Therapists Treat the Dentist-Neglected cheaply & effectively

Aurora Johnson, left, a dental therapist, filled cavities for Paul Towarak, 10, in the village of Unalakleet, Alaska.

Organized dentistry opposes any group that infringes on their lucrative monopoly, even though a dental health crisis has occurred on their watch

[Darrell Pruitt DDS]

It is not dentist’s fault that there are poor people in the world. Let us work together to solve this problem. You might be surprised by the number of generous and compassionate members in my profession.

I must ask. Is doing just about anything for the poor better than doing nothing at all? The answer could surprise you.

Even if Aurora Johnson, the dental therapist who is shown doing a filling on a child, always removes all decay before carefully and expertly placing fillings, sometimes decay is so close to the pulps that teeth become infected anyway. It happens. When the child is in pain from the intense pressure that builds on the inside of the tooth - caused by gas that infective bacteria produce, what can Ms. Johnson do then? After all, she was the one who put the cork in the bottle.

If she had done nothing at all, the tooth would have eventually decayed to the point where even though it would have still become infected (possibly sometime later), the pressure would have perhaps painlessly drained through the hole caused by the reliable progression of the decay. The tooth would still eventually rot away, but the child would have suffered less pain, less swelling and less chance of life-threatening complications.

How well trained is Ms. Johnson for emergency follow-up care? Can she do root canals? Or is she allowed to do only “simple” extractions, and will she know the difference before she gets half-way through one? I have been a dentist for 26 years with a tremendous amount of experience in pulling teeth. I still don’t know when a root is going to break off before it happens.

If the root tip of an upper tooth breaks, can Ms. Johnson safely retrieve it from the floor of the sinus? What happens if the tooth is a lower one and the root tip is lost in the canal that carries major nerves and blood vessels? Even worse, does Ms. Johnson know what happens if a piece of an infected tooth makes its way into the mediastlnal space? Does she even know where that space is located on the human body?

American dentists are very likely to want to help the nation serve the less fortunate with the very best care possible. Lack of adequate care is a social problem with drastic consequences if rationale is not observed. This is not a turf war. I, for one, will not accept the blame for it. Darrell Pruitt DDS

[Darrell Pruitt DDS]

nyscof, you make some very serious anonymous accusations. Darrell Pruitt DDS

[Darrell Pruitt DDS]

Why do you hide?

[Darrell Pruitt DDS]

I would say, "Nyscof. That is an odd name."

[Darrell Pruitt DDS]

Concerning dental therapists, I have copied below a New York Times letter to the editor from Dr. Mark Feldman, President of the American Dental Association. Darrell
http://www.nytimes.com/2008/05/06/opinion/l06...

Standards of Dental Care
Published: May 6, 2008
To the Editor:
Re "Dental Clinics, Meeting a Need With No Dentist" (front page, April 28):

Whether it's Alaska Natives, residents of other rural areas, nursing homes or other institutions, or people who simply can't afford care, too many Americans suffer with untreated dental disease.

Unfortunately, some well-intentioned advocates for improving dental access support having people with considerably less training than dentists performing complex surgical procedures.

You characterize our opposition to these experiments as financial self-interest. In fact, we simply don't want patients exposed to complex surgery performed by people who lack the training to cope with unforeseen complications. And we work every day to find safer, better solutions.

An obvious one is to fully support what's been proved to work: adequately financed Medicaid dental programs, oral health education, community water fluoridation, school sealant and other prevention programs, and incentives to help locate dentists in underserved areas.

It's neither right or necessary to relegate people who live far away or who are poor and whose lives are different from ours to a lesser standard of care. A.D.A. members are committed to solving access disparities without needlessly shortchanging the most vulnerable Americans.

Mark J. Feldman
President, American Dental Association
Chicago, May 2, 2008

[Sean P Drower DMD]

nyscof: It sounds like you are advocating a tiered system of dental care where those who cannot afford dental care at a full fee dental office will get care at a clinic by a lesser trained, albeit good hearted, dental therapist.
What the ADA position states is that everyone should have equal access to care - the same level of care regardless of race, creed, or income. Dr. Pruitt points out the difficulty a dental therapist may run into trying to provide a level of care equal to a dentist trained at a four year institution. A dentist is really a physician of the oral environment, which includes the jaw joint, associated musculature, teeth, and soft tissue. It takes this specialized training to provide the high level of skill, care, and diagnosis that you, nyscof, should demand of someone working on your oral care.
Rather than spend an untold of amount of money to create a parallel oral health system for the poor, we should be funding state and federal Medicaid type programs to provide fair compensation to dentists. These dentists already have the training, staff, and equipment to provide high quality dental care to the poor. It will take less taxpayer money to fix the current system and incentivize dentists to provide subsidized care for the poor than it will to create a new bureauracracy of advanced dental practicioners, dental therapists, and advanced hygiene practicioners.
Dentists do not want to see oral health care delivery fragmented. Patient care and health will suffer.

[Darrell Pruitt DDS]

You are not even wrong, nyscof. Darrell Pruitt DDS