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LETTER |
The authors are with the American Dental Association, Chicago, Ill.
Correspondence: Requests for reprints should be sent to Albert H. Guay, DMD, American Dental Association, 211 East Chicago Ave., Chicago, IL 60611-2678 (e-mail guaya{at}ada.org).
We appreciate the opportunity to respond to the criticisms of our article, "Improving the Oral Health of Alaska Natives,"1 by some members of the dental public health community. The American Dental Association (ADA) is fully supportive of the Dental Health Aide Program in Alaska, except for allowing non-dentists to perform irreversible surgical treatments.
The ADA considers protecting the oral health and safety of the public as its obligation; allowing nondentists to provide irreversible surgical procedures jeopardizes both, particularly Alaska Natives, because of the extent and the severity of oral diseases they suffer. A dentist’s education involves considerably more than manual training, and that knowledge is critical for safely managing untoward events that can occur. Dental Health Aide Therapists (DHATs) operating in remote villages will not have the ready emergency support they need, unlike dental nurses working in New Zealand metropolitan schools. Alaska Natives are a most unlikely group as subjects in a high-risk experimental project of this nature.
It is misleading to state that "there are some 42 countries with some variant of a dental therapist. . . ." Evaluation of the use of auxiliaries is difficult in some areas, because "dental nurse" and "dental therapist" do not have universally agreed upon definitions. Some would be classified as "dental assistants" in other countries. This we do know, however; today, almost 85 years after the introduction of this auxiliary, there is only 1 training program for "oral therapists" in the western hemisphere! This concept has been rejected in most countries.
The ADA supports appropriate expansion of duties for dental team members. One letter states, "[The ADA has] a long record of preventing anyone except dentists from providing treatment, even to the underserved." Were the words "unsupervised, irreversible surgical treatment" to be used, it would be an accurate statement and one of which the ADA would be proud. The "underserved" is not a subgroup of society for which treatment by lesser trained persons is all right and better than nothing, but rather a group that needs to be brought into the mainstream of dental care. It is interesting to note that two thirds of the signers of the letter from current and past leadership of the American Public Health Association Oral Health Section supporting DHATs are not dentists.
James B. Bramson and Albert H. Guay present a more complete discussion of DHATs as Comments2 on David A Nash’s article on the pediatric oral health therapist in the Summer edition of the Journal of Public Health Dentistry.3
References
1. Sekiguchi E, Guay A, Brown LJ, Spangler T. Improving the Oral Health of Alaska Natives. Am J Public Health. 95:5, 769–773.
2. Bramson J, Guay A. Comments on the Proposed Pediatric Oral Health Therapist. J Public Health Dent. 65:3,123–127.
3. Nash D. Developing and Deploying a New Member of the Dental Team: A Pediatric Oral Health Therapist. J Public Health Dent. 65:1, 48–55.
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