Opening Up the Dental Market Is Like Pulling Teeth

Years ago I wrote an article for reason (not available online) that explored the cost-controlling potential of allowing nurse practitioners, physician assistants, and other non-M.D.s to offer services traditionally performed by doctors. Not surprisingly, organized medicine tends to resist these inroads, especially when it comes to operating independently and prescribing drugs. But judging from a recent New York Times story, dentists have been even more effective at fighting off competition from people who have less than the conventional seven or eight years of post-secondary education. The Times reports that "dental therapists," who undergo two years of intensive training after high school, can do basic dental work such as filling cavities and extracting teeth, serving people who otherwise might not get dental care at all. If you've never heard of dental therapists, that's not surprising: Although research indicates their work is just as competent as the average dentist's, they are permitted to operate only in Alaska, under a federally funded program serving people in sparsely populated areas.

Even this limited experiment has drawn fierce opposition from the Alaska Dental Society and the American Dental Association, which say dental therapists threaten dentists' income patients' welfare:

The opposition to therapists follows decades of efforts by state dental boards, which are dominated by dentists, to block hygienists from providing care without being supervised by dentists.

The dental associations say they simply want to be sure that patients do not receive substandard care. But some dentists in public health programs contend that dentists in private practice consider therapists low-cost competition. In Alaska, the federally financed program that supplies care to Alaska Natives pays therapists about $60,000 a year, one-half to one-third of what dentists typically earn....

The American Dental Association...says it does not fear lower-cost competition but instead wants to protect patients from inadequately trained therapists, who may not be able to handle the emergencies, like uncontrolled bleeding, that sometimes occur during routine procedures.

So it's better for someone with a bad cavity to suffer constant pain or yank his own tooth than it is to run the risk of "uncontrolled bleeding" during a visit to a dental therapist. The other argument against dental therapists is even more blatantly paternalistic:

In the long run, the only way to improve dental health is encourage people to take better care of their teeth, Dr. [Amid] Ismail [an ADA consultant] said.

"I'm not in favor of training just to fill teeth, because a solution of filling teeth is not going to reduce disease," he said. "The patients will go home, and they will drink six cans of soda a day, and they will come back with more cavities."

But if the government forces them to suffer with unfilled cavities by blocking access to low-cost dental care, maybe they'll learn to lay off the soda and brush and floss regularly. They'll be better off in the long run!

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  • ||

    We just need government-mandated dental insurance. That would fix everything.

  • ||

    Imagine how low dental insurance rates could be if the cost of simple Class B procedures were to drop substantially. Same thing with normal health insurance.
    The AMA and ADA should be ashamed of themselves. This is actually something I believe France got right, where they allow pharmacists to give drugs for simple maladies and require less schooling for the most basic of practitioners.

    Standard Libertarian Disclaimer # ?:
    I actually do not believe that the state should have legal authority over such things.

  • Elemenope||

    Reinmoose -

    Word.

  • thoreau||

    If you can't open up the ranks of the gatekeepers or reduce their role, maybe creating additional types of gatekeepers, some with fewer barriers to entry, is the next best thing.

    I also like the concept of the "doc in a box" places where nurses handle basic ailments. Most intriguing is that since some of these newer gatekeepers are not yet recognized by insurance they actually have to advertise costs and compete and keep costs somewhat transparent. That's better than medical billing with insurance, where you start off with some astronomical number that gets whittled down by various bureaucratic procedures, and the bill looks something like this:

    Blood drawing: $150,000
    Exempt expenses: -$140,000
    Insurance discount: -$9,970
    Covered benefit: $-25
    Patient responsibility: $5

    Lab tests: $1,000,000
    Exempt expenses: -$499,500
    Insuranc discount: -$500,000
    Covered benefit: -$460
    Patient responsibility: $40

  • ||

    I disagree with this article. The view is short-sighted as dental therapists are not trained to detect oral diseases. Early detection of these diseases is critical of oral care and in some cases life saving (like oral cancer). It's just not about pulling a rotten tooth...you can do that with some fishing wire and a door.

  • Colin||

    This reminds me of the novel McTeague. If they had only allowed that dude to continue practicing denistry no one would've gotten killed.

