laude)
The Push to Integrate Mid-Level Providers into Dentistry
No full textPhoto by lafayett zapata montero on Unsplash
INTRODUCTION
Mid-level providers are not new to the field of medicine. Nurse practitioners and physician assistants have been providing direct care for patients with the oversight of licensed physicians for many years. As a result of their assistance, physicians can focus on complex cases and oversee a larger patient base. This, in turn, creates a more accessible healthcare system. Although many gaps remain between medicine and dentistry, mid-level providers may be the answer to expanding access to dental healthcare needs. Recently, mid-level providers have entered the field of dentistry in multiple states in the US. People commonly refer to this role as a dental therapist. A dental therapist works under a licensed dentist providing preventive and routine restorative care to expand dental healthcare to underserved populations.[1] This new addition to the workforce has proven to be beneficial in some regions but has opened a door to ethical debate among dentists and public health officials.
In 2009 Minnesota approved the first state-wide legislation in the US to legalize the role of dental therapists after seeing a drastic decline in their dentist-to-population ratio. The congregation of dentists in high-income and highly populated areas have left many communities in the US in need of dental care but unable to receive it locally. A case study performed by dental hygienists Minnesota, from 2003 to 2007, concluded that one in four primary school children presented with visible decay, and half of these cases were deemed urgent due to symptoms including toothaches and other oral pain.[2] Minnesota health professionals performed another case study which presented results that they believed to further strengthen the need for dental reform in the state. Over the course of a year, health professionals surveyed seven hospitals in the Minneapolis-St. Paul metropolitan area. The results showed over 10,000 emergency room visits were from dental-related problems such as abscesses or toothaches. These patients had untreated oral health problems, eventually leading to infection and unbearable pain. The total cost for these emergency room visits exceeded 24,000 in additional profit for the practice that year.[9] Expanding dental care to patients enrolled in Medicaid programs has been an ongoing issue. According to the American Dental Association, in 2018, around 30 percent of practicing dentists accepted Medicaid.
In 2012, a case study was conducted in Alaska, which collected the statistics produced by Rochelle Furry, a certified dental therapist. Over the course of a year, Furry saw 750 patients and performed 5,000 procedures. Furry’s addition to the team cost the supervising dentist 385,338, with a yearly net profit of $205,329.[10] Another benefit reported by dentists when integrating a dental therapist into their team was the ability to prioritize their focus toward more complex cases, leaving routine fillings and other minimally invasive procedures in the hands of the dental therapist. With the reduced education of dental therapists comes reduced costs per procedure. This may encourage patients who are uninsured or owe out-of-pocket payments and entice them to follow through with the diagnosed treatment.
II. Areas of Debate
Despite providing benefits to patients and supervising dentists, dental therapists are not prevalent throughout the US. Similar to the debate regarding mid-level providers like physician’s assistants and nurse practitioners, there are disputes between healthcare officials on whether the addition of dental therapists is an ethical solution to the disparities in access to oral care. The different levels of education between dentists and dental therapists spark debates on whether dental therapists have enough training to treat patients. Dentists are required to complete both a bachelor’s and a doctorate program, as well as pass rigorous board exams usually totaling eight years of additional education after a high-school degree. Although dental therapists perform more routine procedures that are minimally invasive, they are primarily working with populations that have received minimal oral care in the past, usually presenting with larger amounts of decay. This increases the complexity of cases that a healthcare worker with minimal training compared to a DDS or DMD attends to. While some patients prefer the low costs of procedures done by a dental therapist, others prioritize quality of treatment and believe only dentists are well-trained enough to provide it. Some argue that a doctorate-level medical professional should do irreversible procedures involving the permanent removal of the tooth surfaces, such as fillings, crowns, or extractions. This position also brings up the issue of a two-tiered healthcare system in which patients of low socioeconomic status are treated by providers with less training, while mid to upper class patients are treated by doctors. Some public health professionals argue there are better solutions. For example, the Academy of General Dentistry “White Paper on Increasing Access to and Utilization of Oral Health Care Services" suggests that one of the biggest challenges in achieving optimal oral health for all is “underutilization of available oral health care.”[11] This argument addresses the noneconomic barriers in seeking professional care, including the patient's behavioral factors, levels of oral health literacy, transportation, location, and cultural or linguistic preferences. This author concludes that increased access can be achieved with the current dentist supply, if optimally utilized, along with public health officials increasing public knowledge and awareness regarding oral health.[12]
CONCLUSION
The remaining question is what may be the best way forward for the health of the US population. The goal of equal and accessible healthcare is not easily obtainable. The introduction of dental therapists to the workforce has provided a possible solution to this problem by expanding access to healthcare to affected populations. Some regions have documented benefits from this addition, but disagreements remain among healthcare professionals on whether this is the ethical solution to the problem of oral health disparities. The practice of integrating dental therapists into all regions with oral health care shortages throughout the US comes down to whether licensed dental therapists are competent in rendering quality treatment in underserved areas. Some are content with the addition of dental therapists, while others continue to look for other solutions, such as better dental education on prevention and optimizing access to already established practices.
