Entry/Reentry, Allied, and Alternative Careers: An IWLC Working Group Report

Pamela Zarkowski, M.P.H., J.D.; Christine Wallace, B.D.S., M.D.Sc.

Prof. Zarkowski and Dr. Wallace were co-chairs of the Entry/Reentry, Allied, and Alternative Careers Working Group at the Fourth ADEA International Womens Leadership Conference. (Other participants in the working group were Sandra C. Andrieu, United States; Sondra Gunn, United States; Susan Kass, United States; Rachel Tham, Australia; and Robyn Watson, Australia.) Prof. Zarkowski is Academic Vice President and Provost, University of Detroit Mercy; and Dr. Wallace is Head of the Department of Oral Restorative Sciences, Westmead Centre for Oral Health (WCOH) and Clinical Coordinator of the D.Cin.Dent. Prosthodontics program, University of Sydney. Direct correspondence to Prof. Pamela Zarkowski, University of Detroit Mercy, 4001 W. McNichols Rd., Detroit, MI 48221-3038; 313-993-1585; pamela.zarkowski@udmercy.edu.

he goal of addressing oral health disparities and access to care is an international concern. Improved utilization of current workforce personnel and/or the creation of an oral health professional who would assist in meeting a variety of unmet dental needs have been suggested. The role of allied dental professionals in addressing unmet needs was the primary focus of this working group discussion. The group began its discussion with a short review of the key goals and objectives of the Global Goals for Oral Health 20201 developed through a collaborative effort of the FDI World Dental Federation, International Association for Dental Research, and World Health Organization. Two primary goals are as follows: 1) minimize the impact of diseases of oral and craniofacial origin on health and psychosocial development, giving emphasis to promoting oral health and reducing oral disease amongst populations with the greatest burden of such conditions and diseases; and 2) minimize the impact of oral and craniofacial manifestations of systemic diseases on individuals and society and use these manifestations for early diagnosis, prevention, and effective management of systemic diseases. Global Goals for Oral Health 2020 outlined specific objectives to meet these goals: To reduce mortality from oral and craniofacial diseases. To reduce morbidity from oral and craniofacial diseases and thereby increase the quality of life. To promote sustainable, priority-driven policies and programs in oral health systems that have been derived from systematic reviews of best practices (i.e., the policies are evidence-based). To develop accessible cost-effective oral health systems for the prevention and control of oral and craniofacial diseases. To integrate oral health promotion and care with other sectors that influence health, using common risk factor approach.
March 2011

To develop oral health programs that will empower people to control determinants of health. To strengthen systems and methods for oral health surveillance, both processes and outcomes. To promote social responsibility and ethical practices of caregivers. To reduce disparities in oral health between different socioeconomic groups within a country and inequalities in oral health across countries. To increase the number of health care providers who are trained in accurate epidemiology surveillance of oral diseases and disorders. Targeted oral health diseases and conditions that are the focus of the goals and objectives appear in Table 1. Assessments of the types of practitioners educated to provide care historically and in the present were briefly discussed. These providers include dental therapists, school dental nurses, expanded duty dental assistants, mid-level practitioners, dental health aides, and advanced dental hygiene practitioners.2 Although countries and regions have taken steps to address unmet needs, the educational programs, scope of practice, supervision requirements, and mobility vary. In most cases, the creation of an allied professional was initiated to address unmet needs influenced by an increased workforce need,
Table 1. Targeted oral health diseases and conditions in the Global Goals for Oral Health 2020
Pain Functional disorders Infectious diseases Oropharyngeal cancer Oral manifestation of HIV infection Trauma Craniofacial anomalies Dental caries Developmental anomalies of the teeth Periodontal diseases Oral mucosal diseases Salivary gland disorders Tooth loss Health care services Health care information systems

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geographical need, or a politically or professionally identified need. Yet, as highlighted by Parkash et al.,3 populations still experience significant unmet needs, inequality in delivery systems, and absence of community-oriented prevention systems. In addition, populations in developing countries are burdened by significant oral diseases aggravated by poverty, poor living conditions, lack of dental awareness, and the absence of appropriate policies and funding to provide basic oral care. Thus, the working group initiated its discussion with the following assumptions: Addressing oral health needs is situational and is influenced by the epidemiology of oral diseases and the political, socioeconomic, cultural, and legislative environment. Allied dental professionals can play a key role in meeting the needs described in Global Goals for Oral Health 2020. Utilizing best practices from current models may assist in creating an allied dental professional category that could play a critical role in a multidisciplinary approach to oral health care. The group, with representatives from the United States and Australia, used the following statements as discussion points: The role of an allied dental professional in oral and health delivery, past, present, and future. The potential roles of an allied dental professional, e.g., intervention, treatment (preventive, restorative, palliative), and education. Collaborative efforts with health professions colleagues, e.g., models from other professional groups including medicine. Educational approaches to training and education of the allied dental professional, e.g., global partnerships and distance education. Recruitment and retention of allied dental professionals. The working group participants shared experiences within their own countries regarding training, licensure, mobility, compensation, and patient and professional acceptance. The group also reviewed the history of dental nurses and dental therapists in Australia and New Zealand and current mid-level and advanced dental hygiene practitioner models in the United States. Participants also provided an update concerning the oral health therapist model currently in place in Australia. The scope of practice of the midlevel practitioners in the United States and Australia were compared and contrasted. The creation and the development process, as well as challenges faced, were included in the discussion.
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Best practices were highlighted, including the education and training programs under way in the U.S. state of Minnesota. One participant noted that the International Federation of Dental Hygiene is developing a global curriculum for dental hygiene. A discussion of the oral health therapist in Australia provided key information. The initial focus was for nursing home and rural placement of the provider. Due to changes in curriculum, the current model offers a bachelor of oral health degree. The curriculum includes therapy, hygiene, and oral health promotion. The challenges include registration issues and lack of mobility for the provider. Limited outcomes assessment data are available, although there are plans to conduct outcomes studies in the future. The working group ended its discussion by creating a list of recommendations for consideration. Their primary focus is to develop an internationally accepted oral health therapist. These recommendations are as follows: Conduct an evaluation of best practices for education and training that include: Defined standards An evidence-based, interdisciplinary curriculum that includes therapy, (restorative) hygiene, and oral health promotion, as well as education in geriatrics, special needs, and disabilities Gather input from key stakeholders and experts (dentists, dental hygienists, dental therapists, educators, public health, medicine, etc.). Utilize resources and technology to engage individuals familiar with models outside the United States. Seek to create an internationally accepted registration/licensure to allow providers to practice in communities of need. Have the American Dental Education Association serve as the convener of key representatives/groups to discuss a standardized global curriculum for an oral health therapist.

REFERENCES
1. Hobdell M, Petersen PE, Clarkson J, Johnson N. Global goals for oral health 2020. Int Dent J 2003;53(5):2858. 2. Nash DA, Friedman JW, Kardos TB, Kardos RL, Schwarz E, Satur J, et al. Dental therapists: a global perspective. Int Dent J 2008;58(2):6170. 3. Parkash H, Mathur VP, Duggal R, Jhuraney B. Dental workforce issues: a global concern. J Dent Educ 2006;70 (11 Suppl):226. Suggestion for Further Reading Donaldson ME, Gadbury-Amyot CC, Khajotia SS, Nattestad A, Norton NS, Zubiaurre LA, Turner SP. Dental education in a flat world: advocating for increased global collaboration and standardization. J Dent Educ 2008;72(4):40821.

Journal of Dental Education Volume 75, Number 3 Supplement