Filling the Cavities in Missouri’s Dental Care

December 15, 2009

Filling the Cavities in Missouri’s Dental Care

[Author's Note: I incorrectly reported that the agreement with the ADA ended Alaska's program; it is, in fact, still thriving, and the second class graduated this past week. Thanks to Fiona Brosnan of the ANTHC for this correction. — Caitlin Hartsell]

Oral health is a huge public health issue in Missouri: The state is 47th in the nation for the percentage of the population that visited a dentist last year. The St. Louis Post-Dispatch recently ran an article highlighting the lack of dentists in rural Missouri and its effect upon dental health.

Alaska had a similar dental problem in the tribal areas, which had the worst rates of oral health in the country. Alaskan dental therapists — trained to do most basic dental work, except for oral surgery — became a much-needed solution to the problem. The New York Times ran a story last year about that program:

After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities. Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. Johnson’s.

The American Dental Association (ADA) sued the Alaskan Native Tribal Health Consortium (ANTHC), and they ultimately reached an agreement that essentially ended the program. The ADA argued that dental therapists cannot adequately provide health care. Some groups have argued that there are too many dentists already; this site features a quote from a dentist in Missouri who argues that a dentist is at most an hour from all rural areas.

But, if dentists are so accessible, why are Missouri’s oral health outcomes so low? Cost and access are both issues; even if a person can get to a dentist, they may deem dental services to be too expensive when money is tight. Dental therapists, because they need only two years of training rather than four post-college, are able to provide comparable care at a more affordable rate. Anyone who needs more than basic drilling and cleaning can then be referred to a professional dentist.

Dental therapists have been successful in England, Canada, and Australia at providing quality dental care. Dental therapists in Australia are proving their worth beyond just basic oral health care. A recent study found that 95 percent of restorations done by dental therapists were successful, and patients were satisfied.

Dental therapists provide more than just quality, affordable health care. They also provide jobs, especially in depressed economies in rural areas that have trouble attracting professional dentists on a permanent basis. Unemployment in Missouri, while lower than the national average, is still higher than 9 percent. A change in the law would benefit both those newly employed therapists and their patients, who would have significantly better access to dental care.

The health care reform debate has focused primarily on health insurance. The majority of people who have health insurance, though, still do not have dental coverage. The best way to improve the dental health of Missourians is to lower the cost in order to improve access. Dental therapists provide an economical way to combat tooth decay, and plans to implement training programs in the United States have already been suggested. The only obstacle to their introduction in Missouri — and to subsequent improvement in the oral health of Missourians — is the regulatory barrier of professional licensing.

Comments (12)

« Read Previous Entry Read Next Entry »

12 Comments »

From that same MO Dentist:
“The dental school here in Kansas City, Mo. is actually increasing their enrollment by about 20 students. Major mistake for the dental community.” (Suburban Missouri dentist)
A market serves a demand and that is a major mistake? I think this gives us all we need to know about occupational licensing.

Comment by David Stokes — December 15, 2009 @ 4:02 p.m.
Caitlin I don’t think that lowering the quality of the Dental providers is the right choice, when I was accepted to the Dental School over 2,000 applications were received and only 40 were accepted, the first 2 yrs of school focused on Basic sciences and the other were more specific and the 3rd and 4th year we started working on real patients… Even w those 4 yrs of INTENSE training we were not completely ready to be proficient)and my school is (or at least was)ranked very high in the US school. Maybe a better approach could be to lower the expenses to become a Dentist, to lower the costs of managing ang having a Dentist office, to use more resources for prevention as fluoridation of the waters, more education on dental care, more education on proper alimentation, and prevention as a whole, the costs for 2 dental cleanings a year is substantially lower than having to do root canal and a crwon w a Post and core rest. so if that particular person avoids (prevent) his/her dental cavities or goes regularly to the dentist then it could avoid the problem, but the problem is that people only comes to the dental office when he/she cant deal w the pain and at that time is often too late… More important not every cavity will require the just filling approach and what might seem a simple cavity could turn into a more dangerous situation. It’s more complicated than just allowing anyone to be able to perform activitites that require KNOWLEDGE…

Comment by Carlos — December 15, 2009 @ 7:10 p.m.
As a rural missouri dentist, I believe we in this state have plenty of dentists.Distribution is a problem,but that is determined by the market. I have to work to stay busy in my two offices. Adding a “dental therapist” will not solve the access issue. Going in for a dental visit is several times cheaper than a medical visit. In general, people don’t go for dental visits unless they are in pain. This is the real reason for low numbers. Only a small portion of patients can say they have no access. A dental visit doesn’t cost more than a car payment. Many only go if in pain.
And to the comment by mr. Stokes, occupational licensing is not the problem. Dentistry, if it is to remain an occupation of high standards cant’ be watered down. Look what has happened to medicine and the gross amount of mediocrity that has occurred there. If we allow the same with dentistry you can only expect the same outcome.
Freud’s definition of insanity was to repeat that which had a negative outcome.