-
[1] Corr, Allison. “What Are Dental Therapists?” The Pew Charitable Trusts, The Pew Charitable Trusts, 9 Oct. 2019, www.pewtrusts.org/en/research-and-analysis/articles/2019/10/09/what-are-dental-therapists.
[2] The Pew Center on the States. “The State of Children’s Dental Health: Making Coverage Matter.” Pew Children’s Dental Campaign, Sept. 2010. https://www.pewtrusts.org/~/media/legacy/uploadedfiles/wwwpewtrustsorg/reports/state_policy/childrensdental50statereport2011pdf.pdf.
[3] Pew Center on the States (2010).
[4] Health Workforce Shortage Areas, Health Resources and Services Administration (HRSA), 31 Mar. 2023, https://data.hrsa.gov/topics/health-workforce/shortage-areas.
[5] David A. Nash, Jay W. Friedman, Kavita R. Mathu-Muju, Peter G. Robinson, Julie Satur, Susan Moffat, Rosemary Kardos, Edward C.M. Lo, Anthony H.H. Wong, Nasruddin Jaafar, Jos van den Heuvel, Prathip Phantumvanit, Eu Oy Chu, Rahul Naidu, Lesley Naidoo, Irvi. “A Review of the Global Literature on Dental Therapists.” Community Dentistry and Oral EpidemiologyVolume 42, Issue 1 p. 1-10, Wiley Library Online, 3 May 2013, https://doi.org/10.1111/cdoe.12052.
[6] Corr (2019).
[7] Urahn, S. and Schuler, A. (2014) Expanding the Dental Team. The Pew Charitable Trust. https://www.pewtrusts.org/-/media/assets/2014/06/27/expanding_dental_case_studies_report.pdf
[8] Corr (2019).
[9] Corr (2019).
[10] Nash, et al. (2013).
[11] White Paper on Increasing Access to and Utilization of Oral Health Care Services, Academy of General Dentistry, July 2008, https://www.agd.org/docs/default-source/advocacy-papers/agd-white-paper-increasing-access-to-and-utilization-of-oral-health-care-services.pdf?sfvrsn=2%20.
[12] Burton L. Edelstein, DDS, MPH. “Examining Whether Dental Therapists Constitute a Disruptive Innovation in US Dentistry.” American Journal of Public Health, American Public Health Association, Oct. 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222362/
The Push to Integrate Mid-Level Providers into Dentistry
No full textPhoto by lafayett zapata montero on Unsplash
INTRODUCTION
Mid-level providers are not new to the field of medicine. Nurse practitioners and physician assistants have been providing direct care for patients with the oversight of licensed physicians for many years. As a result of their assistance, physicians can focus on complex cases and oversee a larger patient base. This, in turn, creates a more accessible healthcare system. Although many gaps remain between medicine and dentistry, mid-level providers may be the answer to expanding access to dental healthcare needs. Recently, mid-level providers have entered the field of dentistry in multiple states in the US. People commonly refer to this role as a dental therapist. A dental therapist works under a licensed dentist providing preventive and routine restorative care to expand dental healthcare to underserved populations.[1] This new addition to the workforce has proven to be beneficial in some regions but has opened a door to ethical debate among dentists and public health officials.
In 2009 Minnesota approved the first state-wide legislation in the US to legalize the role of dental therapists after seeing a drastic decline in their dentist-to-population ratio. The congregation of dentists in high-income and highly populated areas have left many communities in the US in need of dental care but unable to receive it locally. A case study performed by dental hygienists Minnesota, from 2003 to 2007, concluded that one in four primary school children presented with visible decay, and half of these cases were deemed urgent due to symptoms including toothaches and other oral pain.[2] Minnesota health professionals performed another case study which presented results that they believed to further strengthen the need for dental reform in the state. Over the course of a year, health professionals surveyed seven hospitals in the Minneapolis-St. Paul metropolitan area. The results showed over 10,000 emergency room visits were from dental-related problems such as abscesses or toothaches. These patients had untreated oral health problems, eventually leading to infection and unbearable pain. The total cost for these emergency room visits exceeded 24,000 in additional profit for the practice that year.[9] Expanding dental care to patients enrolled in Medicaid programs has been an ongoing issue. According to the American Dental Association, in 2018, around 30 percent of practicing dentists accepted Medicaid.
