Selected words of wisdom from Howard Bailit*
“… the basic problem in dentistry is the … under-served populations do not have the personal financial means to purchase services ….Even those covered have difficulty getting treatment because of low Medicaid reimbursement rates…. just increasing the number of dentists or midlevel professionals will not solve the disparities problem.…The debate about a new type of oral health professional needs to end….dental therapists will become part of the dental workforce, [but] it will take 10 years or more to produce the numbers to significantly affect the child access problem….Many…patients can be seen at intervals longer than the conventional 6 months with minimal health risks. By changing visit intervals, practices can treat more new patients…. productivity of dentists can be substantially increased….the current dental delivery system has the capacity to care for several million more children from low-income families.….Underserved populations do not have to wait until dental therapists are available.”
*From the recently released IOM report on The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. (p. 98-99) [Available at http://www.nap.edu/catalog/12669.html. (Download free PDF)]
Editor’s comment: The IOM report is long on stating the problem of access and the provision of adequate care to the “under-served.” It has a good section on dental therapists in other countries and in Alaska. But the report is short on specific recommendations. Howard’s suggestion that the capacity of the dental delivery system could be increased significantly by eliminating the 6-monthly exam/visit (as long advocated by Aubrey Sheiham and yours truly), as well as worthless prophys, radiographs, and other FUN (functionally unnecessary) procedures is commendable.
How to change the mindset of the practicing profession? How to change the patterns of practice? Reason alone, i.e., evidence-based practice, will not do it. If the dental insurance industry, including Medicaid, adopted a policy of covering only an annual exam and prophylaxis ― documented emergencies and periodontal disease excepted ― the capacity of the work force to treat more patients would be automatically expanded. Of course, this would only work if the “financial means to purchase services” is provided for those who otherwise cannot access oral health care.
Millions more children from low-income families will not be cared for without resolving the geographic maldistribution of the oral health work force, eliminating the social barriers, and accommodating to the non-ambulatory characteristic of children. For this, we need not only evidence-based practicing dentists and hygienists who can treat more patients, but also dental therapists for those they cannot or will not treat.