Comment by Eric S. Wilson D.D.S. — December 15, 2009 @ 8:46 p.m.
To the Dentists:

Having completed dental school is a great accomplishment of which you can be proud and which I believe you should advertise in order to persuade others of the quality of your services. Many people will be happy to entrust their teeth to your care, believing that your training will make you the best qualified to meet their needs.

That having been said, other citizens would happily engage in a cost-benefit analysis when it comes to their dental care. Dr. Wilson complains about “gross mediocrity” in the field of medicine. But what he fails to grasp is that if you give people a choice between excellence that they can’t afford and (alleged) mediocrity that they CAN afford, many people will be willing to take their chances. If a person is willing to take the risk of dealing with a less-skilled service provider who will provide the needed service at a lower cost than better-trained competitors, citizens should have that opportunity.

And, as a side note, I’ll point out that one of the beauties of the free market system is that consumers themselves get to decide whether there are “plenty” of any given type of service provider, rather than having that determination made for them by those who stand to profit from limiting the numbers of service providers.

Comment by Dave Roland — December 15, 2009 @ 11:44 p.m.
I agree with Dave; I am not belittling the amount of knowledge or expertise that a dentist acquires in his or her schooling, nor am I saying that we should not have any professional dentists. On the contrary, I believe our ultimate goals are the same: dental health for all Missourians. The biggest issue here is cost. Even though the cost is not “more than a car payment,” that is still prohibitive if money is tight and it’s an hour’s drive to get to a dentist (and it needs to be done twice a year). Dental therapists provide cleaning and can spot out larger problems that can be referred to a dentist, at a lower cost.

People who want professional care will still go to the dentist who has been fully trained in the hard sciences. But for those people who might not otherwise get their teeth cleaned, dental therapists are a good means to provide care.

Comment by Caitlin Hartsell — December 16, 2009 @ 9:40 a.m.
As dentists, I am sure you are well-acquainted with the term “evidence-based medicine.” Dental therapists have been researched and proven effective across the world… a very quick PubMed search of dental therapists elicits these results, as well as a slew of others:
Nash, D.A. (2009) Adding dental therapists to the health care team to improve access to oral health care for children. Academic Pediatrics Journal, 9(6). 446-51.

From the abstract: “It is inadequate in terms of numbers of dentists, as well as their geographic distribution, ethnicity, education, and practice orientation. Dental therapists, paraprofessionals trained in a 2 academic-year program of postsecondary education, have been employed internationally to improve access to oral health care for children. Research has documented that utilizing dental therapists is a cost-effective method of providing quality oral health care for children.”

Nash, D.A. et al. (2008). Dental therapists: a global perspective. International Dental Journal, 58(2), 61-70.

From the abstract: It concludes by suggesting that dental therapists can become valued members of the dental team throughout the world, helping to improve access to care and reducing existing disparities in oral health.

(2008) NHS should make more use of dental therapists, urges former director of New Cross. British Dental Journal, 205(7), 354.
Radford AJ. (2008). Why nurse practitioners and dental therapists are necessary for rural and remote Australia as well as suburban practices and A&E units. Australia and New Zealand Journal of Public Health. 32(6), 576-577.

Comment by Caitlin Hartsell — December 16, 2009 @ 11:42 a.m.
I feel that those of you not associated with any medical fields don’t understand that in a free market we are held to a higher standard than those in socialized medicine. In the countries you mention, they have socialized medicine and dentistry. So from a government standpoint it only makes sense to allow the cheapest form of care to do the perceived care. If you think socilized medicine is so great , why is it my friends who live north of our border come the us for medical treatment? By the way, dentistry is still private for the most part in canada. Socialize anything and it becomes sub-standard.
The other issues is that in states that have allowed hygienists to practice solo have found that they can’t make it in business because it is too costly and can only survive if they have government support. So we have to assume that it would be difficult for this “dental therapist” to make it without government support, unless they charged a substantial amount to keep the business going.
Should we subject our families to substandard treatment and the added cost of going not only to a paraprofessional’s office and then to a dentist’s office?

