“Dollars and Dentists” by FRONTLINE in association with the Center for Public Integrity, premiered last night on PBS. The investigative program focused on access to care by the poor and Medicaid fraud by larger group practices. It is hard as a dentist to not be frustrated by their portrayal. There are a multitude of factors that contribute to rampant dental disease. Lack of care is only one of them. The ADA's response to this program mirrors this sentiment:
“There are right ways and wrong ways to improve access to dental care in America. The right way is to understand that while oral health care is essential, the ultimate goal is oral health. The right way is to recognize that there are multiple barriers that impede tens of millions of Americans from attaining optimal oral health, including geography, culture, language, poverty and, in the larger sense, a societal failure to value oral health. Taking on just one of them won't work; we must continue to approach the problems holistically. The wrong way is to invest solely in therapist programs that other countries have used for decades, with little appreciable effect on their rates of oral disease.
The country will never drill, fill and extract its way to victory over untreated dental disease.”
Simply allowing wholesale adoption of dental therapists is not a silver bullet. As every dentist knows, no single dental procedure is ever exactly the same. Changes to the course of treatment occur frequently. How will a dental therapist handle a situation that becomes surgical without the training of a dentist? I am not necessarily opposed to their role in a preventative role but the last line of the above quote sums the situation best.
It will take comprehensive reform to increase access to care as well as education initiatives to properly address this issue. Currently, we are incentivizing the wrong behaviors on the part of the patients as well as the dentists and the situation needs to be reformed. Let us know your thoughts below.