Access to Care
California Dental Association Commissions Study by Dr. Ananda P. Dasanayake on "Are Dental Procedures Performed by Auxiliaries Safe and of Comparable Quality? A Systematic Review"

Dr. Ananda P. Dasanayake

Professor, Epidemiology and Health Promotion; Director, Graduate Program in Clinical Research New York University College of Dentistry

The California Dental Association has commissioned a study by Dr. Ananda P. Dasanayake, professor of epidemiology and health promotion and director of the Graduate Program in Clinical Research, to evaluate the safety, quality, cost benefit, and patient satisfaction of the procedures provided by non-dentist providers. Dr. Dasanayake is the lead author on the study, whose coauthors include Dr. Robert Norman, research associate professor of epidemiology and health promotion, Dr. B. S. Brar, a junior research scientist in epidemiology and health promotion, Dr. V. Ranjan, a graduate student in the Department of Epidemiology and Health Promotion, all of NYUCD, and Dr. S. Matta of Columbia University's faculty of dental medicine. The study has been submitted for publication to the Journal of the California Dental Association.

Citing as the rationale for the study the fact that there has been a noticeable imbalance among the dental treatment needs of the US population and the availability, utilization of oral health services, and the emergence of a new group of non-dentist providers, who do both reversible and irreversible procedures, Dr. Dasanayake and his coauthors did a systematic review of the existing literature on all available models of non-dentist providers, including dental assistants, dental hygienists, expanded function dental assistants and hygienists, New Zealand and Canadian models, and Dental Health Aide Therapists in Alaska, as well as several categories of non-dental providers that have been proposed or are under consideration in the US, including the Advanced Dental Hygiene Practitioner (a model proposed by the American Dental Hygienists' Association—see related article; the Minnesota Dental Therapist model; and the Community Dental Health Coordinator (a model proposed by the American Dental Association—see related article).

The investigators' primary question was: "Are the irreversible procedures performed by any non-dentist provider category safe compared to the same procedures performed by dentists?" They concluded that while available evidence is sufficient to state that the non-dentist providers are capable of providing safe and high-quality reversible procedures while enhancing practice productivity, the evidence in relation to the irreversible procedures-related outcomes is insufficient to draw conclusions.

When published in the Journal of the California Dental Association, the study's findings are virtually certain to add to the debate about the need to expand the dental workforce to meet the oral health needs of the US population. Having completed the study, Dr. Dasanayake is thinking ahead to the need for the "gold standard" in clinical research: Randomized controlled trials, which can allocate various procedures to different types of providers who are allowed to perform such procedures and then measure the key outcomes, such as safety, quality, effectiveness, economic considerations, and patient satisfaction. Such data are not currently available. "The challenge," says Dr. Dasanayake, "is to properly 'mask' the study. The alternative is to use existing practice-based research networks to do follow-up studies to measure the same outcomes in a prospective or a retrospective fashion."