Re: The Denturist Issue Revisited, Oral Health, June 2000
The June Viewpoint article entitled ‘The Denturist Issue Revisited’ submitted by the Association of Prosthodontists of Ontario, was somewhat enigmatic in that it actually dealt with two separate and seemingly unrelated topics. One concerned escalating denturist fees while the other related to the unsatisfied prosthetics requirements of needy Ontarions. If the former issue is indeed a causative factor in the latter, then the APO article only implied so in the most oblique manner. Additionally, if such a relationship in the two topics does exist, then any objective discussion of that relationship should include reference to the involvement of our own inflationary fee structure in placing fees beyond the financial reach of indigents and the working uninsured. Should our concern not also extend to all other dental fees, which preclude access on the basis of cost?
I agree with the article’s author, that denturism was touted as an economic panacea in the pursuit of cheaper dentures for the masses. It was quite predictable, given the delusions of professional grandeur often expressed by denturists, that they would eventually equal or surpass the prosthetic fees demanded by dentists. Although only of historic interest now, we should remember that emerging denturism could have been defeated had we been prepared to reduce our denture fees in order to eliminate the need for their establishment.
The article’s fanciful suggestions that public health dentists be specially trained to provide removable prostheses for the poor, and that the government should provide subsidized lab services in addition, are ill conceived. First, public health dentists have traditionally shown little interest in removable prosthetics and, furthermore, they have already been trained in such treatment in their undergraduate courses. Also, governments learned long ago that contracting out lab services is much more cost effective than running its own laboratories, regional or otherwise.
Dentistry and its professional organizations are just as much to blame for the emancipation of denturists as the lamentably uninformed governments that sanctioned their existence. The lobbying efficacy of the denturists was repeatedly underestimated, and as in the particular case of Alberta, the provincial organizations simply rolled over when confronted by the combined denturist/government propaganda machine. The Denturist Act soon became entrenched and eventually their lobbying succeeded a second time in their quest to provide partial dentures. One can agree with the APO article where it states that partial dentures are unacceptable without judicious tooth preparation, and perhaps even pre-prosthetic surgery. Not to worry. In no time at all dentists were almost lining up to perform tooth preparations for denturists in return for patient referrals from them. Will history record such behaviour as benign commensalism or as mutual parisitism? And what of our colleagues who provided educational material to denturists so that the latter could more effectively divert income from our ranks to theirs? I wonder how many readers can recall the word ‘Quisling,’ coined in Europe in WWII to describe collaborators?
Was this article an altruistic appeal on behalf of the downtrodden? I think not. Was it the not-to-subtle musings of a self-interest group? It certainly could be. It’s recommendations certainly offer more than a hint of a make-work programme for public health dentists, prosthodontists and under-employed academics.
Like it or not, denturism is here to stay. No government will admit its previous error by abolishing their existence. But we will always new concerns as a result of their existence: What about the fact that they now teach tooth preparation in the denturism programme; and the alarming realization that they have absolute control over their own educational curriculum? Could cast-etch bridges be in their future?
D.F. Mulcahy, DDS