Editor's Note

March 10, 2014
I recently had the pleasure of working with the National Dental Association on a supplement about the association's 100th anniversary.

By Mark Hartley

I recently had the pleasure of working with the National Dental Association on a supplement about the association's 100th anniversary. The supplement appeared with Dental Economics magazine, a sister publication to RDH. Dr. Hazel Harper, a dentist in Washington, D.C. (and a former NDA president), did most of the hard work, so it was a fairly painless process for me.

A small fraction of the supplement addressed the American Dental Association's apology to the National Dental Association in 2011. The belated apology for "past membership discrimination" was based on "discrimination demonstrated by a number of state societies and local societies in the years before 1955." The ADA embraced diversity that would "reduce oral health disparities that have plagued our nation along racial, ethnic, and socioeconomic lines." In its conclusion, the apology stated, "Working together, the ADA and NDA can bring more talented young people to careers in dentistry, more treatment to people in need, and a more united profession to advance the oral health of all Americans."

Almost three years later, the ADA seems to oppose any ideas to improve access to care except its own.

Numerous proposals have been made to boost access to dental care in underserved areas by a variety of dental professionals and organizations. The ADA likes to "question" "economic viability" and public safety issues associated with each proposal. In addition, the ADA typically states proposals are "redundant," since, of course, its own ideas would prevent deaths and edentulism due to dental neglect.

Several female dentists in Maine and New Hampshire wrote letters to the editor at local newspapers about midlevel proposals this past winter in those two states. Almost all of them seemed to be former hygienists, very eloquently opposing midlevel providers. The former hygienists imparted the message to New Hampshire residents that dentists are busy working to improve access to care. (Once they have figured out economic viability, of course.)

I think my personal annoyance over the proposed midlevel provider legislation in New Hampshire and Maine stems from a social media contact. A Kansas hygienist, who had not been in the profession very long, posted online that she was now a nurse. So I asked her why:

"I have kept my dental hygiene license up to date. I, however, could not find gainful employment in my community due to an oversaturation of dental hygienists in northwest Kansas. I would love to be in a health department or function in a hospital/nursing home as a health-care coordinator. I miss hygiene and look forward to working in the field in some way in the future."

Not all of the proponents of midlevel providers are female. But many of them are, indicating they are willing to venture into underserved areas to provide needed care. I sometimes think the ADA should apologize to female dental professionals too. The association is dismissive of innovative ideas, disrupting well-intentioned careers simply because a dentist didn't provide the solution.

A headline in the Foster Daily Democrat read, "Maine, N.H. proposals blur line between dentist, hygienist." The headline can make us cringe, since we know that's what dentists fear. A short headline explaining that hygienists and dental therapists would be where dentists are not is hard to do. I actually commend the article, though, since the author did a good job of presenting both viewpoints about the issues surrounding midlevel providers. I would like to close with two comments in the article from the state senator who introduced the New Hampshire legislation.

Senator Peggy Gilmour described dentistry as being the last health-care profession to embrace other types of providers. She was quoted as saying, "It [dental midlevel providers] will change eventually. I think part of that change is us looking at how we deliver that care, and other ways we can make that care safe, efficient, cost effective and available to New Hampshire residents."

She also commented on the health care of residents in underserved areas: "They do not get any preventive or restorative care when they go to the emergency room. They only get antibiotics for acute infections. That's wasted money, and it's not an efficient use of the health-care system."

So, yes, I do think it's time that the American Dental Association apologize for its stubbornness in refusing to address valid access-to-care solutions.

Mark Hartley
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