ADA Breaking Down Barriers to Oral Health for All Americans: Repairing the Tattered Safety Net

On August 12, 2011, the American Dental Association (ADA) released the second paper in their series of papers on access to oral health.

The paper is available for download from the ADA at http://www.ada.org/sections/advocacy/pdfs/breaking-down-barriers.pdf

The first paper released on February 22, 2011, was titled Breaking Down Barriers to Oral Health for All Americans: The Role of Workforce as available for download from the ADA at http://www.ada.org/sections/advocacy/pdfs/ada_workforce_statement.pdf. I have previously commented on this first paper here https://blog.teethremoval.com/breaking-down-barriers-to-oral-health-for-all-americans-ada-workforce-statement/

Like the first paper, in the opening of the document is a message from Raymond Gist, D.D.S. and President of the American Dental Association. In this message Dr. Gist states

“…increasing numbers of Americans find themselves unable to pay for dental care….For this growing population, the so-called oral health safety net is the only recourse for preventing and treating oral disease….the general definition of safety net is the sum of the individuals, organizations, public and private agencies and programs involved in delivering oral health services to people who, for reasons of poverty, culture, language, health status, geography or education, are unable to secure those services on their own…..With the acknowledgment that change to the current system is necessary and is a process and not an event, the ADA is determined to lead what must be the concerted efforts of not only the dental profession, but also governments at all levels, the private and charitable sectors, and all Americans with the will and desire to achieve the goal of a healthier, more productive nation. If all of the stakeholders involved keep that goal at the forefront of our thinking and actions, we can truly progress toward better oral health for all Americans.”

The paper goes on to discuss the safety net for the roughly 82 million people in the U.S. in low income families of which only 27.8% visit the dentist each year.

The ADA is adamant about keeping non-dentists from not providing dental services such as extractions and  restorations”

“The ADA remains unequivocally opposed to proposals for these so-called “midlevel providers,” believing that adding lesser-trained “surgeons” to the workforce has the potential to erode the superlative quality of American dental care….The problem is not how many dentists there are; but rather where they are, and whether they are able to serve disadvantaged patients, either in private practices or in connection with clinics, health centers or other facilities.”

The ADA believes that Americans don’t take their oral health seriously:

“Major improvements in the dental safety net will not occur until the nation places greater value on oral health. Despite a growing appreciation in many quarters that oral health is integral to overall health; it remains the poor stepchild of health care in America. This phenomenon extends from government to the media to other health professions to the public at large. This lack of recognition of the importance of oral health is manifest in government policy, in public and private health plans, in the educational system and even in the priorities that individuals set for themselves and their families.”

Unfortunately I think the ADA is thinking and focusing on issues here without recognizing that there other issues that need to be addressed in the current system. As illustrated in the first paper dentists, oral surgeons, and doctors/physicians in private practice in the U.S. clearly have some financial incentives which are in opposition to achieving the goal of a healthier nation. This is simple economics and understandable.

As eloquently put by someone who suffered from a constant headache after having wisdom teeth removed just like myself:

“In our society, protection from liability is primary, profit is secondary, preserving the posterity and ego of the medical profession is tertiary, and treating the patient is somewhere further down [the] priority chain.”

I have recently added a case to the complications from wisdom teeth page where a patient recently had wisdom teeth extracted by an oral surgeon and suffered from a scar on her cheek likely from thermal injury from the dental drill during surgery. She did not know about the injury until after surgery and was told by the oral surgeon’s office the “…condition was not related to the surgery. ” I had a similar experience when I had my wisdom teeth extracted. When I went back to my oral surgeon after having my wisdom teeth extracted preventatively at the age of 20 complaining of a chronic severe 24/7 headache I was told the headache was not from the surgery and to see my family doctor.

Both in my case and the case I just discussed where the woman suffered a thermal burn, there was no access to the court system of the United States. There is no such system that will pay patients who suffer from injury. In my case I had a 24/7 headache develop. This certainly has and will continue to happen to others who have wisdom teeth extracted in the name of prevention. No technology allows for a headache to be “seen” thus this makes it very difficult to have any sort of malpractice case or recover any fees.

Does it not make sense to focus on fixing some of the problems with the current system? I believe it is time for a no-fault insurance compensation system to be in place in the U.S.  Such a system has been successfully implemented in New Zealand. http://www.commonwealthfund.org/Publications/In-the-Literature/2006/Feb/No-Fault-Compensation-in-New-Zealand–Harmonizing-Injury-Compensation–Provider-Accountability–and.aspx

The ADA Repairing the Tattered Safety Net document states:

“A public health model based on the surgical intervention in disease that could have been prevented, after that disease has occurred, is a poor model. The nation will never drill, fill and extract its way to victory over untreated oral disease. But simple, low-cost measures like sealing kids’ teeth, educating families about taking charge of their own oral health, expanding the number of health professionals capable of assessing a child’s oral health, and linking dental and medical homes will pay for themselves many times over.”

Unfortunately, the current system in the U.S. allows for any young adult to go into their dentist or oral surgeon’s private office and have their wisdom teeth removed in the name of prevention.  Then if they suffer a chronic, severe 24/7 headache which severely impacts their life and future earning potential they have no access to receive any compensation and their is no universal healthcare system in the U.S. as it is not considered a right. Of course other possibilities are possible.

I have hence argued that the U.S. needs a single-payer health care in the United States, such as what is advocated by the Physicians for a National Health Program http://pnhp.org/, although this comes with many challenges as well.  The U.S. most certainly needs a major overhaul of the legal system as argued on the page of how the current U.S. legal system rewards doctors for malpractice.

The ADA needs to refocus it’s efforts on removing profits from patient care in the U.S., allowing the people who have been injured  compensation, dentists and doctors respecting and being ethical in their treatment of patients, and most certainly allowing all patients a right to have dental and health care. I can not and will not advocate for surgical extraction of healthy wisdom teeth unless there is clear scientific evidence to demonstrate that removing healthy wisdom teeth preventively is beneficial. Does not the ADA believe in scientific evidence? Current scientific evidence does not support nor refute preventative healthy wisdom teeth extractions and some argue:

“…removing organs such as tonsils and appendices for preventative reasons when they are healthy, have no pathology, and cause no symptoms would be irresponsible, unethical, and negligent and wisdom teeth should be in that category of organs.”

Now certainly this may not apply to all those low income families the ADA talks about in their report who do not regularly see the dentist. The majority of low-income patients maybe should be having their healthy wisdom teeth extracted preventatively particularly those who are uneducated and do not make their oral health a priority which may simply be do to not having the financial resources to do so. However, for the rest of the population particularly in those motivated and educated about making their oral health a priority it seems in most cases to be better served with a strategy of watchful monitoring of healthy wisdom teeth. This is an unfortunate reality of the current state of affairs in the U.S. and I hope and pray that very soon things will change for the better.

I am open to comments and criticisms. Post a comment below or send me an email.