The American Dental Association appreciates the mounting media interest in what Surgeon General David Satcher, M.D., famously called a “silent epidemic” of oral disease. Unfortunately, the situation has improved little since Dr. Satcher wrote those words in 2000. The needless suffering caused by untreated dental disease that could have been prevented or easily treated in its early stages is unacceptable. Coverage by PBS’s “Frontline” and other media can increase awareness of this ongoing tragedy and, we hope, the political will to do something about it.
We regret, however, that “Frontline” chose to title its program “Dollars and Dentists,” and devoted so much of its air time to the debate over allowing so-called “dental therapists” with as little as 18 months post-high school training to perform surgical procedures like extractions and pulpotomies (drilling through the hard tooth surface and removing soft tissue). The ADA believes therapists’ training does not adequately prepare them to do so. This is especially true for the populations in greatest need, in which many people suffer from co-morbidities like diabetes and obesity, or for children with rampant decay and the accompanying chronic infections.
We also are concerned that “Frontline’s” focus on allegations of Medicaid fraud and abuse may create negative and erroneous impressions about the larger sphere of Medicaid providers. Of course, any dentist in any practice setting should adhere to the profession’s self-imposed ethical standards, and should be subject to the laws and regulations of the state in which he or she practices. But we must not let a few bad actors tarnish the work of thousands of honest, caring dentists who treat Medicaid patients, often for breakeven or even negative revenues. They do so because they feel a responsibility to provide care to people whose economic circumstances would otherwise prevent them from receiving it. Further, many dentists who cannot afford to participate in Medicaid or wrestle with its often onerous paperwork instead treat needy patients for free. One estimate has U.S. dentists providing some $2.6 billion in free or discounted care in a single year.
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. A
public health system based primarily on surgical intervention in disease that
could have easily been prevented is ill conceived and doomed to fail. Until we
shift the focus to oral health education and disease prevention, the country
will fail to meet the needs of those who face the greatest barriers to good