Coming Soon: The Big Book of American Smiles
Kerry Howley | October 11, 2007, 12:11pm
The New York Times reports:
Previously unreleased figures from the Centers for Disease Control and Prevention show that in 2003 and 2004, the most recent years with data available, 27 percent of children and 29 percent of adults had cavities going untreated. The level of untreated decay was the highest since the late 1980s and significantly higher than that found in a survey from 1999 to 2002.
It's hard to think of a more obvious class signifier than bad teeth, especially as it grows more difficult to distinguish between income levels by other superficialities like dress. You can't buy a knock-off set of incisors at H&M. And given the correlations between physical attractiveness and financial success, a British smile is likely to reinforce crippling structural inequalities poor kids already face. For this they can thank the dental cartel:
Despite the rise in dental problems, state boards of dentists and the American Dental Association, the main lobbying group for dentists, have fought efforts to use dental hygienists and other non-dentists to provide basic care to people who do not have access to dentists.
Meanwhile, the A.D.A. does not support opening new dental schools or otherwise increasing the number of dentists. The association says it sees no nationwide shortage of dentists, though it acknowledges a shortage in rural areas. Dentists note that in the early 1980s, when schools were graduating nearly twice as many dentists relative to the overall size of the population as they are now, some dentists struggled to keep their practices afloat.
So back when the licensing system was liberal enough to force dentists to compete for patients, some of those dentists "struggled." Sorry kids, we can't have that.
Chavez is a thug | October 11, 2007, 11:54pm | #
"The dirty secret is that being a dentist isn't really that hard. Filling a cavity is about as complex as refinishing a coffee table. Yet, dental school is nearly impossible to get into and a license to print once you get there. We really don't need people with elite intelligence to be dentists. Further, most basic dental care like cleaning and filling in small cavities can and should be done by trained dental assistants."
This is undoubtedly one of the most stupid and definitely the most ignorant post I have ever read on this site. First, let's dispense with the obvious. Most dentists don't do cleanings anymore anyway; they are done by hygienists. As for your statements concerning the filling of small cavities, this demonstrates you have absolutely no knowledge of dentistry whatsoever. Who exactly determines if the cavity is small prior to the excavation of the lesion? This requires a clinical examination as well as the interpretation of diagnostic images, usually taken by the assistant. I can think of nowhere that trains assistants in the interpretation of radiographs; the training hygienists receive is rudimentary, at best, in this regard. To train them would result in a substantial increase in time and resources for said training. Furthermore, interpreting x-rays involves far more than just looking at them and saying "ah-ha, a cavity."; caries detection is often difficult enough in itself though. I daresay any court in the nation would find you negligent if you focused only on cavities at the exclusion of other radiographically-visible pathologies; these pathologies can range from the very benign to the lethal. To be able to detect and then make differential diagnoses concerning possible pathologies requires quite a lot of training; most dental schools require a mininum of 3-4 semesters of general and oral pathology. Also, the detection of pathologies requires a knowledge of healthy dental anatomy and histology to know the appearance of these tissues at health. After all, you can't know if something is wrong if you don't know what it normally looks like. It is obvious that additional training would be required for this knowledge as well. Dental assistants do not receive this kind of training (as a matter of fact, many states require no training at all for the title of dental assistant)and dental hygienists only receive the very basics.
Back to the filling of small cavities. What would happen if there was a carious or mechanical exposure of the pulp during this process? Are you now advocating that dental hygienists be trained in endodontics as well so that they can perform a pulpotomy or pulpectomy on the patient? After all, with pulpal exposure, this is probably the minimum that would be required. And if a pulpal exposure is in doubt, are you going to train them to detect such exposures radiographically in addition to teaching them the myriad of diagnostics tests available to determine if a possible exposure has occured?
But let us give these supremely-trained super assistants the benefit of the doubt as far as pulpal exposures are concerned. Let us just assume that once the lesion is opened up that it is larger than imagined, without an exposure. Even if the lesion is initially thought to be small enough to require no anesthesia, most patients will demand anesthesia for larger lesions. The individuals administering these shots will require a knowledge of the neuroanatomy necessary to provide adequate anesthesia. There is more to giving a shot than just sticking a needle in someone's mouth and pressing down a plunger. You have to know which nerve anesthetizes which portion of the mouth you are working on and where that nerve is located. Furthermore, you have to consider which anesthesia to use based on many factors including potential allergic reactions, age and weight (particularly for pediatric patients), whether to use an anesthetic with a vasoconstrictor, usually epinephrine (an important consideration in individuals with hypertension, as well as other conditions). Furthermore you must be able to adequately obtain and interpret a patients health history for many reasons, including the determination if antibiotic prophylaxis is necessary prior to the administration of anesthesia. All these factors require a knowledge, both academic and clinical, that can only be obtained by a level of training no dental assistant in this country receives; very few states allow dental hygienists to administer anesthesia, and none that I know of let them do it absent a dentist. And this is not merely because we want to pad our wallets. They just do not receive the training. And the additional time required for said training would make this whole "let's have dental assistants do it" argument pointless, primarily because the additional training would increase the cost and lower the availability, both benefits that are assumed will exist once the so-called "dental cartel" is broken.
