How much training do you need to pull a tooth?

Nov 11, 2011

In the old days, you might have tied a string to the door, and pulled a tooth with a slam (see the YouTube video below). But these days, most of us prefer a sterile environment and some anesthetic, not to mention a professional guiding hand.

How much training and supervision you need to pull teeth (and offer dental advice) are the central questions in a dispute between dentists and advocates for poor children. 

With dentists being either too expensive or hard to access for many in Washington, the state Children's Alliance, an advocacy group, is pushing for a new type of dental provider, which they're calling a "dental therapist." These providers would be mid-way between a dentist and a hygienist, in terms of their training.

"Absolutely, they would get less training than a dentist," says Jon Gould, assistant director of the Children's Alliance. "But a physician assistant has less training than a doctor, and physician assistants and nurse practitioners are now a common part of family practice."

With more providers around, the idea is everyone would get better access.

A proposal to allow dental therapists in Washington died in last year’s legislature, but the Children’s Alliance is preparing to try again, with backing from the wealthy Kellogg Foundation, which is pushing this in several states. 

Training and supervision are two big issues. One proposal would make it similar to a community college degree. But in Minnesota, the only state aside from Alaskan tribes to allow the therapists, they need a bachelors degree, and some get a masters. And that relates to how much the dental therapist would be allowed to do without a dentist on hand to supervise.

Dentists have lobbied hard for less freedom and more training for any new dental profession. Rod Wentworth, a dentist in Bellevue and president of the Washington State Dental Association, says simply pulling a tooth can get messy:

"Things may look simple on paper or on an x-ray, but you get in there, from time to time, and you find you cant get that piece of tooth out. You may get a tooth part way out, you're stuck the rest of the way. What do you do with the patient?"

The dentists' group fought last year's legislation on dental therapists. And dentists across the country have lobbied for something much less substantial, which they call "dental health coordinators."

This dad and his little boy on YouTube are trying their own method of tooth removal (remember it's a baby tooth):