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From the ivory tower: Changing times for dentists and teeth

Jan. 1, 2008
On October 11, 2007, the title of an article in the New York Times read: “Boom Times for Dentists but Not for Teeth.
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By Edward F. Rossomando, DDS, PhD, MS, and Mathew Moura, BA
On October 11, 2007, the title of an article in the New York Times read: “Boom Times for Dentists but Not for Teeth.” The article stated that “The dental profession’s critics — who include public health experts, some physicians and even some dental school professors — say that too many dentists are focused more on money than medicine” (New York Times Oct. 11, 2007, sec. Business). The article dealt with the growing concern that not enough Americans have access to oral health care; however, the article focused upon “dental greed” as the major factor in this epidemic.

New models for delivering oral health care

Mark J. Feldman, the President of the American Dental Association (ADA), responded that the dental industry has long made charitable donations to programs such as Give Kids A Smile, Missions of Mercy, and Donated Dental Services, while acknowledging that “ultimately, charity won’t solve this [problem].” Dr. Feldman continued, “That’s why the ADA continuously advocates repairing the tattered oral health safety net. On that score, the Times let the government off too easily. The ADA fought successfully to include a dental benefit in the SCHIP bill currently before Congress, and we regularly work with state dental associations and state oral health coalitions to improve their Medicaid and SCHIP dental programs.”

Though the NYT editorial focused on “dental greed” and Dr. Feldman voiced concern that government programs simply are not enough, perhaps there is an alternative for enhancing oral health care access to underserved populations.

Access in the medical field has recently been enhanced through a service known as MinuteClinic, which operates inside CVS drugstores in New York, Connecticut, and Massachusetts, raising some alarm for its providing of routine medical treatments by nurse practitioners. The clinics are able to prescribe medications such as antibiotics, certain creams, and cough syrups. The clinics also provide vaccines at a cost of $65, advertising that such vaccinations often cost over $300 at a general practice. The Convenient Care Association, which operates and owns MinuteClinic, expects the number of facilities to double by year’s end.

In the dental profession, as described in Time magazine, access has been enhanced through a service known as Vital Dent, which shares many similarities to MinuteClinic.* This delivery method allows for those who do not have the means to afford out-of-pocket expenses, and when surrounded by dental practices that do not accept insurance reimbursements, to have access to oral health care.

It is important to understand that Vital Dent and MinuteClinic are designed to fill a particular market niche. This market “niche” in America, however, includes, according to the Surgeon General’s Report, 108 million people without access to oral health care and the 40 million Americans without health insurance of any kind.

The benefit of such services is that many without health insurance are able to gain access to routine procedures. Even those eligible for government programs such as Medicare and Medicaid, an ADA report noted, “inadequate reimbursement is the most significant reason that dentists do not participate,” a rationale echoed in the NYT article. Such services as MinuteClinic and Vital Dent may provide a low-cost alternative or complementary option for Medicare and Medicaid, relieving some of the financial strain that has been placed on these programs. Therefore, it would be economically beneficial for the government to supplement Medicare and Medicaid with services such as MinuteClinic and Vital Dent in order to increase coverage for the American public.

The dental profession in a new market

Despite the opportunities MinuteClinic and Vital Dent offer the American public, the dental profession can utilize new technologies and management practices to allow for dental practices to become more efficient and more capable of responding to the changes in the delivery of oral health care.

In 2002, the National Institute of Dental and Craniofacial Research (NIDCR), a component of the National Institutes of Health, funded an initiative to encourage research and training to identify educational programs that would promote the transfer of new bio-based discoveries from the research laboratory to the dental practice. One of the programs funded was the Biodontics Educational Program (BEP) at the University of Connecticut (UCONN) School of Dental Medicine (SDM).

The program informs students of the profession’s history, current challenges, and future trends. From visiting dental material manufacturing companies to guest lectures on malpractice cases, students are shown all aspects of the dental profession. From the program’s emphasis on innovation and entrepreneurship, students learn to respond more sensitively and more critically to various opportunities within the profession.

Greater efficiency and new technologies can allow for dental practices to see more patients and offer a different kind of care than services such as Vital Dent; thus, the private dental practice can remain profitable and relevant in the changing market. Also, it will allow for greater access to oral health care for those who are uninsured or underinsured because the dentist can see more patients and provide better, less expensive care by transferring cost savings gained by greater efficiency.

* Editor’s Note: (For information on MinuteClinic and Vital Dent, please visit: and

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Dr. Rossomando is the professor and director of the Center for Research and Education in Technology Evaluation (CRETE) and the University of Connecticut School of Dental Medicine in Farmington, Conn. Reach him by e-mail at [email protected].