  • ||

    thoreau -
    I enjoy the:

    Doctor's visit: $180
    Amount allowed by insurance: $160
    Amount paid by insurance: $140
    Patient responsibility: $20

  • javier||

    Matt,

    when my dentist checks for oral cancer, she just pats along my throat and inside my mouth to feel for any lumps. then looks for spots. I willing to bet that like any job, the expertise doesn't come from their extensive schooling but rather pratical experience. After a few years experience the ability difference between a dental therapist and a dentist would be negligible.

  • Episiarch||

    It's just not about pulling a rotten tooth...you can do that with some fishing wire and a door.

    Right, because that's just the same as Novocaine, sterile environment and equipment, and Vicodin and antibiotic prescriptions for afterwards.

  • ||

    If you go to the doctor with a case of the sniffles, he (instead of throwing you bodily into the street) should immediately strap you down and give you a head-to-toe MRI scan, because "you can't be too careful."

  • thoreau||

    Even if you want to have a dentist involved in treatment and diagnosis, opening things up to dental therapists could lead to a situation where 1 dentist oversees a practice that includes several dental therapists. The dentist could inspect for rarer diseases and treat the more complicated cases, while the dental therapists would handle the more routine drilling and stuff. It wouldn't be a perfect solution, but it would expand access and reduce costs.

  • ||


    Doctor's visit: $180
    Amount allowed by insurance: $160
    Amount paid by insurance: $140
    Patient responsibility: $20



    This could, possibly, explain why people go zooming off to the doctor's office every time they come down with a case of the sniffles.

  • ||

    It wouldn't be a perfect solution, but it would expand access and reduce costs.

    ...and create jobs?!

  • ||

    "I'm not in favor of training just to fill teeth, because a solution of filling teeth is not going to reduce disease," he said. "The patients will go home, and they will drink six cans of soda a day, and they will come back with more cavities."

    So we give dental therapist a 3x5 card that reads

    Cut down on sweets. Brush and floss after every meal.

    and have them read it to patients every visit. That is the sum total of advice I've received from dentists over the last 40 or so years.

  • ||

    P Brooks -
    I was referring more to the $20 that disappears into nothing. How does a visit "cost" $180 and the doctor's office is only getting paid $160? I don't know about these things in depth, but my guess is that $180 is the highest allowance of the multiple insurance companies that they accept.

  • ||

    Javier, your right!!! Lets just end medical school all together and let everyone be doctors!! They are bound to get it right sometime!!! We do not need highly educated people to perform surgeries, or find deseases, heck lightly trained general education majors can do it!! I think we are masking the real problem here, we have to do something about costs of services....not replace the experts.

  • ||

    Matt -
    We should have price ceilings on medical and dental proceedures, right?

  • stuartl||

    Standard libertarian disclaimer -- I think you should have the right to go to whatever kind of medical practitioner you want and that the state should not be involved in any way, including insurance. If you want to waste money on therapeutic healing touch it is fine with me.

    Having said that, my experience with RN's and doc's in a boxes has been very bad. They can handle initial emergency care, but ignore any and all advice they give. I'll pay for a fully educated doctor or dentist. No dental therapists for me.

  • Mike Laursen||

    The view is short-sighted as dental therapists are not trained to detect oral diseases.

    They could be trained to do so.

    I'm not sure how life worked out this way, but I happen to have a lot of friends who are dentists. I'll let you all in on two secrets:

    1. Even though they have all received pretty much the same education, some of them are really, really incompetent;

    2. They all have big stashes of candy in their offices. Seriously.

  • ||

    Reinmoose-

    I wasn't trying to pick on you, but there is an undeniable adverse effect on the system when there is no meaningful connection between services and costs. Apparently, some people believe that medical care is (or should be) "free."

  • ||

    Matt-Your response to Javier is just pathetic. That's not even close to what he suggested and you know it.

    BTW-How do you know that these techs aren't trained to scan for chronic disease? Unless you have a copy of their curriculum, you don't.

  • ||

    I think professionals ultimate get away to creating these barriers to entry because the majority of people really do want someone to oversee the person providing the professional service.