Comment by Eric S. Wilson D.D.S. — December 16, 2009 @ 3:25 p.m.
Dr. Wilson,
I was not arguing (and would NEVER) for socialized medicine. I was actually arguing for the COMPLETE opposite- a free-market for dentistry. We both agree that socializing dentistry (or medicine) is a very bad idea.

I’m arguing to open up the market to more competition and access. We are not “subjecting” anyone to anything. No one is forced to go to a dental therapist anymore than a dentist– the idea is to open up competition and let people choose for themselves. In regards to dental therapists not affording their practice, that comes down to more governmental mandates than anything else (though I would like to see proof that “too costly” is the case.) The evidence I was providing were just more proof about the type of work they do (studies about quality) and how they’ve fared in other countries.

Comment by Caitlin Hartsell — December 16, 2009 @ 4:58 p.m.
Dr. Wilson,

The irony of your argument is amusing. There is nothing “free” about a market in which the government tells citizens what service providers they are permitted to choose for themselves. If dental hygienists or dental therapists cannot succeed in independent practice, that is the market telling them that their services would best be directed elsewhere. As happens in a free market, the skill level and number of service providers will gradually adjust to an equilibrium point at which each community supports as many as they need.

Where a community has a need that the service provider is willing and able to meet at the prices the market presents, they will succeed. Where this is no such need, they will need to seek out a community in which their services will be more highly valued. Thus, in a free market there is no need for someone like you (or me) to decide whether these service providers will “make it”. Let people – service providers and consumers alike – make decisions for themselves. They’re bound to have a better idea that you, I, or any government official what would be in their best interests.

Comment by Dave Roland — December 16, 2009 @ 5:01 p.m.
Dave and Caitlin, I see your points and I for one do support a free market approach and we probably agree on many points within this topic. But, and you knew there was going to be one, there has to be a captain to run the ship or the ship goes in circles. I presently have two fantastic, I’m lucky, hygienists that work at the offices. We work hard and do the best we can for our patients. In a practice like mine,rural, the need of another paraprofessional isn’t needed. In a truly underserved area, there are ways to get a dentist there by helping he/she to move to the area. In the past there were programs for dentists to move to underserved areas. Their dental school debt could be eliminated in exchange for X numbers of years of service to the community. And chances are they will build relationships and stay in the area, like I have. I paid my loans off myself and built my practice. I didn’t grow up here, I moved here because of a percieved need. I have now stayed for almost 19 years and will live my life out here.
I realize this has little to do with the black and white of a free market discussion but when you deal with people like we do it is very personal. To add a person to the dental team, wouldn’t be a problem if they had a well defined place. The liability issues, the educational requirements, and the scope of their job would all have to be determined by dental boards and lawmakers. I’m not afraid of competition, any dentist can move and practice wherever they please depending on their license and the state. But if someone wants to practice dentistry they need to be a licensed dentist.
Thank you for the discussion. ESW

Comment by Eric S. Wilson D.D.S. — December 16, 2009 @ 7:39 p.m.
The Missouri Dental Association recognizes the challenges many people face in accessing oral health care. Our association is advocating for the development of new workers in a way that will provide safe, effective options for improving patient education and providing more preventive services. This includes appropriate education and supervision to ensure the safety of patients.

Comment by Aaron Washburn - MDA — December 18, 2009 @ 11:03 a.m.
American Dental Association Being Held Accountable for Greed

Republican Senator Charles Grassley’s (R-IA) call for a financial discloser from the American Dental Association (ADA) along with other medical groups is just a start of holding corporate ADA accountable for the money it wastes and spends as a nonprofit suppressing and pushing out competition. The American Dental Association lobbies federal and state legislators to disregard legislation that would regulate the denturist profession in many states that include Kentucky and Wyoming. The ADA spends money to persecute denturists.

The ADA lobbied for exclusion of language to expand the dental health aide therapists programs to states other than Alaska in the recent U.S. Senate Bill 1790. The American Dental Association, wasted money fighting Alaska and lost; trying to prevent dental health aide therapists from providing dental services to Natives of Alaska living in remote areas. The American Dental Association lobbies to suppress dental hygienists from having independent boards and practices.

