Kellogg survey finds support for dental therapist concept

More Americans are delaying dental care due to cost, and many are open to the concept of a new type of dental care provider if it would make more services available to those who currently cannot afford them, according to a survey released Tuesday by the W.K. Kellogg Foundation.

According to the survey of 1,023 adults nationwide, 41% of respondents reported that they or someone in their household has put off dental care because of cost, and 30% said they do not have a place to receive dental care. In addition, 79% said that receiving regular dental care is important, but 40% said they do not have dental insurance.

And more than 80% said they believe it is difficult for people to get free or low-cost dental care in their communities and that the number of Americans who cannot access dental care is "a problem."

Survey methodology Conducted by Lake Research Partners, the online survey of 1,023 adults across the U.S. (margin of error: ± 3%) was administered between July 12 and July 18, 2011, by Knowledge Networks, the only online survey vendor that relies primarily on address-based samples, according to Mike Perry, an analyst and partner at Lake Research. Their approach gives 99% of households equal opportunity to be on the panel, Perry noted -- not just those who are already online. For those who need it, Knowledge Networks provides a laptop and Internet access to participate. Lake Research Partners is a public policy and opinion research firm specializing in healthcare issues located in Washington, DC; Berkeley, CA; and New York City.

Those most likely to be putting off care due to cost are those with annual incomes of less than $30,000 (55%), those without dental insurance (54%), and those with a high school diploma or less (47%). In addition, Latinos (47%) are more likely than African Americans (36%) and whites (42%) to have put off dental care in the last 12 months due to costs. Women are also more likely than men (47% versus 35%) to have put off dental care because of cost.

"This survey clearly shows that people throughout the country are struggling to get dental care," said Sterling Speirn, president and CEO of the W.K. Kellogg Foundation.

One of the most surprising findings, according to Mike Perry, an analyst and partner at Lake Research Partners, the company that conducted the survey, came in response to this question:

Many efforts are going on to improve affordable access to dental care in our country. One effort is training license dental practitioners to provide preventive, routine dental care to people who are going without care. Would you support or oppose this effort to train licensed dental practitioners?"

More than three-quarters (78%) of survey respondents said they would support the training of licensed dental practitioners to make preventive, routine dental care more accessible, according to the survey.

"We did not provide them with a definition of dental therapists," Perry said. "You introduce the idea of a midlevel dental professional who is out in the community providing routine and preventive dental care and they say, 'Oh, OK, like a physician's assistant.' This research suggests that the general public is open to someone other than a dentist providing routine and preventive care."

Prior to conducting the survey, he added, Lake Research conducted several related focus groups that yielded similar responses.

"That's when I was surprised to find that there is a gap [in oral health services] that people seem to be aware of, and that people could envision that there are so many people who cannot afford dental care," Perry said. "A lot of the discussion was very emotional. This is a time of change in healthcare, and oral healthcare should be part of the public discussion."

The high cost of dental services, a shortage of dentists in communities across the country, and a lack of dental insurance coverage are among the main barriers to receiving dental care, Kellogg noted in its summary of the report.

"This survey shows that the American public is aware of the gap in dental care," Kellogg concluded. "Furthermore, the survey shows that they are concerned about it."

In response to the survey, the ADA issued this statement, attributed to ADA President Raymond Gist, DDS:

Kellogg's reported findings on people's need for better access to care are consistent with what the ADA, federal and state governments, and numerous other stakeholders have said for years, and it is good to have that message reinforced. Breaking down the barriers that impede people’s ability to attain good oral health is our highest priority. ... Unfortunately, there is no single or simple solution. Barriers to oral health vary from region to region, state to state, city to city, neighborhood to neighborhood. The nation will never drill, fill, and extract its way out of what Surgeon General David Satcher, MD, famously called a “silent epidemic” of oral disease. Oral health education and prevention are the two most important measures that can end that epidemic. Regular care by dentists and their teams will prevent disease from recurring. The ADA believes that everyone deserves a dentist.

The Kellogg Foundation's narrow focus on a single idea -- so called "dental therapists" -- and its claim that a vast majority of Americans favor creating dental therapists lacks credibility. Kellogg's survey question regarding dental therapists implied that care by therapists would somehow cost less than care by dentists. We know of no data to support this. If such data exists, Kellogg should release it.

Kellogg also declined to describe therapists' level of training, whether they would work with a dentist nearby in case something goes wrong, or what types of surgical procedures they would perform, the ADA noted. "Absent that information, the survey respondents could not provide informed opinions," Dr. Gist stated.

“We recognize that calling for large increases in government support for anything during a major economic downturn is simply unrealistic," Dr. Gist continued. "But it is totally appropriate to call on state and federal governments to at least maintain their existing commitments to providing oral healthcare for the millions of Americans -- including one-quarter of the nation's children -- who are most in need."