Tooth or Consequences
Dr. Mary Smith
ADA Trustee – 11th District
In an article from the American Medical News titled “Tooth or Consequences: The costs of poor dental fitness,” one quote in particular stood out, “This is a problem that doctors have to grab hold of if we’re really going to make inroads here. This can’t be relegated to dentists. There are just too many linkages to overall health…”Alan Douglass, Maryland, Middlesex Hospital, Middletown, Conn.
The article went on to say, “Although physicians are getting more involved in oral health because of the science, the lack of access to dental care faced by so many patients…in part because there are far fewer dentists than physicians…” The impression is that there are far more physicians. The facts paint a totally different picture. According to the US Department of Labor, in 2005, family medicine, general practice, and pediatric medical practitioners numbered approximately 142,425 (just under 20% of the total number of physicians). In 2006, the number of dentists in general practice was 136,000. Include the 6400 pediatric dentists (Am. Academy of Pediatric Dentists) and you have 142,400 dentists. The argument that there are many more primary care physicians than dentists just doesn’t hold up.
The fact that the poor are less likely to receive preventive care than those who are more affluent is true of both professions but in medicine the poor can access emergency care at their will through hospital emergency rooms. This is not the case for dental emergencies. While I applaud the initiative to encourage MDs to provide preventive instructions as part of routine care, a huge void will still exist.
From birth to age 2 children are seen by medical professionals on a regular basis for well care and immunizations. After that, many children do not see a health care provider, medical or dental, until they need their immunizations for school (age 5) or they have a condition that requires emergent care (not a routine appointment that would include dental hygiene instructions). It would make sense for the physicians to apply fluoride varnish if they also stress the importance of routine dental care with the intent of ensuring that patient has a dental home prior to the last immunization at age 2. The most effective way the medical community could address the discrepancy between the haves and the have-nots for dental care, would be to reinforce the importance of oral health and good nutritional habits. The key is the coordination of care between the two professions not a hostile take over by one.
The good news is that we now have a medical profession who openly admits the mouth is attached to the body. Add to this the advancements that are being made in salivary diagnostics, the consensus that oral health is essential for overall well-being, the integration of medical-dental health programs (Blue Cross/Blue Shield of Illinois) and we are heading to a fork in the road. Which way will we turn; collaboration and mutual awareness or collision and turf wars?
Historically, the medical profession was taken out of the marketplace over 40 years ago with their participation in Medicare and Medicaid. Nurse Practitioners and Physician Assistants are widely utilized; largely in response to poor reimbursement rates. The medical profession now defines the oral health problem as “there are not enough dentists.” What do you think their answer is going to be? Can you really see your medical counterparts giving home care instructions? Their already over-worked staff applying fluoride varnish? How about a mid-level provider that can do oral health instructions, clean teeth, do minor tooth restorations, and if they feel it is needed, refer to dentist? Whoa!
Do you want to make the decisions for your profession or hide behind the false belief that this may result in two tiers of care? Wouldn’t it make far more sense for the dental profession, who truly understands dental disease, oral health’s influence on well being, office efficiency and cost savings through the use of well trained auxiliaries, to develop a meaningful and comprehensive mid-level provider curriculum? To utilize this expanded dental auxiliary, may permit some dentists to make a living in populations that don’t have the market power necessary for them to do so without such auxiliaries. If the long term result is the reduction of some dental fees in the current private sector but dentists can provide the same quality of care to more people, more cost effectively and with more job satisfaction, while maintaining their incomes, what’s wrong with that?
This professional must be a member of the dental team, licensure should be dependent on education and training, and that license should be controlled by the same entity that oversees dentistry. It is time to let go of the notion that this may result in different levels of care. If the license is overseen by the same entity (DQAC) the same standard of care will be applied to whoever is providing the procedure. Not every office will embrace an expanded function professional but does that give us the right to limit those offices and populations that may benefit from this model? In the end we need to ask ourselves, if dentists can’t offer better dental services, treat more patients, more cost effectively in their practices than a physician, maybe the physician should be offering those services. I don’t believe that for a minute, we need to act now or be prepared for the consequences.
Dr. Smith is the Trustee for the American Dental Associations 11th Trustee District. The 11th District is comprised of Alaska, Idaho, Montana, Oregon & Washington. Her practice is in Spokane, Washington.