In 2012, a case study was conducted in Alaska, which collected the statistics produced by Rochelle Furry, a certified dental therapist. Over the course of a year, Furry saw 750 patients and performed 5,000 procedures. Furry’s addition to the team cost the supervising dentist 385,338, with a yearly net profit of $205,329.[10] Another benefit reported by dentists when integrating a dental therapist into their team was the ability to prioritize their focus toward more complex cases, leaving routine fillings and other minimally invasive procedures in the hands of the dental therapist. With the reduced education of dental therapists comes reduced costs per procedure. This may encourage patients who are uninsured or owe out-of-pocket payments and entice them to follow through with the diagnosed treatment.
II. Areas of Debate
Despite providing benefits to patients and supervising dentists, dental therapists are not prevalent throughout the US. Similar to the debate regarding mid-level providers like physician’s assistants and nurse practitioners, there are disputes between healthcare officials on whether the addition of dental therapists is an ethical solution to the disparities in access to oral care. The different levels of education between dentists and dental therapists spark debates on whether dental therapists have enough training to treat patients. Dentists are required to complete both a bachelor’s and a doctorate program, as well as pass rigorous board exams usually totaling eight years of additional education after a high-school degree. Although dental therapists perform more routine procedures that are minimally invasive, they are primarily working with populations that have received minimal oral care in the past, usually presenting with larger amounts of decay. This increases the complexity of cases that a healthcare worker with minimal training compared to a DDS or DMD attends to. While some patients prefer the low costs of procedures done by a dental therapist, others prioritize quality of treatment and believe only dentists are well-trained enough to provide it. Some argue that a doctorate-level medical professional should do irreversible procedures involving the permanent removal of the tooth surfaces, such as fillings, crowns, or extractions. This position also brings up the issue of a two-tiered healthcare system in which patients of low socioeconomic status are treated by providers with less training, while mid to upper class patients are treated by doctors. Some public health professionals argue there are better solutions. For example, the Academy of General Dentistry “White Paper on Increasing Access to and Utilization of Oral Health Care Services" suggests that one of the biggest challenges in achieving optimal oral health for all is “underutilization of available oral health care.”[11] This argument addresses the noneconomic barriers in seeking professional care, including the patient's behavioral factors, levels of oral health literacy, transportation, location, and cultural or linguistic preferences. This author concludes that increased access can be achieved with the current dentist supply, if optimally utilized, along with public health officials increasing public knowledge and awareness regarding oral health.[12]
CONCLUSION
The remaining question is what may be the best way forward for the health of the US population. The goal of equal and accessible healthcare is not easily obtainable. The introduction of dental therapists to the workforce has provided a possible solution to this problem by expanding access to healthcare to affected populations. Some regions have documented benefits from this addition, but disagreements remain among healthcare professionals on whether this is the ethical solution to the problem of oral health disparities. The practice of integrating dental therapists into all regions with oral health care shortages throughout the US comes down to whether licensed dental therapists are competent in rendering quality treatment in underserved areas. Some are content with the addition of dental therapists, while others continue to look for other solutions, such as better dental education on prevention and optimizing access to already established practices.
-
[1] Corr, Allison. “What Are Dental Therapists?” The Pew Charitable Trusts, The Pew Charitable Trusts, 9 Oct. 2019, www.pewtrusts.org/en/research-and-analysis/articles/2019/10/09/what-are-dental-therapists.
[2] The Pew Center on the States. “The State of Children’s Dental Health: Making Coverage Matter.” Pew Children’s Dental Campaign, Sept. 2010. https://www.pewtrusts.org/~/media/legacy/uploadedfiles/wwwpewtrustsorg/reports/state_policy/childrensdental50statereport2011pdf.pdf.
[3] Pew Center on the States (2010).
[4] Health Workforce Shortage Areas, Health Resources and Services Administration (HRSA), 31 Mar. 2023, https://data.hrsa.gov/topics/health-workforce/shortage-areas.
