Regulation

What Are You Smiling At?

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

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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.

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  1. It’s a mans life in the British Dental Association

  2. Someone point out the correct reason why this is an issue. I’ll give you a hint: it starts with “g”, ends with “t”, and is composed almost entirely of bullshit.

  3. You mean that alternative dentistry does not involve a string attached to a doorknob?

  4. Requiring a dentist to fill a cavity is like requiring a mechanical engineer to repair an automobiles brakes.

    Sorry to all of you DDSs out there, but it ain’t even close to rocket science.

  5. it ain’t even close to rocket science

    It isn’t supposed to be.
    Not that dentists don’t have a vested interest in maintaining their little guild.
    Mine makes about $200/hr torturing me.
    Nice work if you can get it.

  6. 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.

    One thing we libertarians should at least admit it’s that socialized medicine has much to teach us about doing things on the cheap.

  7. If you think dental care is expensive because of anti-competitive actions on the part of dentists and the ADA, look at how expensive child birth is because of OBs and hospitals. How sad that in the land of the free we are so limited on how we choose to take care of ourselves. Increasing the labor supply in the medical industries will reduce the costs. And heaven forbid people might receive better care from a lesser trained individual.

  8. How sad that in the land of the free we are so limited on how we choose to take care of ourselves.

    I agree, and we’ve already got midwife clinics comin’ out our ass. Unfortunately, they’re not always an option for the 42-year-old lesbian couple or high-intensity career woman who decided to go IVF and are staring down the barrel of highly predictable birth complications.

    The medical establishment calls those people “high functioning/high needs” patients.

  9. Paul has the right of it. More and more E-Z deliveries are being done by nurse midwives.

    Let’s not forget that some non-negligible part of the bill for having a baby goes to paying for malpractice insurance, both directly (depending on your state, an OB may have to pay more than $100,000 a year for insurance) and indirectly, as the supply of OBs has dried up due to massive damage awards.

  10. The ADA once again proving that you can’t have a monopoly unless it is endorsed by the government.

  11. RC, what is the story with these OB damage cases? Are the monetary awards high compared to the actual damage that was caused? What exactly were those damages? That just struck my interest for some reason.

  12. Zoltan:

    There’s a thread with high malpractice insurance and the large number of unnecessary C-sections being performed to avoid a spate of high-damage awards because entrepeneurial attorneys have found no shortage of “experts” who will testify that ‘x’ birth problem *could* have been prevented if only a c-section had been done.

  13. This is why the 10th ammendment is so important. It allows states to chip away at government created monopolies.

  14. Unfortunately, most states use the 10 Amendment as their excuse for PILING ON government-created monopolies . . .

  15. It’s only about the money. It was always only about the money and it will always be only about the money. Do you think anyone (read ADA) really cares about the brilliance of some Kentucky backwoods gomer’s smile? And on to OB GYN…it’s only about the money…

  16. Fluoridation is the cover story that poor people are being cared for. Dentists mostly refuse to treat the poor. Fluoridation is now proven to have no benefit as ingested fluoride only damages teeth as shown by Pizzo 2007 with 51% of children now having multiple teeth with dental fluorosis. This causes more damage dollar wise then even the exagerated savings which do not exist. Dentists have learned at accept the huge increase in expensive cosmetic work as a necesary evil. The dental incomes have skyrocketed past doctors and they work fewer hours and the cosmetic dentists lead the pack. What happened to first do no harm? Harm everyone and get rich just does not sound right. The FDA has never reviewed any ingested fluoride. The H2SiF6 which is used 92 % of the time comes directly from smokestack pollution scrubbers and has Arsenic,lead and lots of radioactive decay products. The phosphate mines are also uranium mines but they stopped uranium recovery and just leave it in the acid product as the free unmentioned bonus. Mention this to your dentist as most think it is some sort of pure chemical. Fluoridealert.org Jim Schultz

