1. Overview of Canadian Dental Therapy Programs
Dr. Todd Hartsfield
Director
Dental Clinical and Prevention Support Center
Inter Tribal Council of Arizona, Inc.

2. Canada Large country Many rural, isolated populations
Transportation challenges
Dentists concentrated in population centers
Access to dental care limited

4. Canadian Dental Therapy Programs
2 training schools established in 1972
Response to lack of access to dental care for underserved populations
Federal school at Ft. Smith, NWT – U. of Toronto Dental Faculty
Provincial school at Regina, Saskatchewan
First classes graduated in 1974

5. Federal DT’s work in health centers and nursing stations across Canada
Trained to deliver dental care to children and adults under the general supervision of a licensed dentist
Provincial DT’s worked in school clinics in SK and Manitoba
Trained to deliver care to children under the general supervision of a licensed dentist

6. Scope of Practice Fillings on primary and permanent teeth
Vital pulpotomies on primary teeth
Stainless steel crowns on primary teeth
Extractions of primary teeth (Prov & Fed)
Extractions of permanent teeth (Fed)
Sealants
Cleanings
Fluoride
Radiographs
Education

8. Saskatchewan Dental Plan 1974 - 1987
Much opposition from organized dentistry
Private practitioners in SK felt that dental therapists would take patients away from them
Just the opposite happened – dental therapists referred patients to private practitioners when a child needed dental work that was beyond their scope
New source of patients for private dentists
As the program expanded age groups , more and more children were referred to PP

9. Saskatchewan Dental Plan
Once the children had their dental care completed at school, more parents started seeking dental care for themselves
School program had a large education component for children and parents
Parents were encouraged to attend examination appointments to learn about their child’s oral health
Dental IQ of the entire province was raised which raised the demand for dental care

10. Saskatchewan Dental Plan
By 1987, SK children’s oral health had gone from the worst to the best in Canada
Too many dental staff for the amount of dental work that needed to be done
Large provincial deficit, conservative govt
Government scrapped the program in 1987, except for the northern program
Expanded dental hygiene schools
June 11, 1987 SDP was scrapped

11. Northern Saskatchewan Children’s Dental Program
1 dentist
7dental therapists
8 dental assistants
5,200 high needs children
Each team approx 740 patients
Clinics in schools or health center
Everyone traveled
Each team had satellite clinics

13. Northern Saskatchewan Children’s Dental Program
Daily classroom brushing
Weekly fluoride rinse program
Pre-brushing at every appointment
Individual OHI
Sealants
Topical fluoride
Open house dental clinic on parent –teacher night for education of caregivers
High needs areas a treatment component in addition to prevention

14. Canada Today Federal, Provincial,Territories,
282 employed dental therapists
Federal, Provincial,Territories,
First Nations, NSDT, private practice

15. Saskatchewan Today 181 practicing dental therapists
105 in private practice
Remainder work for First Nations, Federal & Provincial governments, teaching
National School of Dental Therapy is located in Prince Albert
First Nations University of Canada, affiliated with the U. of Saskatchewan Dental school
1996 Sask College of Dental Surgeons petitioned the govt to allow DT’s in private practice.
Dental therapists can now work on adults in private practice – up to the employing dentist.
Dentist does not have to be physically present anymore – available by phone for consultation.
Dentists can hire dental therapists to work on reservations under their name – general supervision.

16. Cost Effectiveness of Dental Therapists
Having a dental therapist living in an isolated community reduced the number of medical evacuations for dental pain
Transportation costs dropped dramatically
Dental therapists can successfully deal with most dental emergencies
Dental therapists assure that the dentists’ visits are more productive by triaging patients and taking any needed radiographs and arranging for needed medications before the dentist arrives

17. Quality of Dental Therapists
Because dental therapists are limited to performing only certain clinical procedures, they focus on performing these procedures many , many times during training and become very skilled at these procedures
1976 and 1989 studies showed that restorations placed by Canadian dental therapists were of equal or better quality to those placed by dentists
15-20 Pulpotomies and SSC’s, amalgams and resins, permanent and primary extractions

18. Continuity of Care
People want to receive services from the same provider each time they seek care
Dental therapists live in the community and become part of community life
They are trusted by the local people
Role models for others
People prefer to receive culturally appropriate care
Parents didn’t care if their child was treated by a DT or a dentist – their main concern was that they

19. Quality Assurance
Each dental therapist undergoes a yearly clinical evaluation by the supervising dentist
Review includes the quality of radiographs, pulpotomies, restorations, charting , consent forms, medical histories, productivity and includes interviews with parents, schools, health center staff

20. Safety of Dental Therapists
Since 1974 there have been no reports of serious injury to a patient who received dental treatment by a dental therapist in Canada
No malpractice claims filed against DT’s
Canadian dental therapy programs have been proven to provide safe, quality dental care