The American Dental Associations total lobbying expenditures as of October for 2009 was $2,110,000.00 reported by opensecrets.org. The ADA’s self-serving political agenda is hurting consumers by suppressing qualified competitors that provide oral health services to those with disparities. ADA works against its very own vision and mission statement by suppressing competition that has been trained and educated in providing oral health care services to those that are unable to pay the high prices charged by dentist leaving Americans without needed dental care.

Many people do without needed dental care because of high prices charged by dentist and not being eligible for Medicaid, low income programs and not having dental healthcare insurance. Corporate ADA has the power and money to change the current dental care delivery system for the better if the American public would speak out against the American Dental Associations deceiving and pacifying public relations campaign for a better public image.

Gary W. Vollan L.D.
State Coordinator, Wyoming State Denturist Association
P.O. Box 332, Basin, Wyoming 82410
307-568-2047
http://www.wysda.org

References:
137th APHA Annual Meeting (November 7-11, 2009): Denturists: Alternative healthcare providers for oral health screenings and referrals

http://apha.confex.com/apha/137am/webprogram/Session27637.html

http://grassley.senate.gov/news/Article.cfm?customel_dataPageID_1502=24413

http://www.nytimes.com/2009/12/08/health/policy/08grassley.html?scp=2&sq=grassley&st=cse

http://www.opensecrets.org/lobby/clientsum.php?year=2009&lname=American+Dental+Assn&id=

Comment by Gary W. Vollan — December 22, 2009 @ 11:22 p.m.

RSS feed for comments on this post. TrackBack URL

From that same MO Dentist:
“The dental school here in Kansas City, Mo. is actually increasing their enrollment by about 20 students. Major mistake for the dental community.” (Suburban Missouri dentist)
A market serves a demand and that is a major mistake? I think this gives us all we need to know about occupational licensing.

Comment by David Stokes — December 15, 2009 @ 4:02 p.m.

Caitlin I don’t think that lowering the quality of the Dental providers is the right choice, when I was accepted to the Dental School over 2,000 applications were received and only 40 were accepted, the first 2 yrs of school focused on Basic sciences and the other were more specific and the 3rd and 4th year we started working on real patients… Even w those 4 yrs of INTENSE training we were not completely ready to be proficient)and my school is (or at least was)ranked very high in the US school. Maybe a better approach could be to lower the expenses to become a Dentist, to lower the costs of managing ang having a Dentist office, to use more resources for prevention as fluoridation of the waters, more education on dental care, more education on proper alimentation, and prevention as a whole, the costs for 2 dental cleanings a year is substantially lower than having to do root canal and a crwon w a Post and core rest. so if that particular person avoids (prevent) his/her dental cavities or goes regularly to the dentist then it could avoid the problem, but the problem is that people only comes to the dental office when he/she cant deal w the pain and at that time is often too late… More important not every cavity will require the just filling approach and what might seem a simple cavity could turn into a more dangerous situation. It’s more complicated than just allowing anyone to be able to perform activitites that require KNOWLEDGE…

Comment by Carlos — December 15, 2009 @ 7:10 p.m.

As a rural missouri dentist, I believe we in this state have plenty of dentists.Distribution is a problem,but that is determined by the market. I have to work to stay busy in my two offices. Adding a “dental therapist” will not solve the access issue. Going in for a dental visit is several times cheaper than a medical visit. In general, people don’t go for dental visits unless they are in pain. This is the real reason for low numbers. Only a small portion of patients can say they have no access. A dental visit doesn’t cost more than a car payment. Many only go if in pain.
And to the comment by mr. Stokes, occupational licensing is not the problem. Dentistry, if it is to remain an occupation of high standards cant’ be watered down. Look what has happened to medicine and the gross amount of mediocrity that has occurred there. If we allow the same with dentistry you can only expect the same outcome.
Freud’s definition of insanity was to repeat that which had a negative outcome.

Comment by Eric S. Wilson D.D.S. — December 15, 2009 @ 8:46 p.m.

To the Dentists:

Having completed dental school is a great accomplishment of which you can be proud and which I believe you should advertise in order to persuade others of the quality of your services. Many people will be happy to entrust their teeth to your care, believing that your training will make you the best qualified to meet their needs.

That having been said, other citizens would happily engage in a cost-benefit analysis when it comes to their dental care. Dr. Wilson complains about “gross mediocrity” in the field of medicine. But what he fails to grasp is that if you give people a choice between excellence that they can’t afford and (alleged) mediocrity that they CAN afford, many people will be willing to take their chances. If a person is willing to take the risk of dealing with a less-skilled service provider who will provide the needed service at a lower cost than better-trained competitors, citizens should have that opportunity.

