Dear RDH:
I lived through all the EDDA, EFDA, and ASH controversies of the 1960s and 1970s. The comment that "no one seems quite sure about the history of the EFDA" in the "Three`s a crowd" article (August 1998) made me feel sorry for those who missed the excitement of that period. If one searches the literature of the times, there are innumerable articles on the subject. The first research, if I recall, was done in Canada, but several U.S. universities, the Indian Health Service, and some other federal and local health agencies were also involved. What follows is a direct quote from a 1978 "TEAM" RFP, which sums up the history:
Federally supported efforts to encourage the effective utilization of auxiliary personnel by the dental profession have extended over many years. From 1961-1972, federal grants were awarded to schools of dentistry to support programs for teaching dental students to utilize dental auxiliaries efficiently. The first effort, known as the Dental Auxiliary Utilization (DAU) Program, has been successful in promoting improved delivery of services through training in "four-handed dentistry." DAU programs have been developed in all dental schools, and teaching four-handed techniques is a growing priority in dental auxiliary programs.
From 1964-1970, studies were conducted at the Dental Manpower Development Center in Louisville, Ky., to investigate the feasibility of expanding the functions of dental auxiliaries. Other federal and non-federal research has similarly been conducted.
In response to P.L. 92-157, the Division of Dentistry initiated the Expanded Function Dental Auxiliary Program in 1972. Through 1977, 83 EFDA projects were supported in eight of 10 DHEW regions under provisions of federal legislation through the contract mechanism. In fiscal year 1978, this program became a grant program administered by the Division of Dentistry, Bureau of Health Manpower, HRA, PHS.
I visited the Louisville project and have slides to prove it. I also testified before the Federal Trade Commission, which was, at the time, investigating dentistry`s restrictive practice in opposing the use of these proven-to-be-effective para-professionals. Much of organized dentistry saw them as an economic threat. Traditionalists feared that dentists using them could cut costs and thereby beat the competition - shades of the "Amalgam War."
Today, managed care makes dentist extenders attractive. Gone are the claims of potential poor quality or second class service. Indeed, I know practitioners who don`t know why they were so opposed to EDDAs in the 1970s and 1980s. They would now not only give them many of their dentist functions to perform, but most of mine as well. What goes around comes around, I guess.
I also recall the Forsyth ASH (Advanced Service Hygienist) Project. Here, hygienists were taught to "drill and fill teeth" much as dental nurses do for children in many other countries. This federally funded project was closed down by a legislative action. It lived long enough to prove, however, that hygienists could be trained to provide such services with no significant technical quality differences from dentists. I guess we can wait on that one to come around, but given the ongoing neglect of our children`s teeth and the development of new restorative technologies, who knows? I just might live to see it.
D. Jean Lewis, RDH, MH
Farmington, Connecticut
Editor`s note: Ms. Lewis kindly provided an abstract about the Forsyth study. But instead of printing it here, we merely encourage readers to skip over to Trisha O`Hehir`s column this month. The Periodontics column addresses this ASH program, and it certainly makes for interesting reading.
