Community Dental Health
Coordinators
Trent Lally
District 6 Trustee
What is a CDHC?
• “Community Dental Health Coordinator” or “CDHC”
• Part of an ADA comprehensive effort to improve access to oral
health care for underserved Americans.
• Promises to help Americans become better stewards of their oral
health.
Is the CDHC a “mid-level provider?”
• No. Mid-level providers are being promoted to drill,
fill, and extract.
• CDHC focuses on the root causes of disease – the lack
of adequate prevention and oral health literacy
among populations.
Background
• To help expand access to the same high quality dental
care available to all Americans, the ADA is helping to
develop a new member of the oral health team.
• National Coordinating and Developing Committee
(NCDC) was established to create a CDHC training
program.
How will the CDHC improve Access?
• Assist the dentist in the triage of patients
• Address social, environment, and health literacy
• Educate community members
• Part of a comprehensive approach that also includes:
• Improving Medicaid reimbursement rates
• Placing new focus on oral health education
• Prevention
• Increasing government investments in the public health
infrastructure
CDHC and the underserved
• Students in the CDHC pilot program are recruited from
the communities in which they serve.
• Comparable to Community Healthcare Workers
(CHWs) but with clinical dental skills.
• Not a one-size-fits-all solution
How are CDHC’s trained?
• Pilot Programs
• 18-month training program (12 months didactic + 6
months internship)
• University of Oklahoma
• Temple University
• A.T. Still University Arizona School of Dentistry
Accreditation
• CODA Accreditation is the Goal
What is the CDHC scope?
• Collect information (photographs, radiographs)
• Screenings
• Fluoride treatments
• Sealants
• Temporary filings
• Simple teeth cleanings (gingivitis) until a patient can
have a comprehensive cleaning
Where do CDHC’s work?
• Clinics
• Schools
• Churches
• Senior Citizen Centers
• Other public settings
Update
• New Mexico first state to authorize CDHC model
Questions?
• Trent Lally
• Email: TLally01@gmail.com
• Phone: (248) 866-0760
Dental Health Aid Therapist
Dusty Pfundheller
District 5 Trustee
What is a DHAT?
• “Dental Health Aid Therapist”
• dependent practitioner working in a satellite clinic under the
general supervision by an off-site licensed dentist located at a
distant regional clinic
How Were DHAT’s Created?
• Alaska
• Alaska Native Tribal Health Consortium (ANTHC)
• 85,000 Alaska Native people live in rural Alaska with no road
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access.
5 times caries risk in children
Alaska allowed high school graduates go to New Zealand for a two
year program
Now ANTHC partnered up w/ Kellogg Foundation to study at
University of Washington’s Medical School - 1 year is pre-clinical, 1
year clinical.
Now students are able to be trained in Washington University.
Training for DHAT
• 2 yr program
• Must have high school diploma or equivalent & 6wk
online anatomy & physiology course
• 1st year = pre-clinical work & classroom setting
• 2nd year = clinical experience, village practice rotations
• 400 clinic hours (six-month) residency program
• Every two years DHATs must be recertified.
• 24 CE credits
• Demonstration of ongoing clinical competency
Scope of practice
• Determined by the supervising dentist during the
residency based on DHAT’s demonstrated clinical skills
and tribal location needs
• Determines of clinical procedures and scope of practice
• Scope of practice is dynamic, may change periodically
depending upon the maturing skills-set of the
therapist.
• Typical DHAT may provide oral exams, preventive
dental services, simple restorations, stainless steel
crowns, extractions and take x-rays.
Supervision
• Dependent practitioner working in a satellite clinic
under the general supervision by an off-site licensed
dentist located at a distant regional clinic.
Questions?
• Dustin Pfundheller
• Email: dpfundheller@dental.ufl.edu
• Phone: (715) 894-0083
The Dental Therapy Model
Ben Youel, District 7 trustee
Aruna Rao, vice chair, Legislative
Grassroots Network
A Little History
• December 2006 – ADHP program approved by Board
of Directors of MN State Colleges & Universities
System
• Spring 2007 – Safety Net Coalition (SNC) convinces
MN Legislative Committee on Health Care Access to
recommend the creation of a dental MLP
• February 2008 – SNC introduces bill to create ADHP in
MN Dental Practice Act
A Little More History
• April 2008 – Bill passes to begin creation of an “Oral
Health Practitioner”
• April 2008 – U of MN unveiled proposed Dental
Therapy program
• May, July & September 2008 – U of MN delegation
visits Saskatchewan, New Zealand & England
• Early 2009 – “Dueling Bills” from U of MN/MDA &
from the SNC
And Finally…
• May 2009 – A compromise reached: Dental Therapy
(DT) & Advanced Dental Therapy (ADT) created
• Fall 2009 – DT program begins at U of MN & Oral
Health Care Practitioner (OHCP) program at
Metropolitan State University
• June 2011 – Seven students graduated with MS: OHCP
from Metropolitan State
• December 2011 – Nine students will graduate with
either Bachelors or Masters Degrees in Dental Therapy
from U of MN
Licensure
• Dental Therapist
• Advanced Dental Therapist
• Graduate w/Baccalaureate or
• All requirements of Dental
Master’s in accredited dental
Therapist
therapy education program
• 2,000 hours of practice as DT
• Pass independent clinical
• Graduate w/Master’s in ADT
competency exam
• Pass board-approved
• Jurisprudence Exam
competency exam
• Apply for certification
Scope of Practice & Supervision
• Dental Therapist
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Radiographs
Preventative Procedures & OHI
Sealants
Temporary Restorations
Space Maintainers*
Direct Restorations*
Pre-fab Crowns*
Pulpotomies (Primary teeth)*
Extractions (Erupted primary teeth)*
Tooth Reimplantation/Stabilization*
Local Anesthesia & Nitrous Oxide
Mouthguards
Provide, Dispense & Administer
Analgesics, Anti-Inflammatories &
Antibiotics
*Require Indirect Supervision
All duties subject to Collaborative
Management Agreement (CMA)
• Advanced Dental Therapist**
• All duties of Dental Therapist
• Oral Evaluations & Assessments
• Extraction (Periodontally involved
permanent teeth)
**All Require Only General Supervision
The Insider Perspective
Questions?
