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LETTER |
Jay W. Friedman is the author of The Intelligent Consumer’s Complete Guide to Dental Health: How to Maintain Your Dental Health and Avoid Being Overcharged and Overtreated.
Correspondence: Requests for reprints should be sent to Jay W. Friedman, DDS, MPH, 3057 Queensbury Dr, Los Angeles, CA 90064 (e-mail: drjfriedman{at}sbcglobal.net).
In the May 2004 issue of the Journal, Lamster1 and Formicola et al.2 lament the sorry status of oral health and oral health care for major segments of our population, specifically, poor children, the elderly, the institutionalized, and the uninsured. They state the usual pious platitudes—the "shoulds" and the "oughts"—without recognizing the contributing deficiencies in dental education and training that are perpetuated by organized dentistry’s unflagging resistance to fundamental change.
So long as filling a tooth and making a denture are considered doctoral-level activities, dentistry will not escape its persistent regressive character and will not be able to adequately serve the public need. More than 80 years ago, New Zealand began to use school dental nurses, highly trained dental technicians assigned to public elementary schools to provide basic preventive and restorative (filling) treatment. These dental nurses are supported by nurse supervisors and by public health and private dentists as needed. Also in New Zealand, and in other countries, dental prosthetists provide dentures much as orthopedic technicians construct artificial limbs.
Periodic efforts by US state and federal public health agencies to implement programs employing dental nurses, now called dental therapists, have been squashed by the American Dental Association, despite the documented success of such programs in New Zealand, Australia, Canada, and many developing countries.3 The Alaska Native Tribal Health Corsortium is currently initiating a dental therapist program for the Alaskan Eskimo population despite the opposition of the American Dental Association.
The use of such sophisticated technicians in the United States would allow dentists to be trained as complete specialists in stomatology. Instead, dentistry is becoming more and more specialized, to the point of absurdity. Filling the root canal of a tooth (endodontics) and filling children’s teeth (pediatric dentistry) do not require specialized knowledge and techniques, thus qualifying as true specialties, but are merely "limited practices." The result of the existing overspecialization is to restrict the supply of competent general practitioners, to restrict access, and to increase the cost of these services to the point where only the insured and the wealthy can readily afford them.
It is a puzzle and a disgrace that the American Journal of Public Health could devote so much space to oral health care issues in this country without referring to the more obvious deficiencies and their resolution, or to the flagrant fraud and abuse in functionally unnecessary treatment and overcharging that is rampant in dentistry.4
References
1. Lamster IB. Oral health care services for older adults: a looming crisis. Am J Public Health. 2004;94: 699–702.
2. Formicola AJ, Ro M, Marshall S, et al. Strengthening the oral health safety net: delivery models that improve access to oral health care for uninsured and underserved populations. Am J Public Health. 2004;94: 702–704.
3. Nash DA. Developing a pediatric oral health therapist to help address oral health disparities among children. J Dent Educ. 2004;68(1):8–20.[Abstract]
4. Friedman JW, Atchison KA. The standard of care: an ethical responsibility of public health dentistry. J Public Health Dent. 1993;53(3):165–169.[Medline]
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