[5] David A. Nash, Jay W. Friedman, Kavita R. Mathu-Muju, Peter G. Robinson, Julie Satur, Susan Moffat, Rosemary Kardos, Edward C.M. Lo, Anthony H.H. Wong, Nasruddin Jaafar, Jos van den Heuvel, Prathip Phantumvanit, Eu Oy Chu, Rahul Naidu, Lesley Naidoo, Irvi. “A Review of the Global Literature on Dental Therapists.” Community Dentistry and Oral EpidemiologyVolume 42, Issue 1 p. 1-10, Wiley Library Online, 3 May 2013, https://doi.org/10.1111/cdoe.12052.
[6] Corr (2019).
[7] Urahn, S. and Schuler, A. (2014) Expanding the Dental Team. The Pew Charitable Trust. https://www.pewtrusts.org/-/media/assets/2014/06/27/expanding_dental_case_studies_report.pdf
[8] Corr (2019).
[9] Corr (2019).
[10] Nash, et al. (2013).
[11] White Paper on Increasing Access to and Utilization of Oral Health Care Services, Academy of General Dentistry, July 2008, https://www.agd.org/docs/default-source/advocacy-papers/agd-white-paper-increasing-access-to-and-utilization-of-oral-health-care-services.pdf?sfvrsn=2%20.
[12] Burton L. Edelstein, DDS, MPH. “Examining Whether Dental Therapists Constitute a Disruptive Innovation in US Dentistry.” American Journal of Public Health, American Public Health Association, Oct. 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222362/
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The Push to Integrate Mid-Level Providers into Dentistry
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INTRODUCTION
Mid-level providers are not new to the field of medicine. Nurse practitioners and physician assistants have been providing direct care for patients with the oversight of licensed physicians for many years. As a result of their assistance, physicians can focus on complex cases and oversee a larger patient base. This, in turn, creates a more accessible healthcare system. Although many gaps remain between medicine and dentistry, mid-level providers may be the answer to expanding access to dental healthcare needs. Recently, mid-level providers have entered the field of dentistry in multiple states in the US. People commonly refer to this role as a dental therapist. A dental therapist works under a licensed dentist providing preventive and routine restorative care to expand dental healthcare to underserved populations.[1] This new addition to the workforce has proven to be beneficial in some regions but has opened a door to ethical debate among dentists and public health officials.
In 2009 Minnesota approved the first state-wide legislation in the US to legalize the role of dental therapists after seeing a drastic decline in their dentist-to-population ratio. The congregation of dentists in high-income and highly populated areas have left many communities in the US in need of dental care but unable to receive it locally. A case study performed by dental hygienists Minnesota, from 2003 to 2007, concluded that one in four primary school children presented with visible decay, and half of these cases were deemed urgent due to symptoms including toothaches and other oral pain.[2] Minnesota health professionals performed another case study which presented results that they believed to further strengthen the need for dental reform in the state. Over the course of a year, health professionals surveyed seven hospitals in the Minneapolis-St. Paul metropolitan area. The results showed over 10,000 emergency room visits were from dental-related problems such as abscesses or toothaches. These patients had untreated oral health problems, eventually leading to infection and unbearable pain. The total cost for these emergency room visits exceeded 24,000 in additional profit for the practice that year.[9] Expanding dental care to patients enrolled in Medicaid programs has been an ongoing issue. According to the American Dental Association, in 2018, around 30 percent of practicing dentists accepted Medicaid.
In 2012, a case study was conducted in Alaska, which collected the statistics produced by Rochelle Furry, a certified dental therapist. Over the course of a year, Furry saw 750 patients and performed 5,000 procedures. Furry’s addition to the team cost the supervising dentist 385,338, with a yearly net profit of $205,329.[10] Another benefit reported by dentists when integrating a dental therapist into their team was the ability to prioritize their focus toward more complex cases, leaving routine fillings and other minimally invasive procedures in the hands of the dental therapist. With the reduced education of dental therapists comes reduced costs per procedure. This may encourage patients who are uninsured or owe out-of-pocket payments and entice them to follow through with the diagnosed treatment.
