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MyView: Offering a public health perspective within organized dentistry

By David Holwager, D.D.S.

Public health dentistry is very much a part of organized dentistry and organized dentistry plays a critical role in the efforts of our public health colleagues. It should be acknowledged that the American Dental Association has played a major role in advancing key elements of the public health agenda, including the reinstatement of the Division of Oral Health to full division status within the Centers for Disease Control and Prevention and tuition support by the Health Resources and Services Administration for dentists pursuing graduate training in public health. The ADA remains a major champion of community water fluoridation and has adopted a leadership role in promoting evidence-based preventive dentistry. The ADA’s Center for Evidence-Based Dentistry continues to make important contributions to prevention in clinical practice through the issuing of recommendations, such as the appropriate use of topical fluorides and dental sealants.

To a large extent, dental public health has contributed to its own visibility challenges through limited participation in component and constituent dental societies. There are many reasons for that level of participation, but the net effect is that public health dentists are largely not personally known to the leaders and rank-and-file members of local and state dental societies. Not only has this course of action led to a lack of understanding at the grassroots level among the broader dental community of what dental public health is and what public health dentists do, it virtually ensures that public health dentistry is largely absent within the leadership of the ADA.

The House of Delegates is the policymaking and supreme governing authority of the ADA. The managing body of the ADA is its Board of Trustees, composed primarily of trustees from each of its 17 districts. As committees of the HOD, the councils are the primary work units within the ADA, composed primarily of members from these same 17 trustee districts. As the ADA’s national leadership is derived from the tripartite system of membership, low participation by dental public health at the grassroots level means that it will not be well represented inside the ADA’s leadership within the HOD, the councils and on the Board of Trustees. In short, organized dentistry at the local, state and national levels is largely led by dentists who have had little interaction, if any, with public health dentists over the course of their careers.

Unquestionably, new high-profile issues will continue to emerge on which there will be substantial differences in opinion among dentists in private practice and those in public health, just as there continue to be areas of disagreement between general dentists and dental specialists. However, rather than remaining sequestered in separate camps only to venture forth to fight the occasional skirmish in the "no man’s land" of public opinion, there is a better way.

Through collaboration based on mutual understanding and respect, all parties seek to find common ground. Such was the environment envisioned when the idea arose within the Council on Access, Prevention and Interprofessional Relations to build bridges of communication between the worlds of primarily private practice-oriented organized dentistry and primarily public sector-based public health dentistry.

By 2006, the ADA had already taken several steps to enhance its competence in community oral health and strengthen linkages with the dental public health community. Staff with appropriate backgrounds in dental public health were recruited and hired. These individuals provide significant expertise in this important discipline of dentistry.

In 2009, CAPIR started an initiative to more formally enhance the voice of public health within the ADA by developing a Public Health Advisory Committee. From its inception, PHAC was envisioned as a group of public health professionals who could serve as a sounding board for CAPIR, make recommendations to the council, and work proactively to promote public health perspectives and priorities within the Association. PHAC members include Reginald Louie, D.D.S., M.P.H.; Donald Marianos, D.D.S., M.P.H.; Kathleen Mangskau, R.D.H., M.P.A.; Hugh Silk, M.D.; Scott Tomar, D.M.D., M.P.H., Dr.PH.; and Robert Weyant, D.M.D., Dr.PH., while CAPIR member Eleanor Gill, D.M.D., serves as the liaison between PHAC and CAPIR.

The inaugural meeting was held in August 2009, at which PHAC articulated its vision: "Overall health and public health perspectives are fully integrated into all aspects of ADA policies." The PHAC defined its mission as "advising the council on effective strategies, which promote the full integration of overall health and public health perspectives." During its first two years, PHAC offered a substantial number of recommendations to CAPIR, provided frequent feedback on issues facing CAPIR, and developed an educational module on dental public health. That educational module is now required reading for all members of the ADA Board of Trustees and members of all ADA councils.

Perhaps the most valuable contributions of the PHAC are its alternate perspectives and its demystification of public health within organized dentistry. To this end, PHAC is helping the parallel universes of public health and private practice to find a path of intersection—or at least to better understand each other’s worlds. A quotation from President Lyndon Baines Johnson’s 1964 State of the Union Address in many ways captures the very essence of why CAPIR chose to establish a PHAC: "If we are to live together in peace, we must come to know each other better."

Dr. Holwager is the chair of the ADA Council on Access, Prevention and Interprofessional Relations. His comments, reprinted here with permission, appeared in the August issue of the Journal of Public Health Dentistry.