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LETTER |
Myron Allukian Jr is an oral health consultant in Boston, Mass. Michael E. Bird is a public health consultant in Albuquerque, New Mexico. Caswell Evans Jr is with the Prevention and Public Health Sciences, University of Illinois at Chicago, College of Dentistry, Chicago.
Correspondence: Requests for reprints should be sent to Myron Allukian Jr, 100 Boylston St, Suite 806, Boston, MA 02116 (e-mail: myalluk{at}aol.com).
As past presidents of the American Public Health Association, we were quite surprised to read the commentary coauthored by Dr. Sekiguchi,1 a past president of the American Dental Association (ADA), and ADA staff in the May 2005 American Journal of Public Health opposing the use of dental therapists in rural Alaska.1 This commentary, which was published without an Op-Ed piece, would be comparable to the Journal publishing a commentary from only the American Medical Association in the 1960s stating that there is no need for pilot programs for nurse practitioners, physician assistants, or nurse-midwives, even in high-need areas, and that only physicians should provide health care. I am sure our readers would be quite upset.
New Zealand has successfully trained dental therapists for more than 80 years, and many other countries also use them.2 The Alaskan dental therapists are receiving state-of-the-art training, and they are being monitored and evaluated from A to Z.3 Although the ADA has a good track record of supporting preventive measures, such as community water fluoridation and most public health programs, they have a long record of preventing anyone except dentists from providing treatment, even to the underserved.
This commentary includes some useful information and correctly documents the array of ongoing efforts of the Indian Health Service and the Tribes to respond to the dental access crisis of Alaskan Natives. However, the authors’ opposition to a pilot program for 6 to 12 dental health therapists without any evidence, data, or studies marginalizes the credibility of the authors and the ADA.
Beginning in 1966, the American Public Health Association Governing Council has supported the use of expanded duties at least 3 times.4 This commentary by itself would not normally create much concern; however, because organized dentistry is lobbying state and federal decisionmakers to stop this pilot program, including a full-page ad to the governor in the Juneau Empire newspaper,5 we can not help but think that there was a hidden political agenda for their publication.
In these times of dwindling resources, complex access issues, and evidence-based medicine, dentistry, and public health, now is not the time to block innovative programs trying to serve the underserved. Let the Alaskan Natives, a sovereign nation, decide for themselves who can best meet their long-standing, unmet dental needs.
References
1. Sekiguchi E, Guay AH, Brown LJ, Spangler TJ Jr. Improving the oral health of Alaska natives. Am J Public Health. 2005;95:769–773.
2. Facts and figures. Available at: http://www.fdiworldental.org/resources. Accessed May 20, 2005.
3. Alaska dental health aide. Available at: http://www.phs-dental.org/depac/newfile50.html. Accessed July 1, 2005.
4. APHA Governing Council Resolutions: 6604: A National Dental Health Program for Children; 7214: Increased Utilization of Dental Auxiliaries; 8121: Employment of Expanded Function Dental Auxiliaries in Public Dental Care Programs. Washington, DC: American Public Health Association; 1988.
5. Alaska Dental Society, Inc. Governor Murkowski 2nd class care for Alaska Natives deserves a ferocious reaction! Juneau Empire. May 26, 2005: C7.
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