II. Areas of Debate
Despite providing benefits to patients and supervising dentists, dental therapists are not prevalent throughout the US. Similar to the debate regarding mid-level providers like physician’s assistants and nurse practitioners, there are disputes between healthcare officials on whether the addition of dental therapists is an ethical solution to the disparities in access to oral care. The different levels of education between dentists and dental therapists spark debates on whether dental therapists have enough training to treat patients. Dentists are required to complete both a bachelor’s and a doctorate program, as well as pass rigorous board exams usually totaling eight years of additional education after a high-school degree. Although dental therapists perform more routine procedures that are minimally invasive, they are primarily working with populations that have received minimal oral care in the past, usually presenting with larger amounts of decay. This increases the complexity of cases that a healthcare worker with minimal training compared to a DDS or DMD attends to. While some patients prefer the low costs of procedures done by a dental therapist, others prioritize quality of treatment and believe only dentists are well-trained enough to provide it. Some argue that a doctorate-level medical professional should do irreversible procedures involving the permanent removal of the tooth surfaces, such as fillings, crowns, or extractions. This position also brings up the issue of a two-tiered healthcare system in which patients of low socioeconomic status are treated by providers with less training, while mid to upper class patients are treated by doctors. Some public health professionals argue there are better solutions. For example, the Academy of General Dentistry “White Paper on Increasing Access to and Utilization of Oral Health Care Services" suggests that one of the biggest challenges in achieving optimal oral health for all is “underutilization of available oral health care.”[11] This argument addresses the noneconomic barriers in seeking professional care, including the patient's behavioral factors, levels of oral health literacy, transportation, location, and cultural or linguistic preferences. This author concludes that increased access can be achieved with the current dentist supply, if optimally utilized, along with public health officials increasing public knowledge and awareness regarding oral health.[12]
CONCLUSION
The remaining question is what may be the best way forward for the health of the US population. The goal of equal and accessible healthcare is not easily obtainable. The introduction of dental therapists to the workforce has provided a possible solution to this problem by expanding access to healthcare to affected populations. Some regions have documented benefits from this addition, but disagreements remain among healthcare professionals on whether this is the ethical solution to the problem of oral health disparities. The practice of integrating dental therapists into all regions with oral health care shortages throughout the US comes down to whether licensed dental therapists are competent in rendering quality treatment in underserved areas. Some are content with the addition of dental therapists, while others continue to look for other solutions, such as better dental education on prevention and optimizing access to already established practices.
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[1] Corr, Allison. “What Are Dental Therapists?” The Pew Charitable Trusts, The Pew Charitable Trusts, 9 Oct. 2019, www.pewtrusts.org/en/research-and-analysis/articles/2019/10/09/what-are-dental-therapists.
[2] The Pew Center on the States. “The State of Children’s Dental Health: Making Coverage Matter.” Pew Children’s Dental Campaign, Sept. 2010. https://www.pewtrusts.org/~/media/legacy/uploadedfiles/wwwpewtrustsorg/reports/state_policy/childrensdental50statereport2011pdf.pdf.
[3] Pew Center on the States (2010).
[4] Health Workforce Shortage Areas, Health Resources and Services Administration (HRSA), 31 Mar. 2023, https://data.hrsa.gov/topics/health-workforce/shortage-areas.
[5] David A. Nash, Jay W. Friedman, Kavita R. Mathu-Muju, Peter G. Robinson, Julie Satur, Susan Moffat, Rosemary Kardos, Edward C.M. Lo, Anthony H.H. Wong, Nasruddin Jaafar, Jos van den Heuvel, Prathip Phantumvanit, Eu Oy Chu, Rahul Naidu, Lesley Naidoo, Irvi. “A Review of the Global Literature on Dental Therapists.” Community Dentistry and Oral EpidemiologyVolume 42, Issue 1 p. 1-10, Wiley Library Online, 3 May 2013, https://doi.org/10.1111/cdoe.12052.
[6] Corr (2019).
[7] Urahn, S. and Schuler, A. (2014) Expanding the Dental Team. The Pew Charitable Trust. https://www.pewtrusts.org/-/media/assets/2014/06/27/expanding_dental_case_studies_report.pdf
[8] Corr (2019).
[9] Corr (2019).
[10] Nash, et al. (2013).
[11] White Paper on Increasing Access to and Utilization of Oral Health Care Services, Academy of General Dentistry, July 2008, https://www.agd.org/docs/default-source/advocacy-papers/agd-white-paper-increasing-access-to-and-utilization-of-oral-health-care-services.pdf?sfvrsn=2%20.
[12] Burton L. Edelstein, DDS, MPH. “Examining Whether Dental Therapists Constitute a Disruptive Innovation in US Dentistry.” American Journal of Public Health, American Public Health Association, Oct. 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222362/