• Ben Youel – bcyouel@gmail.com
• Aruna Rao - raox0062@umn.edu
Advanced Dental Hygiene
Practitioner (ADHP)
Burton Coleman
ASDA District 4 Trustee
What is it?
• Advanced Dental Hygiene Practitioner
• American Dental Hygiene Association (ADHA) proposed
position in 2004
A dental hygienist who has graduated from an accredited
dental hygiene program and has completed an advanced
educational curriculum approved by the ADHA, which
prepares the dental hygienist to provide diagnostic,
preventive, restorative and therapeutic services directly to
the public.
• Response to 2000 US Surgeon General’s call to increase
access to care & tx underserved.
• M.D./Nurse Practitioner Analogy
Where is it?
• Currently a proposed model
public health settings
schools
federally qualified health centers (FQHCs)
long-term care facilities
hospitals
nursing homes
• State by state, currently none in full form
Training & Curriculum
• Training requirements & curriculum not fully established
• Bachelor’s degree + 2 years = Registered Dental Hygienist
• RDH + 2 year Master’s level program
Training & Curriculum Proposal
• The proposed ADHP educational framework is
organized by general domains (themes) and
more specific competencies within each domain.
I. Provision of Primary Oral Healthcare
II. Healthcare Policy and Advocacy
III. Management of Oral Care Delivery
IV. Translational Research
V. Professionalism
Scope of Practice
• Hygiene
• Dx + Perio eval, SRP, Prophy, Fluoride Tx, OHI
• Restorative
• Dx + Direct Restorations (composites, amalgams, sealants)
• Palliative Care
• Temp restorations, pre-formed crowns, pulp caps, place & remove
sutures
• Prosthodontics
• Adjust & repair removable, re-cement fixed
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Surgery – dx, uncomplicated extractions
Path – dx & refer
Ortho – dx & refer
Anesthesia – local & N2O
*generally, dentist supervision not required
State by State Basis
• Many states unsupervised perio, fluoride, sealants
• Trend to administer supervised local anesthesia & N2O
monitoring
• ADHP varieties appearing commonly in state legislation
• Connecticut
• New Hampshire
• Idaho (ISU M.S. in DH but restorative, surgery, pulp exceptions)
• Washington (Native American reservation)
• Michigan
• Licensing process not yet determined
Resources
• ASDAnet.org/midlevel-providers (page)
• ADA Workforce Statement (pdf)
• ADHA Resource Center (page)
• ADHA.org/governmental_affairs (page)
• State Dental Boards
• Google
Burton Coleman
burtoncoleman@gmail.com
615.477.2781
Summary of Mid-Level Providers
Location?
• DHAT = Alaska (trained in University of Washington)
• Dental Therapist = Minnesota
• CDHC = University of Oklahoma, Temple University, &
A.T. Still University Arizona School of Dentistry
• ADHP = currently none in full form
Which program is approved by ADA?
• Community Dental Health Coordinator or CDHC
What can each program do?
All can do:
• Collect information (photographs, radiographs)
• Screenings
• Fluoride treatments
• Sealants
• Temporary filings
• Simple teeth cleanings (gingivitis) until a patient can
have a comprehensive cleaning
What can each program do?
DHAT
• What dentist determines they can do in 400 hr residency
Dental Therapists
• Temporary Restorations
• Space Maintainers
• Direct Restorations
• Pre-fab Crowns
• Pulpotomies (Primary teeth)
• Extractions (Erupted primary teeth)
• Tooth Reimplantation/Stabilization
ADHP
• Hygiene : SRP, Prophy,
• Restorative: Direct Restorations (composites, amalgams, sealants)
• Palliative Care: Temp restorations, pre-formed crowns, pulp caps
• Prosthodontics: Adjust & repair removable, re-cement fixed
• Surgery uncomplicated extractions
ASDA Policies
• Current Statements of Position or Policy
• Voted on at House of delegates Feb 29th-March 3rd
• Speaker – Stephanie explains more on this
C-1 Expanded Functions of Dental Assistants and
Dental Hygienists
• Endorses expanded functions for dental auxiliaries
only when each has received the appropriate
education and training to guarantee competence, and
when such functions fall within the laws established
by their respective state of employment.
• Expanded functions for dental auxiliaries will not
adversely affect the health and well-being of the
public.
• The practice of dentistry entails more than the simple
performance of routine technical procedures. A
dentist must possess a wide range of knowledge of
the biological, anatomical, and physiological sciences
in order to successfully and safely perform such
procedures. A dentist must also be able to process
and apply both the knowledge and the skills acquired
in dental school in order to successfully and safely
perform these tasks.
Only the Dentist Should Perform
• Examination, diagnosis and treatment planning
• Prescribing work authorizations
• Performing irreversible dental procedures
• Prescribing drugs and/or other medications