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Letters: Need more of ADA view

June 18, 2012

OK, when I read the April 23 ADA News article, "ADA’s View of Access Solution Differs From Kellogg Report," I was looking for more of the ADA’s view. Any dentist seeing "Kellogg report" at this point should have some idea of what they will be seeing: access to care, and one of their solutions to it, dental therapists.

The creation of dental therapists, as currently proposed, will provide for a high school graduate, with 22 months training, to be able to do irreversible and surgical procedures without direct supervision. In other words, nondentists will be doing dentistry. This will be the creation of two-tiered system in dentistry. Is this the best we can do for the underserved in America?

The article stated that the ADA will submit a letter to the editor offering dentistry’s dramatically different view, but it would be at ADA.org. Without a more complete ADA response, I felt the article became more of an advocacy piece for the Kellogg report. I read that former Health and Human Services Secretary Louis Sullivan, M.D., was in favor of dental therapists. The principal author of the report, Dr. David Nash, stated that of the 1,100 documents, there was no compromise to children’s safety or quality of care. He wrote the report and was also in favor of dental therapists. Naturally, we were given his side of the controversy.

The ADA has already shown that there will be no shortage of dentists in the future. Dental workforce size is not a problem now, nor will it be in the predictable future. The problem is where the dentists are in relation to the underserved populations. There are solutions that exist and others are being tested. The National Health Service Corps, the Indian Health Service and the loose network of federally qualified health centers use various combinations of incentives to place dentists in underserved areas. The greater problem is that the states and federal government have reduced funding for Medicaid and other programs. They are also trying to provide care to more people, while reducing the money to pay for their treatment. Since they are reducing money for care, how will they fund new programs for schools, training and salaries for dental therapists?

So what I wanted from the ADA are facts as to whether dental therapists are the solution or not? Does it really work in the 54 countries cited? I have since seen the ADA response and it is good, but I would like it available for all to see. We must have evidenced-based data and the facts to refute the Kellogg report. In an Academy of General Dentistry webinar, Drs. Carter Brown and Mike Bromberg gave information on two programs. The following is an excerpt from the webinar that was published in the January AGD Transcript:

"New Zealand’s oral health has seen an overall decline even though the dental therapist program has been in place for decades. According to Dr. Brown, the therapist model there has also not been shown to be an economic success either. ‘There is significant evidence suggesting that there is a large amount of unmet dental care in New Zealand. In the dental health survey of 1988, it was found to be as high as 33 percent. The dental health survey results published in a December 2010 report, A Progressive Dental Health Policy 2011, the House of Representatives, New Zealand, show that this level has grown to 44 percent,’ [said Dr. Brown.] These dental therapists are also utilized in Australia. According to Quarter of a Century of Change: Caries Experience in Australian Children, 1977-2002, a report in the Australian Dental Journal 2008 by School of Dentistry, Faculty of Health Sciences, the University of Adelaide, South Australia members JM Armfield and AJ Spencer, ‘Since the mid to late 1990s, deciduous 6-year-old decayed, missing or filled teeth has increased by 24 percent and 12-year-old DMFT has increased by almost 15 percent. Reductions in caries experience of those children with the most disease have also ceased, and between 1999 and 2002 an increase in the Significant Caries Index occurred.’ "

We need all the help we can get, as the foundations, the public health lobbies and many dental schools are supportive of midlevel providers. The Kellogg Foundation has pledged $16 million over three years to promote the expansion of midlevel providers in Kansas, New Mexico, Ohio, Vermont and Washington. This year legislation failed in these states, but they will be back!

Mel Kessler, D.D.S.

Editor’s note: The ADA has two significant studies under way: one looking at the economics of new workforce models and a systematic review of the literature related to new workforce models and their impact on the oral and cost effectiveness on the health of the population.