And, as a side note, I’ll point out that one of the beauties of the free market system is that consumers themselves get to decide whether there are “plenty” of any given type of service provider, rather than having that determination made for them by those who stand to profit from limiting the numbers of service providers.

Comment by Dave Roland — December 15, 2009 @ 11:44 p.m.

I agree with Dave; I am not belittling the amount of knowledge or expertise that a dentist acquires in his or her schooling, nor am I saying that we should not have any professional dentists. On the contrary, I believe our ultimate goals are the same: dental health for all Missourians. The biggest issue here is cost. Even though the cost is not “more than a car payment,” that is still prohibitive if money is tight and it’s an hour’s drive to get to a dentist (and it needs to be done twice a year). Dental therapists provide cleaning and can spot out larger problems that can be referred to a dentist, at a lower cost.

People who want professional care will still go to the dentist who has been fully trained in the hard sciences. But for those people who might not otherwise get their teeth cleaned, dental therapists are a good means to provide care.

Comment by Caitlin Hartsell — December 16, 2009 @ 9:40 a.m.

As dentists, I am sure you are well-acquainted with the term “evidence-based medicine.” Dental therapists have been researched and proven effective across the world… a very quick PubMed search of dental therapists elicits these results, as well as a slew of others:
Nash, D.A. (2009) Adding dental therapists to the health care team to improve access to oral health care for children. Academic Pediatrics Journal, 9(6). 446-51.

From the abstract: “It is inadequate in terms of numbers of dentists, as well as their geographic distribution, ethnicity, education, and practice orientation. Dental therapists, paraprofessionals trained in a 2 academic-year program of postsecondary education, have been employed internationally to improve access to oral health care for children. Research has documented that utilizing dental therapists is a cost-effective method of providing quality oral health care for children.”

Nash, D.A. et al. (2008). Dental therapists: a global perspective. International Dental Journal, 58(2), 61-70.

From the abstract: It concludes by suggesting that dental therapists can become valued members of the dental team throughout the world, helping to improve access to care and reducing existing disparities in oral health.

(2008) NHS should make more use of dental therapists, urges former director of New Cross. British Dental Journal, 205(7), 354.
Radford AJ. (2008). Why nurse practitioners and dental therapists are necessary for rural and remote Australia as well as suburban practices and A&E units. Australia and New Zealand Journal of Public Health. 32(6), 576-577.

Comment by Caitlin Hartsell — December 16, 2009 @ 11:42 a.m.

I feel that those of you not associated with any medical fields don’t understand that in a free market we are held to a higher standard than those in socialized medicine. In the countries you mention, they have socialized medicine and dentistry. So from a government standpoint it only makes sense to allow the cheapest form of care to do the perceived care. If you think socilized medicine is so great , why is it my friends who live north of our border come the us for medical treatment? By the way, dentistry is still private for the most part in canada. Socialize anything and it becomes sub-standard.
The other issues is that in states that have allowed hygienists to practice solo have found that they can’t make it in business because it is too costly and can only survive if they have government support. So we have to assume that it would be difficult for this “dental therapist” to make it without government support, unless they charged a substantial amount to keep the business going.
Should we subject our families to substandard treatment and the added cost of going not only to a paraprofessional’s office and then to a dentist’s office?

Comment by Eric S. Wilson D.D.S. — December 16, 2009 @ 3:25 p.m.

Dr. Wilson,
I was not arguing (and would NEVER) for socialized medicine. I was actually arguing for the COMPLETE opposite- a free-market for dentistry. We both agree that socializing dentistry (or medicine) is a very bad idea.

I’m arguing to open up the market to more competition and access. We are not “subjecting” anyone to anything. No one is forced to go to a dental therapist anymore than a dentist– the idea is to open up competition and let people choose for themselves. In regards to dental therapists not affording their practice, that comes down to more governmental mandates than anything else (though I would like to see proof that “too costly” is the case.) The evidence I was providing were just more proof about the type of work they do (studies about quality) and how they’ve fared in other countries.

Comment by Caitlin Hartsell — December 16, 2009 @ 4:58 p.m.

Dr. Wilson,

The irony of your argument is amusing. There is nothing “free” about a market in which the government tells citizens what service providers they are permitted to choose for themselves. If dental hygienists or dental therapists cannot succeed in independent practice, that is the market telling them that their services would best be directed elsewhere. As happens in a free market, the skill level and number of service providers will gradually adjust to an equilibrium point at which each community supports as many as they need.

