March 12, 2011
Dentists should take their heads out of the sand and recognize the inevitable. The public will ultimately succeed in obtaining more accessible and less costly dental care, and it will not be too long before they will not be able to distinguish between nondentist providers and the more medically- and surgically-qualified dentists. There is ample evidence from countries such as New Zealand1, Canada2 and the Forsyth experiment in the United States3 that nondentists can and do provide quality oral health care.
Yet the negative arguments expressed recently in the “ADA Statement on the Kellogg Study of Alaska Dental Health Aide Therapist Program” are unconvincing and self-serving. For example, the statement that, “In many rural states for instance, residents are accustomed to driving hours to reach a shopping or entertainment destination and can be expected to travel similar distances to reach a dentist,” ironically implies that dental care is a luxury rather than an essential health care service. Moreover, patients driving these long distances themselves who receive post-operative pain medications may be putting themselves and others at risk; or the converse, enduring suffering because of inadequate pain relief.
To avoid becoming irrelevant to overall health care4, those among us who are willing and able to treat disorders of the orofacial area within the context of obtaining general health must reinforce our present roles and responsibilities as de facto oral physicians. By re-allocating oral health resources, dentists should be able to do what only they can do, thus leaving time to help alleviate the other major health care deficit: primary care. Thus, dentists should be able to provide preventive limited primary care in their offices; e.g., vital signs and screening for major diseases, certainly no less than is currently available in pharmacies and shopping malls.
Based on actual and projected changes in the health care system, now is the time to assert ourselves and assume the superordinate designation as oral physician in name and deed who will oversee all dental care, whether provided by dentists or nondentists, including physicians. Moreover, the term oral physician is a more accurate reflection of the actual and potential health care services which dentists can provide.
In summary, the ADA is leading us in the wrong direction. Dentists have to re-invent themselves as much as the other major paramedical health professions have done or are doing5; that is to say, pharmacists graduating as PharmDs, podiatrists as podiatric physicians, and chiropractors as chiropractic physicians, some of whom are receiving additional training as nurse practitioners to enable themselves to administer medication, perform physical exams, etc.
With impending health care reform, now is the time to act before the federal and state governments recognize the economic benefits now being enjoyed by dentists relative to increased access to care provided at lower cost and of comparable quality by nondental providers2,6.
Let us take charge as oral physicians before it is too late.
Brian J. Swann, D.D.S., M.P.H.Clinical InstructorHarvard School of Dental MedicineBoston
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