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‘That model is not the solution’

Dr. Olga Gonzalez “was very interested in participating in the focus group regarding dental therapists,” she told market researchers inviting her to join Chicago area dentists Oct. 27. Declining in favor of “a previous commitment” to her son’s birthday, Dr. Gonzalez offered a written response to Moderators Etc., Inc., which convened the focus group.

IMAGE: Dr. Olga Gonzalez
Dr. Olga Gonzalez

“I hope my comments, in their entirety, can be included in the discussion,” she wrote.

In response, Mediators Etc., Inc.’s Ana Rivera told her, “This was a powerful letter. Sorry you couldn’t attend,” Dr. Gonzalez said. But at the focus group, “They didn’t even bring up my letter,” she said she learned from a participant.

Dr. Gonzalez, a general practice dentist in northwest Chicago with a predominantly Hispanic patient base, told the ADA News, “I wrote the letter because I felt that with regard to the access to care problem, if anyone has something to say about it, it should be a dentist. That model is not the solution. There are too many chances for something to go wrong. I thought, what if a dental therapist had these patients? What would a dental therapist do in this situation?”

Dr. Gonzalez gave permission for ADA News use of her letter, which we offer in its entirety.

Dear Ms. Rivera,

I received your email and was very interested in participating in the focus group regarding dental therapists.  Unfortunately it is on an evening for which I have a previous commitment.

I have been practicing dentistry for over 30 years. In my experience, it has become apparent that even during the most routine procedures, complications can arise.  It is in these instances, that my doctoral education and clinical preparation dictated the course of action necessary to safeguard my patients.
  
I recall treating a patient with developmental disabilities. In the course of preparing the patient’s tooth for a restoration, I detected a change in color, of the lips and gingival tissue. Immediately, I reacted and turned the patient on her side, suctioned her mouth, and was successful in getting her to start breathing again.
  
In another instance, I was working on one of my regular patients when I detected that he had a swelling on the right side of his neck. I advised the patient to see his doctor and followed up with him. He was diagnosed with thyroid cancer and had to have surgery to remove the thyroid gland. To this day he thanks me for saving his life.
  
I also treated a patient who was a heavy smoker. My clinical exam discovered a solitary white lesion. I made an appointment for the patient to have a biopsy. He never went to that appointment. I got the patient to return to my office, at which time the lesion was ulcerated, and painless. I knew it was a malignant cancer. I called and set up an appointment with a head and neck surgeon. The patient had to have a resection of a large portion of his mandible as well as a major neck muscle. He went on to live cancer free.
  
Besides these examples, there are many instances of patients fainting, patients experiencing tachycardia and hypertension, and patients hemorrhaging. My academic and clinical preparation enabled me to safeguard my patients’ overall health. I must be aware of their physical status, as well as the risks inherent in treating them. I am a doctor not a technician of the mouth.
  
I do not subscribe to the premise that inferior care is better than no care at all. I believe the patient population with access to care issues, is also the population with limited economic resources, limited educational attainment, and more compromised medical histories. These are the most vulnerable patients, the poor, uneducated, disabled, and elderly. It boggles my mind that we should consider having this most vulnerable population treated by the least qualified provider, a dental therapist.
  
I believe the access to care problem is a public health issue. Our public health agencies should work with professional organizations and dental schools to relieve the shortage of licensed dentists in certain areas.
  
Dental schools should provide scholarships to students from these hardship areas. They would then return and practice there. Public health agencies should incorporate dental services in their clinics. There are many dentists who would work at these clinics part time. Professional organizations would also be willing to provide services to these disaffected populations through their foundations.
  
We are fortunate, in this country, to provide the best dental care in the world. Allowing unlicensed dental therapists to practice dentistry downgrades the standard of care that has become the model for dental health.
  
Dental auxiliaries are already part of the dental team. These auxiliaries have had their duties expanded to provide more direct patient care.  Under the supervision of a licensed dentist services can be provided to a greater number of people with minimal risk to patient safety.
  
I also worry that creating another tier of dental provider will allow graduates of foreign dental schools to circumvent the licensing requirements to practice dentistry in this country. They would become dental therapists and provide all services. Enforcement of the limits of what a dental therapist could do would only be applied when a complaint is made. There would not be enough oversight and patients would be harmed.
  
Allowing dental therapists to practice dentistry would also encourage private dental insurance companies to adopt the therapist model. They would dictate that patients be seen by dental therapists. This would result in an overall decrease in the standard of care in this country.
  
In conclusion, I believe a scaled down dental education to a dental therapist would jeopardize the health and safety of the public. This is not the answer to the access to care issue.
  
Ms. Rivera, I regret I could not attend tonight’s focus group. I hope my comments, in their entirety, can be included in the discussion.
  
Sincerely, Dr. Olga Gonzalez