    Almost by definition, professional services require an expert knowledge in order to judge the quality of the work. Consumers often simply lack the knowledge to determine if a professional did a good job in any particular instance. In the case of medicine, people are more afraid of incompetence and fraud than they are high price.

    I think we need to concentrate on creating some kind of decentralized, market oriented mechanism that allows lay people to judge and communicate the work of experts. Until we do that, people will support the current system of professionals overseeing themselves.

  • ||

    I wonder: does the twenty bucks which disappears into thin air appear on the doctor's profit-and-loss statement as an "expense?"

  • ||

    I wasn't trying to pick on you, but there is an undeniable adverse effect on the system when there is no meaningful connection between services and costs. Apparently, some people believe that medical care is (or should be) "free."

    Oh, no doubt. I wasn't trying to imply that you were picking on me. You just weren't responding to what I tried to point out so I thought I'd make it clearer what I was trying to say in case it didn't come through.

    Yes, People have no idea what things cost when they only pay $20 for a doctor's visit.

    Doctors have become viewed as public agents, and that's just not right at all.

  • ian||

    the other thing that pisses me off about dentists is that a dental visit today is quite similar to a dental visit from 20 years ago....they have no incentive to come up with new and better ways of treating problems.....not the same when i visit the doctor

  • ||

    Alaska Natives pays therapists about $60,000 a year

    Salary!? On only two years of secondary education? Holy Crap! What kind of benefits? Do they get dental?

  • stuartl||

    I think we need to concentrate on creating some kind of decentralized, market oriented mechanism that allows lay people to judge and communicate the work of experts.

    Shannon, funny you should say this. Earlier today I went looking for a medical practitioners site along the lines of the excellent "Rate My Teachers" site. None of the ones for doctors seemed to be worth much.

  • ||

    The view is short-sighted as dental therapists are not trained to detect oral diseases.

    Good example of the perfect being the enemy of the good. Many populations are so woefully underserved for dentistry that the alternative to dental therapists is nothing at all, not a fully credentialed dentist.

    I wonder: does the twenty bucks which disappears into thin air appear on the doctor's profit-and-loss statement as an "expense?"

    Barring crooked tax accountants, it shouldn't, any more than the grocery store should expense the discount on those T-bones it just put on sale.

    The "charge" number in medical billing is almost entirely fictitious. Practically nobody pays it - all the big payers have their own negotiated schedules, and even the walk-in uninsured get a cash discount. I think its like an appendix - its vestigial, a remnant of a bygone day.

  • ||

    The thing is, a visit to the doctor doesn't cost $180, any more than an aspirin costs $5. The market distortions in medicine are so grotesque that there really is no connection between what a service costs and what people are charged. Transparency would be a good thing here.

    In general, as long as people stick to their scope of practice, I think Nurse Practicioners, treat and release Paramedics and the like are a good idea. One does not need 8 years of medical school to bandage a wound or prescribe antibiotics for an ear infection.

  • ||

    Mike, no secret.

    I've seen 7 dentists in my life. I would rate them as follows:
    1 excellent, 2 good, 1 fair, 2 hacks and 1 super hack (think Marathon Man).

  • ||

    What about paralegals? Why can't they clean teeth?

  • stuartl||

    ...prescribe antibiotics for an ear infection.

    # 6, for one of my kids we had an NP screw up what should have been an easy prescription for strept throat. Sent us to an ENT, recommended surgery, blah, blah, blah. A visit to a doctor and a prescription for penicillin had her on the road to recovery in a few hours. I stick to doctors.

    I'm not going to argue that doctors and dentists are always good, they definitely are not. But your odds are better.

  • ||

    The most effective reform we could make to the health care system would be to treat doctors and dentists more like plumbers, and less like wizards. Starting with posted rates, and "If it's not fixed, you don't pay!

  • ||

    It would ber nice if I had automotive engineers changing the oil and replacing the PCV valve in my car. However, I am unwilling to pay for all of that unneeded expertise. A similar situation occurs with tooth extractions and filling cavities. It really isn't that complicated, and doesn't require 8 goddam years of schooling to perform.

    Full disclosure, my primary health care provider for years was an independent duty hospital corpsman. He could diagnose and treat the clap, perform immunizations, set broken bones, etc. (minor stuff really) as well as any doctor on the planet.

