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Allan J. Formicola, DDS

Correspondence: Requests for reprints should be sent to Allan J. Formicola, DDS, Columbia University School of Dental and Oral Surgery, 630 West 168th St, Box 100, New York 10032 (e-mail: ajf3{at}columbia.edu).

Friedman asserts that in our editorial on strengthening the oral health safety net we "state the usual pious platitudes—the ‘shoulds’ and the ‘oughts’ " regarding care to the under-served. However, what we actually did was describe innovative programs to bring care to the population in need. Friedman argues that we should use our energy elsewhere, that is, to support the use of allied dental health workers such as the nurses New Zealand uses to bring care to those in need.

Debates about the role of the dentist versus the role of allied dental health workers go back to the 1920s. The dean of Columbia University’s dental school at that time, Alfred Owre, conceptualized the role of the dentist as that of a diagnostician supported by "dental mechanics" who would be trained to undertake the technical dental procedures.¹ But that is not how the profession developed, and although in the 1970s successful programs showed that allied dental health workers (expanded-function dental auxiliaries) could successfully be trained to perform several dental procedures, the concept has not taken hold in this country. A few states permit the independent practice of dental hygienists or pros-thetists, and many states make provisions for dental hygienists or dental assistants to be delegated greater responsibilities for treatment than previously permitted. From time to time there is discussion about not training greater numbers of dentists, but instead expanding the training and responsibilities of allied dental health workers.

These are important health policy, financing, and oral health systems issues. But they are clearly not what we were describing in the editorial to which Friedman objects. We were describing how resources could be used to bring dental care to underserved populations under current laws governing the practice of dentistry. The 3 models we described—in Manhattan, New Mexico, and North Carolina—efficiently use dentists and allied dental health workers, such as dental hygienists and dental assistants, to the extent permitted under current state laws. In the meantime, while debate continues on how to reorganize the current system of dental care, there are millions of underserved children and adults without access to dental care. The Community Voices models we described bring necessary dental services to those with critical oral health care needs.

Reference

1. Wilson N. Alfred Owre: Dentistry’s Militant Educator. Minneapolis: University of Minnesota Press; 1937.

This Article Extract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Formicola, A. J. Search for Related Content PubMed Articles by Formicola, A. J. Related Collections Dental/Oral Health Access to Care School Health