Now, let us discuss the actual filling of the cavity. While it may be easy to fill an extremely small cavity, as I made clear above there is no guarantee it will be small once the excavation begins. Larger cavities require much greater skill to excavate and fill as one must take into consideration such factors as potential pulpal exposures, the need for cavity liners, the patient's dental anatomy and occlusion, the need to maintain contact with adjacent teeth etc. When I attended dental school, I was required to see patients six hours a day, five days a week, for the last two years of my schooling to hone my skills. Knowing the extent of the training received by assistants and hygienists, there is no way in hell I would let them put a drill spinning at 100,000 rpm, at least, in my mouth. As for your implication that all dentists do is fill cavities, that is too stupid to comment upon further. In addition, individuals with bachelors degrees in English would be wise not to pontificate on dentistry and the skills and training required for certain procedures as if they were experts in the field.
The implication contained within this article that dental assistants (this is particularly laughable) and dental hygienists receive enough training in school to be able to safely intrepret, diagnose, anesthetize and then treat even basic dental problems is absurd to the extreme. Furthermore, as I pointed out above, the increase in the training cost and time involved would simply result in an increase in the price of the services rendered and lower the availability of these super-trained hygienists and assistants. What would be the point? Moreover, there is no such thing as "safe" basic care involving only the filling of cavities. What good is a decay-free smile if the hygienist misses the extremely lethal palatal melanoma or oropharyngeal carcinoma?
As for the asinine comments concering the intelligence of dentists, dentistry is like any other profession. Good dentists, as well as other medical specialists, are usually intelligent individuals . Dentists are just doctors that happen to limit their practice to the oral cavity. And from my personal experience, dentists and dental students are easily as intelligent as M.D.s. I know because I have a D.M.D and M.D. and I also have to put up with both to do my job.
P.S. joe is an apologist for Chavez
Chavez is a thug | October 12, 2007, 6:49am | #
"Holy crap, did you take twelve years and spend $150,000 to go to college? Also, not to impugn the intelligence of dentists, but I think much of this thread has been about the ADA using the government large and small to protect a monopoly on the profession and make sure it stays lucrative."
It cost way more than that. Also it did not quite require twelve years. After college, it requires 4 years of dental school, 2 years of medical school and 4 years of oral surgery residency, of which 30 months must be spent on the actual surgical rotation.
I realize that the original article concerned the maintenance of a monopoly. However I was responding to the absolutely idiotic statement made by an individual who clearly has no idea what is involved in the practice of dentistry. Anyone who suggests that filling cavities properly is the same degree of difficulty as finishing a dining room table is an ignorant jackass, plain and simple.
Furthermore, I was hoping that my lengthy post would dispel the myth concering so-called "simple" irreversible dental procedures and who exactly is qualified to perform them. As I thought I made abundantly clear in my post, dental hygienists and particularly assistants do not receive the training required to make these procedures even remotely simple, particularly when you consider that the unexpected will inevitably arise during one of these procedures. A whole heck of a lot more goes into performing these procedures and providing a MINIMAL amount of care then just doing a little buzz with the drill and sticking in some filling material. It is criminally negligent in pretty much every state to fill cavities and neglect other oral health issues. Again, dental auxillaries are not trained to perform most of that additional necessary work or even recognize the need for it, and the required extra training would increase costs and limit the numbers of practicioners to a degree that it would defeat the purpose, just as I pointed out.
As I also pointed out to the person who started this thread, there is an obvious misconception as to what is involved in performing dentistry, or it would not just be blithely suggested that an individual with a few months training would be adequately qualified for the purposes of providing care in order to break a supposed "dental monopoly". Perhaps a solution other than foisting dangerously underqualified practioners on the unknowing public should be suggested. And believe me, the comments have more than proved that most people are absolutely clueless about dentistry and oral health. And like I said before, individuals with a bachelors in English usually have virtually no knowledge of dentistry and its practice and thus should not be snarkily offering definitive policy solutions as if they were an expert in the field.