  17. Follow the money is why the intense lobby by industry to dispose of toxic waste bu drinking it. Fluoride air pollution had more lawsuits then all other air pollutants combined but small doses to all is hard to prove damage when the health department and dentists doing the dirty work of cover up for you. Europe figured this was stupid long ago as 98% of western Europe does not fluoridate water. They have reduced cavities as much and more then those that do and have much less of the dental fluorosis discolored porous brittle stainable teeth that over 51% of the kids have now. All our foods and beverages contain as much and more fluoride often. Dental products as toothpaste can overdose small children as most swallow half of what they put in their mouth and most put way too much in . Any more then a small smear is too much. Read the science as your dentist does not. A

  18. I remember reading in Milton Friedman’s Capitalism & Freedom how the AMA constrains the number of doctors by constraining the number of size of ‘approved’ medical schools. Of course, that book was written in the 60s, but I suspect they do the same things today. More articles on how these boards are constraining the supply of practitioners to drive up costs would be timely ammunition against the drive towards state-funded/mandated universal coverage.

  19. “…look at how expensive child birth is because of OBs and hospitals. How sad that in the land of the free we are so limited on how we choose to take care of ourselves.”

    I am staring down this barrel myself at the moment. The cost of having my baby is somewhere around $13,500 with all of the associated doctor visits, ultrasounds, blood tests, and the hospital stay. And I have a so-far uncomplicated pregnancy with zero health problems for me or baby and my OB anticipates I will be able to give natural delivery and avoid a C-section. A C-section birth would be around $20,000.

    Going the midwife route in NJ would be cheaper for me by about 3 or 4 thousand, but my health insurance company will not cover visits with a midwife since they are considered “alternative medicine” by the particular plan under which my insurer provides coverage. I cannot afford to pay a midwife (my preference for care) out of pocket, so I am at the mercy of my insurance plan to see my OB and only pay a fraction of the cost out of pocket (about $2000 by my estimate). Also, if I want my insurance co. to pay for the birth, I have to take a mandatory childbirth and parenting class for EACH pregnancy. There is some sort of racket going on here… (/sarcasm)

    How DID we ever get ourselves out of the caves without the help of doctors and insurance companies to provide for our care?

  20. “Requiring a dentist to fill a cavity is like requiring a mechanical engineer to repair an automobiles brakes.

    Sorry to all of you DDSs out there, but it ain’t even close to rocket science.”

    And my guess is you have next to no knowledge of dentistry. But don’t let that stop you from commenting on the difficulties of dentistry. Your ignorance has never stopped you before.

  21. I have been a dental technician for over 50 years. A Denturist for the last 28 years. For all these years dentist have had a monoply, it could not be considered a monoply because there was no documented profession to compete with them. Denturist are now a documented profession therefore that part of all dental statutes forbidding me to practice is in violation of the Sherman Act, as well as most state anti trust acts. I am to old to fight them any more ,but if some young energetic Denturist would file a federal law suit, there would no reason to fight the ADA any more.My experance in the U.S. Navy for ten years working in all phases of dentistry and the education I have attained since discharged makes me more than qualifed to construct full and partial dentures for the general public. I will continue until can no longer function. My fees are less than one third that of dentist, and I back my product 100%.

  22. FTN Jack.

    Alaskan Native Veteran

    Tlingit

    USN

  23. Dear editor,

    Denturist across America, are trying to provide affordable denture care service to the people that are economically disadvantaged but instead are forced to use resources fighting and defending our services.

    Here in the U.S. corporate ADA, the American Dental Association does everything it can to suppress the denturist profession across the nation, with the ADA’s monopolistic grip on dentures and their high denture prices, due to their high overhead, leaving the edentulous, denture-less, and paying the denture lab technicians pennies, for a oral prosthesis (denture) that’s worthy of artistic recognition.

    Denturists are on the front lines providing denture care to the homeless, those on a fixed or low income, the disabled, veterans and/or senior citizen. Most of the denture patients I see have been edentulous for 10 or more years and have no plans of going to a dentist because they have no natural teeth and they can’t afford the high prices dentists charge.

