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State needs dental solutions other than a new layer of therapists

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Accurate diagnosis is vital to properly treat an ailment. This is true for dentists and for legislators. I do a patient no good, for instance, if I pull a tooth when a filling is needed.

The right diagnosis is also necessary before we can knock down the barriers that rural and low-income Arizona families face in receiving oral health care.

jones-gary

Gary Jones

An out-of-state foundation sees access as a workforce problem. The state doesn’t have enough dentists, it argues, so it wants legislators to create a new mid-level position. These dental therapists, with only three years of post-high-school education, could perform irreversible surgical procedures such as cutting and removing teeth. This, the out-of-staters say, will solve the access problem.

They’re wrong. Arizona has no shortage of dentists. There are 15 percent more dentists practicing in the state today than 10 years ago – a net increase of 599 dentists. And we already have more dentists per capita than the projected national average by 2035. Adding another layer of health providers, with all the new costs that entails, would not solve access issues.

The correct diagnosis leads to the correct answer. We need more prevention, not more drilling. Here’s a better prescription:

— Gov. Doug Ducey and lawmakers can start by restoring dental care for adults using AHCCCS, which was zeroed out during the Great Recession. As a result, those suffering from tooth pain turned to emergency rooms, where there are no dentists. Doctors treated the pain or infection, but not the underlying dental problem — guaranteeing that those patients would return. That is neither financially nor morally defensible.

— Dental care for children on AHCCCS is covered, but less than half of eligible families use the benefit. We need to get more children to the dentist through education and outreach.

— Community dental health coordinators, a relatively new approach championed by Arizona dentists, show a great deal of promise. They come from the local community and understand the local culture. They can work with their neighbors to take control of their oral health, provide preventive services and connect people with dentists and hygienists, making sure they show up for appointments.

A five-year pilot project showed these coordinators make a real difference. Rio Salado Community College, which provides the training, just enrolled its second class. Let’s give this time to work.

— Teledentistry is another answer, also recently approved by the Legislature. This allows dentists to extend their reach into remote areas, removing another barrier by erasing the need for families to make repeated, long trips to a city.

I am a lifelong Republican who believes in free-market solutions. Those places that have experimented with dental therapists have found they can survive only with extensive government subsidies. The free market does not see them as a solution.

This is not surprising because adding dental therapists rarely address the real barriers to seeing a dentist. The right diagnosis leads to the correct treatment: restore AHCCCS benefits, get children to the dentist and give community dental health coordinators and teledentistry time to work.

— Dr. Gary Jones practices in Mesa and is a past president of the Arizona Dental Association.

3 comments

  1. The Guest Opinion ”State needs dental solutions other than a new layer of therapists” by Dr. Gary Jones is full of misinformation about dental therapists as one of the solutions to improve access to oral health care in Arizona. Just to name a few: 1) “An out-of-state foundation sees access as a workforce problem”. Not True- Local, grassroots people, supported by the PEW Trusts, see improving access with dental therapists as one of the solutions to improving access to dental care, not the only solution. 2) “These dental therapists, with only three years of post-high-school education, could perform irreversible surgical procedures such as cutting and removing teeth.” Irreversible surgical procedures is a term only meant to scare the public. What Dr. Jones did not tell you is that 100 years of international experience, 12 years of Alaska experience and 4 years of Minnesota experience and even the American Dental Association says that these dental therapists can provide safe and effective dental care within their scope of practice. 3) “Arizona has no shortage of dentists.”. WRONG! Federal reports clearly document a shortage and maldistribution of dentists in Arizona. 4) “Community dental health coordinators, a relatively new approach”. Early results do appear promising for the role of these new oral health workers but there is little actual published evidence yet and no evidence that they will work effectively in private dental practices. 5) “Teledentistry is another answer”. Teledentistry cannot deliver services, only consultations and education. 6)” free-market solutions. Those places that have experimented with dental therapists have found they can survive only with extensive government subsidies. The free market does not see them as a solution.”. The BIGGEST misstatement. Free Market groups do support dental therapy and dental therapists in practice do not receive subsidies. 7) “adding dental therapists rarely address the real barriers to seeing a dentist.”. WRONG. If Dr. Jones would take the time to read the published evidence, he would see that dental therapists do solve part of the access to dental care problem.
    The sad thing to me is that dentistry prides itself as an evidenced based profession but critics of dental therapy refuse to read or correctly interpret the evidence.
    Frank Catalanotto, DMD
    University of Florida College of Dentistry
    Unpaid consultant to PEW Trusts

  2. Allen Hindin, DDS, MPH

    Dr. Gary Jones writes that dental therapists, represent an unacceptable risk to the oral health public. He additionally states that there is no access to dental care problem in Arizona. This, from one who describes himself as a believer in “the free market.” He would deny Arizonans a choice to select dentist led teams employing dental therapists and would prevent dentists from employing dental therapists, even if they wanted to. Tell me this is not control over the “free marketplace.”

    Can anyone imagine physicians similarly attempting to prevent creation of EMT, Paramedics, PAs or Nurse Practitioners, claiming them to be unsafe? Keep in mind that 40 years ago, there were none of these types of physician extenders to be found. At least organized medicine did not aggressively attempt to prevent their evolution.