  • Christopher Monnier||

    Even if all dental services could only be performed by licensed dentists who went to medical school, there would still be a difference in diagnostic expertise between the best dentist and the worst dentist. So if we apply Matt's line of thinking, we should demand that only the best dentist ever be allowed to serve each and every person; otherwise, everyone served by the non-best dentists are liable to have non-symptomatic illness go undiagnosed.

    Perhaps a good model to emulate would be that of an IS/IT help desk (annoying as they may be, they're usually effective). Your initial complaint gets handled by a low-level technician, and if they can't figure it out, it gets passed higher and higher up the chain of experience and expertise until it gets resolved.

    Healthcare is different, of course, because not everyone with a health problem is symptomatic, which is where education and specialized knowledge becomes necessary to find problems before they manifest themselves. But it seems eminently feasible that people need only see such experts only so often. And if no such experts are available, then low-level technicians are better than no technicians at all. After all, it's not like there's a glut of dentists sitting around looking for work.

  • ||

    stuartl, others:
    Please don't confuse "you shouldn't have to go to 8 years of school to do basic things like make basic prescriptions" with "those who have less schooling are better than doctors/dentists" or "I would go to someone with less credentials if given the choice."

  • Kevin Trudeau||

    Reinmoose,

    Clearly, you haven't read my book! Medical professionals are all liars. With my book, you don't need any formal training!

    Buy my book! Or die!

  • Christopher Monnier||

    > Clearly, you haven't read my book! Medical professionals are all liars. With my book, you don't need any formal training!

    Sounds like something Kevin Trudeau would say.

  • ||

    Warren | May 2, 2008, 12:46pm | #
    "Alaska Natives pays therapists about $60,000 a year"

    Salary!? On only two years of secondary education? Holy Crap! What kind of benefits? Do they get dental?


    Before this thread disappears into the aether, I wish to announce Warren as "Winner of the Thread".

  • stuartl||

    Reinmoose,

    I am not confused, I was making an observation based on too much experience.

    I agree that you shouldn't have to get 8 years of schooling for the simple stuff, but my experience is that going to less credentialed practitioners is more expensive in the long term and potentially dangerous.

    I know doctors that got rid of NPs after having problems. The NPs cannot even handle interpreting simple tests and making basic prescriptions. My recommendation to others is to pay more in the short term and avoid them, but feel free to spend your time, money, and health however you see fit.

    On the flip side, I would and have trusted my family's health to ER nurses. A very different, and much more competent, breed.

  • ||

    we need the government to negotiate all of our dental care at group rates so that we can get better prices. We also need stricter certification standrads on Dentist so that we don't have market failure. Just ask Matt Welch and Kerry Howley, all international countries we have lived in with government provided care have been excellent experiences.

    Dentist should also only be allowed to work out of special complexes designed by certified urban planners like Joe.

  • Sam Grove||

    I have a plastic squeeze bottle, part of a dental acrylic package, labeled thusly:

    CAUTION: U.S. FEDERAL LAW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A DENTIST

    The bottle is similar in appearance and function to a ketchup or mustard dispenser. It is filled with plastic beads for constructing dental appliances. The bottle is initially empty. Yet it is illegal to sell the bottle outside of the circumstances described in the warning. As near as I can tell, the only thing that makes it so is the warning printed on the bottle!

  • ||

    I agree. Some people should not be able to afford basic health care because it would be horrible for them to see someone who I would consider to be less all-knowing than my current doctor, and therefore less suitable for myself.

    I know, you said you weren't confused. You then went on to complain about all the NPs you've ever known.

    People in other developed countries get care from people with less schooling than our GPs all the time and seem to have longer life spans. How ever do they manage with such incompetent practitioners?

  • stuartl||

    People in other developed countries get care from people with less schooling than our GPs all the time and seem to have longer life spans. How ever do they manage with such incompetent practitioners?

    Better diet and more exercise.

  • stuartl||

    Some people should not be able to afford basic health care because it would be horrible for them to see someone who I would consider to be less all-knowing than my current doctor, and therefore less suitable for myself.