    People across America need a public outcry to state and U.S. legislators to support legislation so denturist can provide affordable denture service directly to the public, without harassment from the American Dental Association and state dental associations.

    Thank you for your consideration. Gary W. Vollan, L.D.

    “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
    Martin Luther King, Jr.

    P.O.Box 332
    Basin, Wyoming, 82410
    307-568-2047
    wysda.org

  24. So where is Bob Barr 08 on this? Why is it that liberterians talk theory all the time why Odumba is offering spanish lessons to the poor. Yo! RonPaulBobBarr08 you think dental hygenists might vote for you if you set them free. Nah, the freedom chant was an ideal, not something that was practicle.

  25. This commentary proves once again that what is good for society is not necessarily good for the ADA and it’s state’s components. Opposition from the ADA regarding the Alaska Dental Health Aid Therapist (DHAT) has nothing to do with substandard care of the provider, this issue is about control. The reason the ADA was opposed to UW starting a dental therapist program was because they were afraid that it would expand from Alaska to other states and infringe upon their monopoly.
    Dental therapy is a profession practiced the world over, but Alaska is the first place in the United States to have these providers. A congressional board created the dental therapist program to address the scarcity of dentists in rural Alaska, a region with tooth decay rates among the highest in the nation. The first eight therapists, trained in New Zealand because no American dental school would accept them, began working in villages in 2005.
    The ADA said they were opposed to the DHAT program because the education levels of those delivering treatment is “far below” standards in our country. Who is the ADA to say that 42 countries throughout the world who use dental therapists are providing substandard care?
    Some of America’s largest charitable foundations have spent millions of dollars to find out if the New Zealand dental health therapist experience can be replicated in this country. The Rasmuson Foundation has pumped about $1.5 million into the program. The Denali Commission donated $200,000 and the Alaska Mental Health Trust gave $77,000. Their commitments brought more dollars, including $2.7 million from the Kellogg Foundation.
    While these chairatable foundations were pumping money into a pilot program that has proved itself to reduce dental disease for rual Alaskans receiving care from therapists, the ADA filed a lawsuit against them.
    The ADA authorized an advertising campaign of up to a $150,000 to educate Alaskan natives and others about the risks of allowing non-dentists to perform irreversible procedures,” allocated over $650,000.00 to stop and/or severely modify the dental health aide therapist program, and ended up paying out $537,000 to a Consortium foundation to promote preventive dental care in rural Alaska after State Superior Court Judge Mark Rindner ruled in favor of the program.
    Just think what the million plus dollars the ADA paid out to prevent this measure from transpiring could have provided in preventive services.
    Had the ADA and Alaska Dental Society been more collaborative for a solution, instead of jumping in with litigation against the indigent students who had to travel to New Zealand for training, this entire episode could have been mitigated. The ADA is like a school yard bully who uses intimidation as a weapon and is funded by the deep pockets of it’s Political Action Committee members.
    Eventually our society, already outraged at the skyrocketing costs of healthcare and lack of dental access, will force our elected officials to change laws. Change is inevitable and the ADA can be a part of it, or get out of the way.

  26. An acquaintance, the brother of a friend, was a dentist in West Virginia. His name was Arthur Rybeck, and we were both Georgists (try Googling Henry George). He was quite an old man, and up until almost the last day of his life, he was working part time, providing cheap dental treatment to people in need. (Plenty of West Virginians are poor, a problem Georgists are trying to fix.) I seem to recall hearing that the dental gang wasn’t happy about his competing with the dentists who were trying to make as much money as they could out of their practices, but he was a licensed dentist, and there wasn’t much they could do.

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  28. I love my new repair dentures, I can finally eat in confidence and it has completely changed my life.

  29. I love my new repair dentures, I can finally eat in confidence and it has completely changed my life.

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