FTC Staff Comment Before the Commission on Dental Accreditation Concerning Proposed Accreditation Standards for Dental Therapy Education Programs

Office of Policy Planning
Bureau of Competition
Bureau of Economics
November 21, 2014
Sherin Tooks, Ed.D., M.S.
Director, Commission on Dental Accreditation
211 East Chicago Avenue, 19th Floor
Chicago, IL 60611
Dear Dr. Tooks:
The staffs of the Federal Trade Commission Office of Policy Planning, Bureau of
Economics, and Bureau of Competition (collectively, “FTC staff”)1 appreciate the opportunity to
respond to a request for public comments on the Commission on Dental Accreditation’s
(“CODA”) proposed ACCREDITATION S TANDARDS FOR DENTAL THERAPY EDUCATION
P ROGRAMS.2 The current version of the draft standards includes modifications based on
comments from communities of interest, including FTC staff, submitted in response to the
version circulated by CODA in 2013.3
As the December 2013 FTC Staff Comment explained, FTC staff support CODA’s
efforts to facilitate the creation of new dental therapy education programs and to expand the
supply of dental therapists because these initiatives are likely to increase the output of basic
dental services, enhance competition, reduce costs, and expand access to dental care. The FTC
Staff Comment commended CODA’s proposed accreditation standards as an important first step
in encouraging the development of a nationwide dental therapy profession, but also
recommended several revisions to address portions of the standards that could have been
interpreted to impede competition.4 With many of those concerns now addressed, we write to
urge CODA to finalize and adopt proposed standards without unnecessary delay, so that the
development of this emerging service model can proceed, and consumers may reap the likely
benefits of increased competition.
As the FTC Staff Comment explained, categorical statements regarding a supervising
dentist’s responsibility for diagnosis and treatment planning could limit the competitive benefits
of an expansion of the supply of providers of basic dental services. In particular, these statements
might discourage state-level legislation allowing dental therapists to conduct evaluations and
formulate treatment plans in the absence of an on-site dentist, and also might hinder the
development of education programs that would train dental therapists to perform those
functions.5 The 2014 ACCREDITATION S TANDARDS appear to have addressed this issue by
deleting statements about supervision of dental therapists by dentists and a dentist’s
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responsibility for diagnosis and treatment planning,6 and by acknowledging that a “dental
therapist provides care with supervision at a level specified by the state dental practice act.”7
The FTC Staff Comment also recommended that CODA consider developing
accreditation standards for master’s or graduate level programs that train dental therapists to
conduct oral evaluations and develop treatment plans with supervision consistent with state
requirements.8 The proposed 2014 ACCREDITATION S TANDARDS have the potential to support
such graduate programs because they no longer specify that “graduates [will be] awarded a
baccalaureate degree,”9 and because they require that an “educational program curriculum must
include content at the level, depth, and scope required by the state[’s]” dental board.10 In
addition, by encouraging institutions to provide advanced standing and career laddering for
students licensed in other dental professions such as dental hygiene or dental assisting,11 the
proposed standards could enhance competition by increasing the number of dental therapists
entering the field.
By moving forward expeditiously to adopt its proposed ACCREDITATION S TANDARDS,
CODA would be taking an important step to address the growing interest in training and
licensing dental therapists to meet dental care needs. In addition to Minnesota’s legislation
creating a licensure scheme for dental therapists and advanced dental therapists, Maine recently
authorized the licensing of dental hygiene therapists.12 Like Minnesota’s legislation, Maine’s
legislation anticipates that licensure of dental hygiene therapists will be based on an applicant’s
completion of a CODA-accredited program, but provides for approval of education programs by
the state’s Board of Dental Examiners in the interim.13 It is likely that more states will pass
similar legislation; recently introduced bills in Kansas, Massachusetts, New Hampshire, New
Mexico, Vermont, and Washington would provide for licensing dental therapists.14
The timely adoption of accreditation standards by CODA has the potential to enhance
competition by supporting state legislation for the licensure of dental therapists, and also to
encourage the development of dental therapy education programs consistent with a nationwide
standard, which would facilitate the mobility of dental therapists from state to state to meet
consumer demand for dental services. Conversely, any further delay in the adoption of
accreditation standards could discourage and delay the development of education programs,
reduce the availability of these new professionals, and hinder their ability to practice in different
states. For these reasons, FTC staff urges CODA to move forward expeditiously to finalize and
adopt ACCREDITATION S TANDARDS for dental therapy education programs.
We appreciate your consideration of these issues.
Respectfully submitted,
Andrew I. Gavil, Director
Office of Policy Planning

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Francine Lafontaine, Director
Bureau of Economics
Deborah Feinstein, Director
Bureau of Competition
1 This letter expresses the views of the Federal Trade Commission’s Office of Policy Planning, Bureau of
Economics, and Bureau of Competition. The letter does not necessarily represent the views of the Federal Trade
Commission (“Commission” or “FTC”) or of any individual Commissioner. The Commission has, however, voted
to authorize us to submit these comments.
2 COMM ’N ON DENT AL A CCREDITATION (“CODA”), A CCREDIT ATION STANDARDS FOR DENT AL T HERAPY
EDUCAT ION PROGRAMS (2014) (showing revisions from 2013 version in red),
http://www.ada.org/~/media/CODA/apx7_proposed_dentaltherapy.ashx [hereinafter A CCREDIT ATION ST ANDARDS].
3 See Comment from FTC Staff to the Comm’n on Dental Accreditation (Dec. 2, 2013),
http://www.ftc.gov/policy/policy-actions/advocacy-filings/2013/12/ftc-staff-comment-commission-dental-
accreditation [hereinafter FTC Staff Comment].
4 See id. at 1-2.
5 See FTC Staff Comment at 2, 7, 9.
6 See A CCREDIT ATION STANDARDS at 12, 14, 15, 25, 30.
7 See A CCREDIT ATION STANDARDS at 30.
8 See FTC Staff Comment at 2, 7, 9.
9 A CCREDIT ATION STANDARDS at ¶ 2-1.
10 A CCREDIT ATION STANDARDS at ¶ 2-21 (emphasis in original).
11 See A CCREDIT ATION STANDARDS at 15-16, ¶ 2-9.
12 See M INN . ST AT . §§ 150A.105, 150A.106 (2013). See also An Act to Improve Access to Oral Health Care, ch.
575, 2013 Me. Laws 1485 (to be codified at M E . REV. ST AT . A NN . T IT . 32, §§ 1094-AA to 1094-KK).
13 See M INN . ST AT . § 150A.06, subdiv. 1d (2013) (requiring graduation from “a dental therapy education program
that has been approved by the board or accredited by the American Dental Association Commission on Dental
Accreditation or another board-approved national accreditation organization”). See also An Act to Improve Access
to Oral Health Care § 1094-AA(2)(A) (licensure requires successful completion of a dental hygiene therapy
education program that “[i]s accredited by the American Dental Association Commission on Dental Accreditation”)
and § 1094-KK (“Notwithstanding Title 32, section 1094-AA, subsection 2, paragraph A, until a dental hygiene
therapy education program has been accredited by the American Dental Association Commission on Dental
Accreditation or a successor organization, the Board of Dental Examiners may approve the dental hygiene therapy
education program.”).
14 See FTC Staff Comment at note 35 and accompanying text. The status of these bills varies. See American Dental
Hygienists’ Association, Legislation by Type, Workforce, at http://www.adha.org/legislation-by-type (last visited
Nov. 3, 2014).