Dentistry’s Missing Middle

A new dental therapy program aims to address a gap in need.

Across much of Washington, getting a toothache is a pain that goes well beyond a throbbing jaw — even for those who can afford treatment. Thanks to a shortage of rural practitioners, dental patients can wait weeks for an appointment, face long drives to a clinic and, too often, experience care deferred to the point of crisis.

According to a 2023 report by the Washington Department of Health, 38 of 39 counties are federally designated as complete or partial Dental Health Professional Shortage Areas. Our situation is hardly unique. Millions of Americans lack reliable access to even basic dental services. The pipeline of dentists has simply not kept pace with the nation’s needs.

Into the gap steps an old idea that’s gaining new momentum: the “dental therapist,” a mid-level provider operating under the supervision of a dentist who is trained to do more than a typical hygienist. Dental therapists examine patients, administer anesthetics, fill cavities, place temporary crowns and, in some cases, pull teeth. The model is common in dozens of countries and has been used in parts of the United States, particularly in tribal communities, for more than a decade.

Unfortunately, academic training for dental therapists is rare. Only three programs in the country hold accreditation from the Commission on Dental Accreditation, and just one offers a master’s degree. Eastern intends to become the next. Backed by a $10.5 million commitment from the Legislature and a $1 million grant from Delta Dental, EWU is developing a master’s-level dental therapy program in the College of Health Science and Public Health. Dawn Lewis-Kinnunen, the college’s dean, says accreditation work is underway, with a target of enrolling the first cohort of students in fall 2028. “Rural communities don’t have adequate access to oral care in Washington state,” Lewis-Kinnunen says. “Our goal is to improve availability by educating a new tier of providers.”

Development of the dental therapy master’s program is occurring as EWU enters the beginning stages of its plan to create a health sciences hub in Spokane’s University District. The new program will be located in the SIERR Building, adjacent to EWU’s Dental Hygiene program and the university-run clinic that provides oral health services to underserved members of the Spokane community.

The dental programs also will be in close proximity to the School of Nursing, which is also housed in SIERR. The Regional Initiatives in Dental Education (RIDE) program, meanwhile, a partnership between EWU and the University of Washington School of Dentistry, will stay in the 840 Building located next door.

“This is the ideal plan for the interprofessional work we want to foster,” says Lewis-Kinnunen. “It’s going to be pretty, and productive.”