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!