The Denturist Issue Revisited

During the 1970s, in an effort to increase the availability of complete denture service to the public, the Ontario government legalized the provision of this service by denturists. These were largely persons who claimed to be able and willing to provide denture service of comparable or better quality than dentists, but cheaply. The legislators rightly saw this as having the potential for increasing the availability of complete denture services and legalization of denturists, thus yielded a group of about 300 therapists who were going to make dentures for a needy public. It should be noted that no baseline studies provided groundwork for consideration of this issue; rather, the decision was taken in a furor of media hype and political lobbying. The action has never been dispassionately reevaluated.

Then in 1991 the claim that denturists could and would provide less expensive prosthodontic services resurfaced in an initiative to legalize unsupervised partial denture treatment by denturists. Mr. Battell, then president of the Denturist Association of Ontario, rejuvenated the claim on August 21, 1991. He stated for the benefit of the Government Review Committee: “With the passage of this legislation [unsupervised provision of removable partial dentures] consumers will finally have the legal right to have access to high-quality partial dentures at an affordable price.” Access at an affordable price was a major factor leading to legalization of denturist activities in the 1970s, respecting complete dentures and, in 1992, respecting removable partial dentures. Comparisons of the 1999 Fee Guide of the Denturist Association of Ontario with that of the 1999 Ontario Dental Association Suggested Fee Guide for General Practitioners discloses that denturists’ fees for prosthodontic services are generally higher.

Dental practitioners who properly execute removable partial denture therapy always prepare the mouth to receive the prosthesis through modifications of the teeth and, commonly, soft tissues. This is accepted, usual and proper, and requisite treatment everywhere in the world. Denturists legally cannot alter patients’ teeth or soft tissues (not to suggest that they be allowed to do so) to prepare them for reception of a removable partial denture. Since denturists do not spend time in requisite mouth preparation, nor do they assume any responsibility for such preparation, their fees ought to be lower than those of dentists.

Further, since no mouth preparation is undertaken, accepted standards assert that this omission will discourage a positive long-term outcome. The service then has to be of less value to the consumer. To paraphrase Mr. Battell, it seems that with the passage of the 1992 legislation, “consumers finally had the right to access low quality partial dentures at a higher price.” Legalization of denturists as a source for cheaper prosthetic treatment has failed. The initiative is plagued by continued lack of affordable prosthodontic services, another expression of restricted access. (It should be noted that indigent individuals are eligible for some financial support to pay the cost of dental treatment, but the amount is inadequate). The unavoidable conclusion is that there remains a population of completely and partially edentulous individuals in Ontario who still cannot afford prosthetic treatment and constitute unmet need.

To conclude, the following suggestions are offered:

1. It is recommended that provincial governments sponsor surveys conducted by universities that have appointed professors in dental public health, and that the surveys assess the prevalence of complete and partial edentulism comprehensively. The survey should identify the adequacy and efficacy (including cost/benefit ratio) of various forms of prosthetic treatment and the source(s) of treatment. In this context, the participation of prosthodontic specialists should be employed. These studies should be tendered, focused and properly funded by government.

2. That steps be taken to augment provision of prosthetic services in the dental public health services. This should include expansion of the personnel ranks in these services, sponsoring educational as well as clinical training programs for public health dentists and provision of regional supportive laboratory services.

A committee of The Association of Prosthodontists of Ontario prepared this submission. Communication with the Association can be through its president: Dr. Karl Lederman, 3-60 St. Clair Ave. W., Toronto M4V 1M7.