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Ira B. Lamster, DDS, MMSc

Correspondence: Requests for reprints should be sent to Ira B. Lamster, DDS, MMSc, Columbia University School of Dental and Oral Surgery, 630 W 168th St, New York, NY 10032 (e-mail: ibl1{at}columbia.edu).

Friedman writes with emotion about my editorial and another editorial that appeared in the May 2004 issue. His comments are aimed at the need for fundamental change in the dental profession, with a focus on the use of dental nurses/expanded-function dental auxiliaries to address the oral health care needs of populations that have difficulty accessing care.

In my editorial I focused on the oral health care needs of the elderly and suggested a number of potential approaches for addressing the looming crisis of delivery of oral health care services to this population. These include increasing awareness by the medical and dental professions of this crisis, using home health workers in long-term care facilities to assist with oral hygiene measures, and increasing emphasis in the predoctoral dental curriculum on elder care.

As the dean of a dental school, I know firsthand that the nation’s dental schools have made substantial efforts to provide services to those who have the greatest difficulty accessing care. At the Columbia University School of Dental and Oral Surgery, for example, more than 120 000 patient visits were provided in 2002–2003, and approximately 50% of these visits were by Medicaid recipients. We provide care at on-site and off-site locations including school-based clinics, community health centers, and a mobile dental van. Last year alone, the school provided nearly $9 million dollars of uncompensated care. To specifically address the oral health care problems of the elderly, we developed a service agreement with the largest long-term care facility in Northern Manhattan; in cooperation with the New York Presbyterian Hospital, we are constructing a 4-chair dental clinic specifically for older adults.

Words without actions ring hollow. Freidman focuses on the use of dental nurses, and dental auxiliaries could certainly be used to expand the provision of services. No single solution will solve the problem of access to oral health care, particularly if that solution relies on a radical change in the system of provision of these services in the United States. Such a change would take years to accomplish, or it might never occur.

Further, Friedman closes his letter with unsubstantiated comments about fraud, unnecessary treatment, and overcharging in dentistry. Such claims detract from a meaningful dialogue about how best to address the oral health care needs of patients who are currently without vital services.

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