    Of course some skill is better than none. In most cases penicillin is better than both. If you want to prevent heart disease, run 10 miles a week, don't go to a doctor for meds.

    My apologies if I was confusing, but nowhere did I mean to suggest that people should not be able to see someone that I would not find suitable. My first post started with I think you should have the right to go to whatever kind of medical practitioner you want...

  • ||

    Additionally, for those wondering why the Alaska Rural Dental program is the way it is and what procedures are being followed to insure patient health, I highly suggest you take a look at this PDF evaluation of the program.

    The first paragraph sums it up perfectly:

    The unmet dental needs of Alaska's native population are overwhelming. The caries rate among Alaska Native children and young adults exceeds the amount of caries in the general U.S. population by 250 percent. That nearly 70 percent of the 125,000 Alaska Natives live in 200 villages in rural areas, most not accessible by road, compounds the problem. The remoteness and harsh climate combine to impose significant challenges to those seeking routine and emergency care. Moreover, the difficulty and expense of travel and the spartan living and working conditions often awaiting them discourage most dentists from volunteering their services. Five full-time paid dentist positions in the Yukon-Kuskokwim Delta have remained vacant for six years despite a salary/benefits package starting at $177,000.

  • thoreau||

    I wouldn't be surprised if an NP who goes from formal education to private practice is rather bad at it. I would just observe that after the formal education doctors spend a lot of time in apprenticeship before doing it on their own, and I know doctors who say that they learned a lot more in apprenticeship. That's not to say that the formal education wasn't an important piece of it, but the importance of practice suggests that there's more than one way to do this.

    I'd be reluctant to get my cavities filled by an independent dental therapist. I'd have less of a problem going to an office where a dentist oversees a staff of dental therapists, with the dentist checking things out but leaving most of the routine stuff to the dental therapists.

    I once went to a very good dentist who let a very experienced technician do some things that probably weren't strictly on his license. After going there for a while, I trusted the experienced technician more than a brand new dental school graduate who joined the practice and couldn't figure out which tooth had the problem.

    In general, I'd trust people who have less in the way of classroom training if they've spent a long time working under somebody more experienced and have transitioned towards independence. FWIW, that's the model that Ph.D. scientists are trained in. We start with coursework, then we do research with lots of advice (and close monitoring from the more senior grad students in the lab), then we get more leeway, then eventually we realize that we know more about this project than the professor because we're the ones doing it. At which point we get our degrees.

  • ||

    I wouldn't be surprised if an NP who goes from formal education to private practice is rather bad at it.

    In my experience, very few NPs go straight through school. The vast majority spend years as RNs, then go back for the upgrade. So they've got more hand-on experience than you could shake a catheter at.

  • Kolohe||

    Even if you want to have a dentist involved in treatment and diagnosis, opening things up to dental therapists could lead to a situation where 1 dentist oversees a practice that includes several dental therapists. The dentist could inspect for rarer diseases and treat the more complicated cases, while the dental therapists would handle the more routine drilling and stuff. It wouldn't be a perfect solution, but it would expand access and reduce costs.



    My impression is that this sort of thing is pretty standard and has been going on for some years.

    When I was a teenager w/ braces my orthodontist had a (literal?) harem of women that actually seemed to do all the work in the office. He did the initial instalation and removal, and of course was the 'brains' of the operation, but the majority of face time, so to speak, was with all his assistants.

  • ||

    RC is right. In my state to become an NP, you must work as an RN for several years. My experience has been that every NP I have ever seen or had my children see, is as good or better as any MD or DDS we've seen. The bonus is that they're not nearly as arrogant either and will usually actually listen to the patient!

  • Mike Laursen||

    Moreover, the difficulty and expense of travel and the spartan living and working conditions often awaiting them discourage most dentists from volunteering their services.

    Bullshit, I happen to know that Alaska is full of charming little towns where a dentist might meet a quirky, but beautiful lady bush pilot, a quirky local D.J., a quirky ex-astronaut, and all kinds of other quirky, but loveable people.

  • ||

    My apologies if I was confusing, but nowhere did I mean to suggest that people should not be able to see someone that I would not find suitable. My first post started with I think you should have the right to go to whatever kind of medical practitioner you want...

