What Are You Smiling At?

The American Dental Association's unfunny habit of blocking healthcare reform

Q: What are the eligibility requirements to legally receive dental care from a therapist with a two-year degree?

A: Native American ancestry.

Some 60,000 indigenous Alaskans living in villages accessible only by plane, boat, or snowmobile received little dental care until the Alaskan Native Tribal Health Consortium decided to break a few rules. Following a model that is popular in Canada, England, Australia, New Zealand, and 42 other countries, the consortium sent tribal members to an accredited two-year dental program in New Zealand, where they learned how to fill cavities and clean and pull teeth.

Upon completion of the program, the members returned to their villages as certified dental therapists, capable of providing basic dental services. The therapists have since helped to bring down a rate of tooth decay that is almost three times the national average. But their efforts were nearly undone by the American Dental Association (ADA), which objected to anyone other than a licensed dentist conducting "irreversible dental procedures," such as pulling teeth and filling cavities. By the ADA's standards, a licensed dentist is one that has completed an undergraduate degree, a doctorate of dental medicine, or a doctorate of dental surgery, and has passed a statewide exam.

The consortium spent over a year battling the ADA and the Alaskan Dental Society for the right to send dental therapists into tribal areas. Alaska's Superior Court ruled in favor of the tribes in June 2007, allowing the therapists to continue their work, but only in indigenous communities. In light of the ruling, the ADA altered its strategy and decided to support the tribes' efforts until it could send enough licensed dentists into remote tribal regions to render the therapists unnecessary.

The case received little national attention until the New York Times' Alex Berenson wrote in April that "dentists in private practice consider therapists low-cost competition" because they are only paid "one-half to one-third" as much as licensed dentists. Current ADA President Mark J. Feldman responded a month later in a letter to the Times, denying that the ADA objected to the Consortium's "experiments" out of its own "financial self-interest."

Yet the ADA's actions toward the University of Washington School of Dentistry, which backed the consortium, supports the financial self-interest angle. According to a story in the Seattle Post-Intelligencer, the Washington branch of the ADA "intimidated university officials by threatening to block donations by their members" until the dentistry school withdrew its support for the consortium and abandoned its plans to cosponsor, along with the medical school, a dental therapy track in its physician's assistant program.

This wasn't the only time the ADA has attempted to block a newcomer to the dental market. In December 2007, another New York Times reporter, Ian Urbina, wrote about the work of denturists. Denturists develop and install dentures and replace teeth; their inexpensive services are changing lives for the better in Kentucky, where residents, like indigenous Alaskans, suffer from tooth decay at a rate that is much higher than the national average.

Unlike the Alaskan tribes, however, denturists have had no luck challenging the ADA. The association refuses to recognize denturism, even though denturists can practice legally in a number of states, including Idaho, Montana, Maine, Oregon, and Washington. Additionally, in Arizona and Colorado, denturists can work under the supervision of licensed dentists. The ADA officially "opposes denturism, the denturism movement, and all other similar activities," claiming that denturists are "educationally unqualified to practice dentistry in any form on the public." A 1985 study published in the American Journal of Public Health suggests the animosity stems more from the economic effects of legalizing denturism than anything else. In 1978, the year Oregon became the first state to allow denturism, "The major campaign issue" between those for denturism and those opposed, "was the effect denturism would have on the cost of dentures." Sure enough, the cost of dentures "had a much lower rate of increase after passage of the denturism initiative."

Since then, the ADA has combated denturists by attempting to block their access to supplies. The agency openly discourages manufacturers of dental equipment from selling products to unlicensed dental practitioners, the only exception being dentistry students enrolled in ADA-approved schools.

According to the association and other opponents of alternative dentistry, dental work done by anyone other than a licensed dentist equates to "substandard care," but their argument suffers when international comparisons are taken into account. Canada, for instance, created a regulatory board for dental therapy in 1974. The Australian goverment permits it as well, calling it dental prosthetics. In 1984, the United Kingdom amended its dentistry laws to make room for several types of alternative dentistry, among them the British equivalents to both denturism and dental therapy. And according to the Seattle Post-Intelligencer, some studies have shown that graduates of dental therapy programs "are better trained to provide care to children than dentists are."

Despite the ADA's best efforts at controlling the cost of dental care, the tide may be turning. In May, reports The Charleston Gazette, West Virginia (whose dental problems rival those of its neighbor, Kentucky) passed a bill that will allow dental hygienists—whose services cost a fraction of those of a licensed dentist—to practice outside of a dentist's office and without a dentist being present. Legislators passed the bill—in spite of loud ADA objections—after journalist Eric Eyre wrote a series of articles detailing the state's abysmal dental care.

Bills like the one in West Virginia create new jobs while lowering medical costs. And there is perhaps a bigger benefit: putting smiles on the faces of millions of Americans who, thanks in part to the monopolistic behavior of the ADA, are literally too embarrassed to open their mouths.

Mike Riggs is the City Lights editor at Washington City Paper.