Albert H. Guay

Where is dentistry going? : Advice from the Cheshire cat

Albert H. Guay, DMD A s Alice was traveling down the road, she met the Cheshire cat at a junction in that road and asked, “Would you tell me, please, which way I ought to go from here?” “That depends a great deal on where you want to get to,” replied the cat. George Harrison of the Beatles summed up that conversation in the refrain of the song Any Road: “If you don’t know where you’re going, any road will take you there.” Dentistry is in the midst of radical changes that have increased in scope and accelerated from an evolutionary to a revolutionary time frame during the end of the last century. These changes are coming from both inside and outside the profession. The organization and administration of all health care is in a state of flux, and dentistry, although apart from general health care in many ways, is not immune from challenges to the status quo and changes. The profession faced a similar crossroad in the early part of the 20th century regarding dental education—which path to take so that the best interests of the public would be served. Dr. William J. Gies, from Columbia

Simple indicators for projecting short-term dental market fluctuations

BACKGROUND There have been fluctuations over time in dental care expenditures in the United States. This project aims to develop simple indicators that are easily available to people and that can be useful to predict short-term market fluctuations. METHODS The authors analyzed data concerning 30 variables for the period of 1980 through 2012 for correlations with dental care expenditures during that period, looking for factors that historically moved in a highly correlated manner, either positively or negatively, with dental care expenditures. The authors lagged the factors to determine their potential predictive value for dental care expenditures. RESULTS Personal consumption expenditures and gross domestic product emerged as valid leading indicators for predicting short-term dental market fluctuations. CONCLUSION Two simple measures that are easily available to dentists and others can serve as indicators of short-term fluctuations in the dental marketplace. Their validity as indicators can, and should, be monitored regularly. PRACTICAL IMPLICATIONS These indicators can be of significant value for practitioners in being alerted to potential market changes and planning to accommodate these changes. Combined, these factors can tell what changes are coming and when they have arrived.

SEKIGUCHI ET AL. RESPOND

We appreciate the opportunity to respond to the criticisms of our article, “Improving the Oral Health of Alaska Natives,”1 by some members of the dental public health community. The American Dental Association (ADA) is fully supportive of the Dental Health Aide Program in Alaska, except for allowing non-dentists to perform irreversible surgical treatments. The ADA considers protecting the oral health and safety of the public as its obligation; allowing nondentists to provide irreversible surgical procedures jeopardizes both, particularly Alaska Natives, because of the extent and the severity of oral diseases they suffer. A dentist’s education involves considerably more than manual training, and that knowledge is critical for safely managing untoward events that can occur. Dental Health Aide Therapists (DHATs) operating in remote villages will not have the ready emergency support they need, unlike dental nurses working in New Zealand metropolitan schools. Alaska Natives are a most unlikely group as subjects in a high-risk experimental project of this nature. It is misleading to state that “there are some 42 countries with some variant of a dental therapist. . . .” Evaluation of the use of auxiliaries is difficult in some areas, because “dental nurse” and “dental therapist” do not have universally agreed upon definitions. Some would be classified as “dental assistants” in other countries. This we do know, however; today, almost 85 years after the introduction of this auxiliary, there is only 1 training program for “oral therapists” in the western hemisphere! This concept has been rejected in most countries. The ADA supports appropriate expansion of duties for dental team members. One letter states, “[The ADA has] a long record of preventing anyone except dentists from providing treatment, even to the underserved.” Were the words “unsupervised, irreversible surgical treatment” to be used, it would be an accurate statement and one of which the ADA would be proud. The “underserved” is not a subgroup of society for which treatment by lesser trained persons is all right and better than nothing, but rather a group that needs to be brought into the mainstream of dental care. It is interesting to note that two thirds of the signers of the letter from current and past leadership of the American Public Health Association Oral Health Section supporting DHATs are not dentists. James B. Bramson and Albert H. Guay present a more complete discussion of DHATs as Comments2 on David A Nash’s article on the pediatric oral health therapist in the Summer edition of the Journal of Public Health Dentistry.3