Where a community has a need that the service provider is willing and able to meet at the prices the market presents, they will succeed. Where this is no such need, they will need to seek out a community in which their services will be more highly valued. Thus, in a free market there is no need for someone like you (or me) to decide whether these service providers will “make it”. Let people – service providers and consumers alike – make decisions for themselves. They’re bound to have a better idea that you, I, or any government official what would be in their best interests.

Comment by Dave Roland — December 16, 2009 @ 5:01 p.m.

Dave and Caitlin, I see your points and I for one do support a free market approach and we probably agree on many points within this topic. But, and you knew there was going to be one, there has to be a captain to run the ship or the ship goes in circles. I presently have two fantastic, I’m lucky, hygienists that work at the offices. We work hard and do the best we can for our patients. In a practice like mine,rural, the need of another paraprofessional isn’t needed. In a truly underserved area, there are ways to get a dentist there by helping he/she to move to the area. In the past there were programs for dentists to move to underserved areas. Their dental school debt could be eliminated in exchange for X numbers of years of service to the community. And chances are they will build relationships and stay in the area, like I have. I paid my loans off myself and built my practice. I didn’t grow up here, I moved here because of a percieved need. I have now stayed for almost 19 years and will live my life out here.
I realize this has little to do with the black and white of a free market discussion but when you deal with people like we do it is very personal. To add a person to the dental team, wouldn’t be a problem if they had a well defined place. The liability issues, the educational requirements, and the scope of their job would all have to be determined by dental boards and lawmakers. I’m not afraid of competition, any dentist can move and practice wherever they please depending on their license and the state. But if someone wants to practice dentistry they need to be a licensed dentist.
Thank you for the discussion. ESW

Comment by Eric S. Wilson D.D.S. — December 16, 2009 @ 7:39 p.m.

The Missouri Dental Association recognizes the challenges many people face in accessing oral health care. Our association is advocating for the development of new workers in a way that will provide safe, effective options for improving patient education and providing more preventive services. This includes appropriate education and supervision to ensure the safety of patients.

Comment by Aaron Washburn - MDA — December 18, 2009 @ 11:03 a.m.

American Dental Association Being Held Accountable for Greed

Republican Senator Charles Grassley’s (R-IA) call for a financial discloser from the American Dental Association (ADA) along with other medical groups is just a start of holding corporate ADA accountable for the money it wastes and spends as a nonprofit suppressing and pushing out competition. The American Dental Association lobbies federal and state legislators to disregard legislation that would regulate the denturist profession in many states that include Kentucky and Wyoming. The ADA spends money to persecute denturists.

The ADA lobbied for exclusion of language to expand the dental health aide therapists programs to states other than Alaska in the recent U.S. Senate Bill 1790. The American Dental Association, wasted money fighting Alaska and lost; trying to prevent dental health aide therapists from providing dental services to Natives of Alaska living in remote areas. The American Dental Association lobbies to suppress dental hygienists from having independent boards and practices.

The American Dental Associations total lobbying expenditures as of October for 2009 was $2,110,000.00 reported by opensecrets.org. The ADA’s self-serving political agenda is hurting consumers by suppressing qualified competitors that provide oral health services to those with disparities. ADA works against its very own vision and mission statement by suppressing competition that has been trained and educated in providing oral health care services to those that are unable to pay the high prices charged by dentist leaving Americans without needed dental care.

Many people do without needed dental care because of high prices charged by dentist and not being eligible for Medicaid, low income programs and not having dental healthcare insurance. Corporate ADA has the power and money to change the current dental care delivery system for the better if the American public would speak out against the American Dental Associations deceiving and pacifying public relations campaign for a better public image.

Gary W. Vollan L.D.
State Coordinator, Wyoming State Denturist Association
P.O. Box 332, Basin, Wyoming 82410
307-568-2047
http://www.wysda.org

References:
137th APHA Annual Meeting (November 7-11, 2009): Denturists: Alternative healthcare providers for oral health screenings and referrals

http://apha.confex.com/apha/137am/webprogram/Session27637.html

http://grassley.senate.gov/news/Article.cfm?customel_dataPageID_1502=24413

http://www.nytimes.com/2009/12/08/health/policy/08grassley.html?scp=2&sq=grassley&st=cse

http://www.opensecrets.org/lobby/clientsum.php?year=2009&lname=American+Dental+Assn&id=

Comment by Gary W. Vollan — December 22, 2009 @ 11:22 p.m.