Filling rural oral health care gaps with dental therapists

In northwest Oregon, rural residents travel dozens of miles to a dental office in Salem to seek care – often for routine procedures like cleanings or fillings, but sometimes for tooth pain that has become so severe that it keeps them up at night. Like many states across the country, Oregon is experiencing a critical shortage of dentists, with 35 of its 36 counties designated as dental health professional shortage areas. These disparities are particularly pronounced in rural areas, where residents might have to drive an hour or more to receive basic oral health care services.

The situation in Oregon is not unique. According to a 2024 report by the CareQuest Institute for Oral Health, 67 percent of rural areas in the United States are considered dental health professional shortage areas, and 34 percent of individuals living in a rural environment rate their oral health as fair or poor, compared with 27 percent of urban residents and 24 percent of suburban residents. These troubling statistics have led several states to consider utilizing dental therapists to expand oral health care to rural and underserved areas.

Practicing in more than 50 countries around the world, dental therapists are licensed providers who are supervised by a dentist to provide routine dental care, including exams and fillings. The National Partnership for Dental Therapy asserts thatRaelene Cabrerathey are an important and growing part of a dentist-led team that includes dental hygienists and dental assistants, often collaborating with the rest of the team via telehealth.

Practicing out of her office in Salem, dental therapist Raelene Cabrera cares for many patients who would not otherwise have access to oral health care. She says the ability to reach individuals who are often unable to travel long distances is part of what makes dental therapy unique.

“I always think of a dental therapist as an extension of a dentist,” Cabrera says. “We go into communities and work in collaboration with the dentist to diagnose, make a treatment plan, and provide routine services to patients. It expands the workforce and the number of providers who can go out into rural communities when there’s already a lack of dentists available.”

After working as a dental assistant for 10 years, Cabrera decided to further her education and pursue dental therapy, which she calls “the perfect marriage between dentistry and public health.” She wanted to help patients overcome the challenges they faced in accessing care, which she says commonly include a lack of locally available care and an inability to travel.

“I always say that dental therapy found me,” she says. “I saw struggles patients would encounter, whether it was through insurance, lack of access to care, or finding providers they could trust. It is rewarding to actually address a patient’s needs, especially if they’re in pain or chronic pain. I am not the only solution to the problem, but I’m helping find a solution to the problem.”

After receiving her dental therapy training and completing her rotations in Minnesota, Cabrera returned home to Salem to practice in her hometown. This is another part of what makes dental therapists unique – similar to community health workers, they are often from the communities they serve, allowing them to establish trust among their patients.

“A lot of dental therapists come from rural and tribal communities, so they’re able to build a relationship with vulnerable populations,” Cabrera says. “On top of that, with dental therapy you don’t need to have a dentist present. Providers can travel Raelene Cabrerainto communities. That’s how dental therapy is very different from any other provider on the dental team.”

Currently 14 states allow the authorization of dental therapists – Alaska, Arizona, Colorado, Connecticut, Idaho, Maine, Michigan, Minnesota, Nevada, New Mexico, Oregon, Vermont, Washington, and Wisconsin – while other states have introduced legislation that would allow dental therapists to practice. Cabrera notes that more dental therapists are still needed in these places, but authorization is an important first step in expanding care and preventing costly emergency room utilization.

“There are patients who want to get routine preventive services, but the system is overwhelmed so they have trouble getting their issues addressed,” she says. “There are also populations who only come to the dentist if they have tooth pain, but access is still an issue – they have to wait multiple weeks for an appointment. This puts more strain on the health care system, because you have more patients going to the ER for dental pain when it could have been prevented.”

While some stakeholders have expressed concerns over dental therapy regarding reimbursement and patient safety, studies from around the world have found similar quality of care between dental therapists and dentists. According to the National Institutes of Health, “research also shows increased access to dental care, declining rates of dental disease, and decreased costs associated with dental care after the introduction of dental therapists.”

NIH goes on to explain that dental therapy complements regular dentistry by allowing underserved patients to access safe, high-quality care, such as low-income families, tribal communities and communities of color, rural areas, kids, seniors, and people with disabilities. For Cabrera, allowing dental therapists to practice in more states and expanding the dental therapy workforce can only benefit patients and providers.

“Dental therapy is a proven model for being able to address an overwhelmed system,” Cabrera says. “The research supports it, and other countries have implemented it and had a lot of success with it.

A greater prevalence of dental therapists will contribute to the dental workforce and impact the most vulnerable patients in a positive way.”

Sources

CareQuest report: https://www.carequest.org/about/press-release/new-report-rural-populations-have-worse-oral-health-care-access-utilization-and

NIH: https://pmc.ncbi.nlm.nih.gov/articles/PMC5415248/

National Partnership for Dental Therapy: https://www.dentaltherapy.org/