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would be the most effective intervention for improving access to oral health care in the United States, the evidence clearly suggests dental therapists are clinically competent to safely perform the limited set of procedures that falls within their scope of practice. Key Words: mid-level provider, quality of care, review, access to care, restorative, auxiliaries. Dental therapists are members of a workforce model that, while not common in the United States, is widely used internationally. Sometimes compared with physician assistants or nurse practitioners, dental therapists perform a limited set of restorative procedures under the supervision of a dentist. A primary goal of this workforce model is to improve access to care by reducing costs and increasing the number of providers. In the United States, dental therapists practice only on Alaskan tribal lands and in Minnesota, though interest is increasing elsewhere. Rarely a week goes by without a reference to dental therapists somewhere in the national press, and their possible widespread introduction into the American workforce is evoking heated debate. The American Dental Association and most state dental associations oppose the concept, citing concern for patient safety and viability in the U.S. market (ADA, 2005, 2011). In contrast, several other groups, such as the American Association of Public Health Dentistry, the Kellogg Foundation, and the Pew Charitable Trusts, maintain that therapists provide safe and affordable care and have expressed interest in adding them to the U.S. dental team. Legislators at the Federal level and in many states have also expressed interest. While there appears to be little concern internationally, a primary area of contention in the United States is the safety of the care provided by therapists. In fact, therapists’ ability to provide safe, quality care has been a topic of reports dating to the early 1950s, though the results of the totality of these studies have never been presented in a single targeted review. A recent Kellogg report, A Review of the Global Literature on Dental Therapists, prepared by Nash et al. (2012), is extensive, touching on topics well beyond technical competence, but the format makes analyzing and comparing studies nearly impossible. Thus, with the goal of providing a valuable resource as this workforce model continues to be explored in the United States, the current review identifies and reviews every English-language study from an industrialized country that assesses the clinical competence of non-dentists performing irreversible restorative procedures. Twenty-three studies have addressed this issue, as either a primary or secondary point of interest. While the large variation in methodology, as well as a lack of details in some, precluded a formal metaanalysis (effect sizes cannot be standardized), a systematic framework was developed to assess these reports. A series of tables lays out, in a concise and comparable fashion, each study’s methods, sample, procedures evaluated, and findings with respect to competence. While a longer review article, including this full, detailed set of tables, can be found in the Appendix to this essay, a summary of key findings is presented here. Downloaded from jdr.sagepub.com at UNIV OF MICHIGAN on May 24, 2013 For personal use only. No other uses without permission. © International & American Associations for Dental Research 2 JDR Clinical Research Supplement Month 2013 The Table lists the 23 studies included in the review. The earliest are predominantly observational reports based on fact-finding missions to New Zealand, where, in 1921, dental therapists were first introduced. The majority of the studies, however, are empirical, and of these, 5 are true experiments. Studies are discussed by type: observational reports first, then the experiments, and then other empirical reports. The earliest findings come from 3 visits to New Zealand in the early 1950s. Two additional fact-finding trips (one of which also included stops in Australia) were conducted in the early 1970s. In each case,