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Vulnerable Populations, notes that “[a]n improved and responsive dental education system is needed to ensure that current and future generations of dental professionals can deliver quality care to diverse populations in a variety of settings, using a variety of service-delivery mechanisms, and across the life cycle.”34 The traditional dental team includes dental assistants, dental hygienists, and dentists. Another option to expand the workforce is to introduce a new type of dental provider, called midlevel dental providers, allied dental providers, or dental therapists, to the team. These providers are sometimes described as the dental equivalent to a nurse practitioner. Right now, these providers are 4 5 Dr. Frank Catalanotto, Professor and Chair, Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, Florida: “Academic dental institutions are an important part of the safety net that provide access to care for underserved and vulnerable patients. Many dental schools have dental students spend time in communitybased sites such as federally qualified community health centers and county health departments where the students can provide dental care to patients served by these institutions.” currently practicing in Minnesota, in more than 50 countries around the world including Great Britain, Australia, Canada, and New Zealand, and in some rural Alaska Native communities.35 Research studies demonstrate that these midlevel providers increase access and provide high quality care within their scope of practice.36 37An analysis by the Pew Center on the States also suggests that most private practice dentists could serve more patients while maintaining or improving their bottom line by hiring an allied dental provider.38 Advocates in about a dozen states including Kansas, New Mexico, Ohio, Vermont, and Washington are working to develop proposals with models to expand their dental workforce. Other options for expanding the workforce are possible too. Some states allow dental hygienists to provide care directly without a dentist on site, allowing dental hygienists to practice in areas with high levels of need and in nontraditional service settings. Health care professionals, such as nurses, pharmacists, and physicians, can also play a role in screening for oral disease and delivering preventive care to improve access. In 2010, 35 states reimbursed primary care medical providers for performing preventive oral health services.39 Integrating Dental Services: FQHCs and SBHCs as Models The oral health care system in America is currently designed around the needs of dentists rather than the needs of those who are underserved. While over 90% of dentists currently work in private dental practices,40 very successful community- and school-based models for the delivery of dental care exist. Dental services have been successfully integrated into Federally Qualified Health Centers (FQHCs), which provide comprehensive health services to everyone in a community regardless of their ability to pay. Low-income people and those without Dr. David Nash, William R. Willard Professor of Dental Education, Professor of Pediatric Dentistry, College of Dentistry, University of Kentucky, Lexington, Kentucky: “Society has granted the profession of dentistry the exclusive right and privilege of caring for the oral health of the nation’s children. Unfortunately, the dental delivery system in place today does not provide adequate access to care for our children. In many instances it is because few dentists will accept Medicaid payments. In other countries of the world, children’s oral health is cared for by dental therapists, primarily in school-based programs. This results in an overwhelming majority of children being able to receive care. Dental therapists as utilized internationally do not create a two-tiered system of care. They have extensive training in caring for children, significantly more than the typical graduate of our nation’s dental schools. International research supports the