I am writing regarding the March JADA editorial by Drs. Michael Glick and O.T. Wendel, "Lessons Learned: Implications for Workforce Change" (JADA 2008;139[3]:232, 234).
As an ADA-member general dentist in private practice for 27 years, I am confused by the warning that "demand for oral health care is forecasted to increase dramatically over the next decade." While this may be the case, those of us in the trenches still have holes in our schedules. If you call my office, chances are that you will be able to get an appointment for tomorrow. With respect to disparities in service delivery, it is essential to, first, educate the public, especially those in the vulnerable segments of society, about the importance of good oral health.
The essence of this issue is that it is imperative for our patients to understand the importance of optimal oral health and their role in maintaining it.
Creating and enhancing social services to ensure that those in need will understand the value of dental care is the much-needed first step. Ask any general practitioner who treats Medicaid patients about how much higher the "no-show" rate is among this patient population.
Many of these people are dealing with severe economic, cultural and social problems that hamper their ability to address their dental needs. This is where applicable social services could augment access to care. Private dental offices are not equipped to deal with the social circumstances surrounding Medicaid patients’ lack of prioritization for dental treatment. To offer the community dental health coordinator and the advanced dental hygiene practitioner as "the solution" to this disparity is a "Band-Aid" approach, at best.
The authors write that we need to take proactive steps to address health care disparities before "we are told what to do." In 2006, the ADA delegates were given this warning in the much-remembered "freight train coming your way" speech.
If this federal "freight train" is to gain momentum, it will need money to fuel it. Funding for dental care is something the federal government has been reluctant to provide for many years. We have seen decreased funding for Medicaid, Title VII and General Practice Residencies (GPRs), the latter having been mercilessly slashed. These GPRs have brought dental care to underserved communities and have a proven record of retaining graduates in those communities.
While the authors write that "the academic dental institutions are in the driver’s seat," the problem we face is much bigger than the dental health aide therapist issue and presents a more complex set of economic, cultural and social hurdles than can be solved with the wave of a magic wand and the creation of midlevel providers, while, at the same time, meddling with state dental practice acts.
All of the communities of interest need to be at the table to address the future of dental care. The predominant voice needs to be that of the general practitioner, who historically has been on the outside looking in when it comes to having a say in changing trends in dental care delivery.
And, while open discussion is essential, it should not move quickly to planning until the barriers to equitable delivery of oral health care are painstakingly identified. Only then can objective, apolitical and realistic remedies be presented to the dental community and to the patients who are so very much in need of our services.