    That's why I always use a Standard Libertarian Disclaimer©.

  • Mike Laursen||

    Standard Libertarian Disclaimer # ?:
    I actually do not believe that the state should have legal authority over such things.


    The Disclaimers would be easier to reference if they were assigned mnemonic codes rather than numbers.

  • ||

    But if the government forces them to suffer with unfilled cavities by blocking access to low-cost dental care, maybe they'll learn to lay off the soda and brush and floss regularly. They'll be better off in the long run!

    Or maybe they'll turn to abusing prescription and/or street drugs to deal with the pain.

  • ||

    re: J Sub D @ 1:13

    I was once an AF Independent Duty Medical Technician and I can attest that the diagnosis & treatment of disease & injury is a learned skill that can be aquired without years of medical school (in my case, it was about a 400-hour course.) However, AF IDMTs (and Navy IDCs) are supervised (albeit indirectly) by a licensed physician who reviews everything they do, so there's still professional oversight. I didn't RTFA, but from Jacob's post it seems as though the dental therapists want to operate without oversight by a dentist. Based on my personal experience of 14 years as a medic, I think that would be a bad thing. MDs aren't perfect, but most provide conscientious oversight of medical paraprofessionals -- especially if their expensive credentials are on the line.

  • ||


    The "charge" number in medical billing is almost entirely fictitious. Practically nobody pays it - all the big payers have their own negotiated schedules, and even the walk-in uninsured get a cash discount.


    How could you tell? I can see a cash customer getting screwed by getting a "discount" from the "charge", which is a heck of a lot more than the negotiated schedule from an insurance company.

  • B||

    It always amazes me when the editors of Reason decide they have enough dental knowledge to claim "dental therapists" have the proper qualifications to perform procedures reserved to dentists. Two years no matter how "intense" (what bullshit, as if throwing in that adjective all of a sudden makes the argument more viable)is not enough.
    Dentistry goes beyond just giving shots and filling teeth, tasks which can be difficult enough, particularly when you consider that filling a cavity, which necessitates removal of tooth structure, is an irreversible procedure. Are these "dental therapists" trained in oral pathology and oral medicine? Can they diagnose pathological conditions in and around the oral cavity, some of which are potentially lethal, or do they just fill in an obvious fucking cavity and call it a day? It takes more than two years of training to do the job of a dentist. If I go to one of these therapists, and I have very subtle, but detectable (by a trained individual) signs of oral cancer, will these people be able to notice it, or are they just gonna numb me up and yank a tooth out?
    If these people are the only individuals someone is seeing for dental care, then they have to be trained to diagnose the entire spectrum of oral pathologies, or you could walk out of there with a potentially lethal illness and not know it. Two years training is quite simply not enough. There is a reason dentists are required to undergo four years of supervised training with very specific cirricular requirements, and it's not just to fill up their pocketbooks, regardless of what the ignorant editors of Reason think.

  • ||

    B -

    So the only people who are competent to judge what qualifications are necessary for performing dental work are dentists? Let's examine the consequences of using that line of reasoning, shall we.

    Only cops are qualified to judge LEO requirements.
    Only politicians are qualified to judge elcted office qualifications.
    Only teachers are qualified to determine fitness for educators.
    Only certified nail technicians are qualified to determine the competence of a manicurist.

    Should we bring back guilds and give them legal standing?

  • ||

    You don't need a weatherman to know which way the wind blows.

  • B||

    "So the only people who are competent to judge what qualifications are necessary for performing dental work are dentists? Let's examine the consequences of using that line of reasoning, shall we.

    Yeah, because a grand total of zero of the jobs you listed require anywhere near same amount of skill. Smoothing someone's nails and diagnosing oral cancer? The same thing. At least they are according to your idiotic "argument", which by the way did absolutely nothing to address the fact that 2 years of "intense" (oooh, now I'm convinced) training is nowhere near enough to be performing dental work unsupervised. As I wrote before, there is a reason dental school is four years.

    And please, spare me the notion that having an expert in the field judge the qualifications of ohers is somehow novel.