    The Commission on Dental Accreditation, which accredits all of dental education nationwide, after much investigation, debate and several public hearings, has recently adopted standards for dental therapy education. These standards are consistent with those used to accredit dental schools. Dr. Jones may believe whatever he wishes, but in the interests of truth, readership should know the whole story. Organized dentistry has fought against research and use of dental therapists throughout America, even though studies worldwide, since 1921, have repeatedly shown them to be as safe as dentists, when performing their relatively narrow scope of services. Therapists in Alaska and Minnesota, with tens of thousands of clinical services performed have repeatedly shown themselves to be safe, competent and culturally tuned in. Populations long under served are now being served, by a dentist supervised individual, who costs no more than 10% of what it costs to create a dentist. They make it possible to run a practice successfully, while accepting significantly less that what usual and customary fees have been.

    Just because Dr. Jones claims to be a “free market believer,” does not really make him one. His questionable claim, that dental therapist based programs succeed only with taxpayer support, ignores the very real fact that much of dental education in America is supported. NIH grants to dental schools are one example, state funding another. Graduate dental education; residencies in general and specialty dentistry, are frequently recipients of federal CMS pass through funds, often $150-200,000/yr per position. Perhaps Dr. Jones does not know, simply does not consider taxpayer support of dentists education inappropriate.

    What Dr, Jones, as a former President of the Arizona Dental Association, must know is that there is not one study supporting his claim that dental therapists are unsafe and that CODA accreditation is coming, blowing the claim that therapists will be unsafe, out of the water.

    As a health professional, has a duty to be truthful, among other things. While some may claim my words are nothing more than another opinion, I sincerely hope that your readers and staff will seek evidence, before jumping to any conclusion regarding dental therapists and what they might do for Arizonans, who have difficulty in accessing basic dental care. Even a little investigation will lead them to appreciate the noble task Kellogg has undertaken, in the face of misinformation, disinformation and an apparent high level of incuriosity on the part of organized dentistry.

    Allen Hindin, DDS, MPH
    Danbury, CT

  3. Dr. Jones’ conclusions corroborate his own faulty logic. In his essay, Dr. Jones obfuscates and conflates incongruous issues in an effort to confound and instill fear in the public regarding dental therapists. This is nothing new. To paraphrase conservative Supreme Court Justice Samuel Alito, professionals often act in ways that serve their own interests and not those of the public.
    “An out-of-state foundation sees access as a workforce problem. “
    This common phrasing used by authoritarians to upset and alarm listeners ignores the facts that many in-state advisers agree with these advocates, and that out of state experience can be used as a guide. Dr. Jones further claims, against the conclusions of those who have actually employed dental therapists, “those places that have experimented…have found they can survive only with extensive government subsidies.” How would Dr. Jones, an out-of-stater to Minnesota and Alaska, be in a position to comment on what works in those states? Either he believes an out-of-stater is in a position to comment or he does not. He cannot have it both ways.
    “We need more prevention, not more drilling.”
    We certainly do, but that does not preclude the need for someone to do the drilling until the need has subsided.
    Dr. Jones asserts Arizona has no shortage of dentists because there are 15 percent more dentists practicing in the state today than 10 years ago and there are already more dentists per capita than the projected national average by 2035. Neither of these statistics proves nor disproves sufficiency. (“Uganda has no shortage of food because there is more food in the country today than 10 years ago and there is already more food per person than the projected African average by 2035”-would anyone agree with this statement?)
    “Teledentistry … allows dentists to extend their reach into remote area, removing another barrier by erasing the need for families to make repeated, long trips to a city.” This testimonial specifically supports rather than refutes the need for dental therapists! Telemedicine requires someone at the other end of the connection to perform procedures in place of the primary provider. Only dental therapists are qualified to perform restorations and extractions, thereby extending the reach of the dentists. Dr. Jones claims we must give teledentistry the time to work, but how does he expect that to happen if we don’t give it the resources first. “Accurate diagnosis is vital to properly treat an ailment,” he says, but the right treatment first requires the right instrumentation!

    “These dental therapists, with only three years of post-high-school education, could perform irreversible surgical procedures such as cutting and removing teeth.” This is perhaps the most hypocritical and deceitful proclamation consistently proposed by therapist opponents. Dentists are licensed to practice significantly more numerous, complicated and precarious procedures after only four years of training than the much more limited list of procedures that therapists perform after three. (Alleging that the four years of college prior to dental school counts towards the eight year total that opponents claim is part of dental training is disingenuous and dishonest.)
    “I am a lifelong Republican who believes in free-market solutions. Those places that have experimented with dental therapists have found they can survive only with extensive government subsidies. The free market does not see them as a solution.”
    If that turns out to indeed become true in Arizona, then the free markets will bring to an end to the practice. A true free market Republican allows the free markets to control policy, not an authoritarian state licensing board composed primarily of active market participants. Such a board has been ruled by the Supreme Court to be non-immune from antitrust laws. Clearly, the state boards of dentistry that seek to prevent dental therapists from becoming licensed in their individual states are acting in such a non-competitive, anti-free market manner.
    Steven Krauss, DDS, MPH, MBA

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