  • B||

    "So it's better for someone with a bad cavity to suffer constant pain or yank his own tooth than it is to run the risk of "uncontrolled bleeding" during a visit to a dental therapist"

    Uh, yes it is actually, at least until they can get to someone competent; allowing unqualified individuals to do the work is not the answer. That you seem to think otherwise shows how breathtakingly ignorant you are of what goes on when extracting teeth, or any other procedure for that matter. The notion that somehow the cases these undertrained individuals are seeing will work out without a hitch always and nothing will ever go wrong demonstrates how little the editors at Reason know about dental procedures. Please, for the sake of everyone, stick to railing against marijuana laws.

  • ||


    Smoothing someone's nails and diagnosing oral cancer? The same thing. At least they are according to your idiotic "argument", which by the way did absolutely nothing to address the fact that 2 years of "intense" (oooh, now I'm convinced) training is nowhere near enough to be performing dental work unsupervised.


    Competence at diagnosing oral cancer has nothing to do with competence at identifying and treating dental caries. Nothing at all. All they need to know about oral cancer is "if you see something abnormal, punt". Somebody else will do the oral cancer diagnosis (if oral cancer it is).

    The same goes for pharmacists. Why are they full MDs? 99.99% of the time, a pharmacist doesn't need to know how to diagnose disease. The diagnosis and treatment decisions were made by somebody else. All the pharmacist really needs to know is "what does this drug do", "what are its side effects", and "how does it interact with other drugs". I could care less whether my pharmacist can read an x-ray, set a broken arm, or even diagnose the common cold.

  • nyscof||

    Dentists must be mandated to accept Medicaid patients and to accept non-insured patients on a sliding scale basis.

    They focus you on water fluoridation to give the illusion they care about poor people - whom they will never allow in their dental chairs. Many dentists make three times as much as physicians while working fewer days, fewer hours doing less critical care.

    Organized dentistry lobbies against, or sues, any group that dares to infringe on its lucrative Monopoly. Currently, the Minnesota dental association is lobbying against Dental Therapists in their state. Massachusetts Dental Society is against hygienists doing regular hygienist work without dentist supervision. Dentists don't want to give up a cut of the money pie.

    If fluoridation really reduced tooth decay and their bottom line, do you really believe organized dentistry would not only be in favor but instigate it using stealth politics (J of the California Dental Association, "The Fluoridation Victory") and fund fluoridation schemes which they often do. They have the American public bamboozled on that one.

    Dentists accept welfare for the rich. They don't make it on their own. Their tuition and/or dental schools are government subsidized. They are given permission to drill holes in people's teeth by state governments.

    Their dental unions, with loads of money from businesses that profit from dental products, lobby our legislators to get laws passed that puts more money in their own pockets and less dental work in our mouths. Do you really believe coporations that make products to put into our decayed teeth care about prevention? When was the last time your dentist told you that your diet (and not just avoid sugar) was the cause of your cavities?

    There's a whole bunch of physicians, physician assistants, nurse practitioners and other specialists you can choose to go to - alternative or mainstream for anything that ails any of your body parts. But the dentist has the tooth monopoly.

    Is there anyone reading this who hasn't had or heard several dentist horror stories from their friends or relatives. The dentists have made a very low bar for dental therapists to reach. Should be no problem!

  • ||

    So what if the technology for oral cancer diagnosis already exists and is in use? See URLs below. There is no reason for the dental therapists to see oral high risk patients who chew tobacco, take meth, or even smoke--that could be the sole realm of dentists. But in the US there is no incentive or even obligation to give affordable dental care, except for some dentists who volunteer their time or the few that accept state Medicaid patients. If there were an obligation, such as public service for a couple of years as part of repayment for their dental school loans, there could be a pool of new dentists giving low cost care in communities needing them the most. Then perhaps most of the people going into dentistry would go into it to serve instead of just for the income. You have to read dental students' chatroom posts to get this picture. In my community established dentists work 3 days a week and have greater annual income than generalist physicians. Their "union," the ADA is there to protect that income, because there are still varying levels of dental care: poor, average or excellent practitioners. The ADA does not really govern that standard of care in their ranks.

    http://jada.ada.org/cgi/content/full/137/6/734

    http://www.king5.com/health/cancer/stories//NW_010308HEB_oral_cancer_KC.86270b9.html

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