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Denturists: Alternative Healthcare Providers
For Oral Health Screenings and Referrals
by Gary W. Vollan
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The denturist is qualified to provide oral
health screenings and referrals.
Denturists are licensed oral health care
professionals who perform a variety of intra-oral procedures and related
activities pertaining to the design, construction, repair or alteration
of removable dentures for the fully or partially edentulous patient in a
variety of practice environments. In all activities and all
environments, the denturist works independently with the patient, and
collaboratively with other health care providers where necessary or
appropriate. [1,2]
There is a shortage of dentists in Wyoming and across the United
States.[3,4]
Due to this shortage and the high cost of denture care by dentists,
denture care by denturists has proven to be a safe alternative denture
delivery system. Denturists serve all segments of the public, especially
the economically disadvantaged providing affordable and accessible
denture care. This is an opportunity for oral health wellness to be
recognized by a qualified, educated denturist and referral services
provided in the event that abnormalities are found. The denturist plays
a crucial part in alleviating the aftermath of the shortage of dentists
by freeing up valuable chair time for restorative, cosmetic, and
emergency dental procedures while at the same time serving the Surgeon
General’s National Call to Action to Promote Oral Health,
[5] “Raising
awareness of oral health among legislators and public officials at all
levels of government is essential to creating effective public policy to
improve America’s oral health. Every conceivable avenue should be used
to inform policymakers; informally through their organizations and
affiliations and formally through their governmental offices, if
rational oral health policy is to be formulated and effective programs
implemented.”
[6]
Oral Health
Oral refers to the mouth to include the teeth, gums or gingival and
supporting connective tissues, ligaments and bone. It includes the hard
and soft palate and tissues of the mouth, throat, tongue, lips, salivary
glands, chewing muscles and the upper and lower jaws.
Health is defined as being free from
disease, defect and pain. Health was defined by the World Health
Organization in 1948 as, “a complete stage of physical, mental, and
social well-being.[6]
Oral Health Education
Denturists are required to obtain education and training in oral health
at an accredited college to qualify to sit for the Washington, Oregon,
and other regulated state denturist licensing examinations. The
denturist college program curriculum includes orofacial anatomy,
physiology, microbiology, embryology, histology, oral pathology,
infection control, pharmacology, emergency care, ethics, nutrition,
gerontology, radiology, periodontology, denture laboratory and clinical
procedures and involves clinical experience in an on campus denturist
clinic. [7,8]
The denturist receives the most comprehensive study in removable oral
prostheses, far surpassing dentists in hours and required number of
completed dentures. Most denturists have been denture laboratory
technicians before graduating from an accredited denturist college. This
makes the denturist well versed in the technical and clinical conclusion
of denture care service and referral service with other health care
providers.
As healthcare providers, denturists can play a role in promoting healthy
lifestyles by incorporating tobacco cessation programs, nutritional
counseling, and other health promotion efforts into their practices.
[6]
The Need
Health care professionals have played a significant role in prevention
of oral disease by safe and effective disease prevention measures. The
denturist profession has played a major role in prevention measures by
advocating for people in need of accessible and affordable denture care.
Oral health is essential to an older adult’s general health and
well-being. Yet, many older adults are not regular users of dental
services and may experience significant barriers to receiving necessary
dental care.[9]
It’s been my experience as a licensed denturist since 1992 that people
who are economically disadvantaged normally do without dental or denture
service and oral health exams for five or more years because they’re not
able to afford the high prices charged by dentists or they see no reason
to see a dentist because they have no natural teeth. This puts these
people at greater risk of ill-health.
When the denturist
profession is first regulated in a state and people learn about the half
price denture service, people hurry in to get new dentures or have
existing dentures serviced. This gives the denturist opportunity to do a
health history and oral exam for healthy tissue and in return; if
unhealthy or abnormal tissue is recognized the denturist expresses
concern to the patient and refers the patient to a dentist, oral surgeon
or physician to provide comprehensive services to the patient. In most
cases denturists act as frontline healthcare providers, working with the
economically disadvantaged that include the homeless, the disabled,
senior citizens, and veterans by providing a service that involves
overall healthcare maintenance.
Statistics
People who were unable to
receive or delayed in receiving needed medical care, dental care, or
prescription medicines, by income and insurance status:
2004

Source: Agency
for Healthcare Research and Quality, Medical Expenditure Panel Survey,
2004.
http://www.ahrq.gov/qual/nhdr07/Chap3.htm
The
proportion of people who were unable to receive or delayed in receiving
needed medical care, dental care, or prescription medicines was
significantly higher for poor (16.5%), near poor (14.1%), and middle
income (11.2%) people than for high income people (7.4%;).
[9]
The
proportion of people who were unable to receive or delayed in receiving
needed medical care, dental care, or prescription medicines was two
times higher for people with no health insurance than for people with
private insurance (18.7% compared with 9.1%).
[9]
Number of
Teeth Remaining in Adults Age 20 to 64
[10]
-
Adults age 20 to 64 have an average of 24.92 remaining teeth.
-
Older
adults, Black adults, current smokers, and those with lower incomes
and less education have fewer remaining teeth.
Number of
Adults with Total Tooth Loss Age 20 to 64
[10]
-
3.75% of adults 20 to 64
have no remaining teeth
-
Older adults, Black and
Hispanic adults, current smokers, and those with lower incomes and
less education have fewer remaining teeth.
Number of
Teeth Remaining Over Age 65
[11]
-
Seniors over age 65 have
an average of 18.90 remaining teeth.
-
Black seniors, current
smokers, and those with lower incomes and less education have fewer
remaining teeth.
Number of
Adults with Total Tooth Loss
[11]
-
Older seniors, women,
Black seniors, current smokers, and those with lower incomes and less
education are more likely to have no remaining teeth.
-
27.27% of seniors over
age 65 have no remaining teeth.
Seniors
living in rural America are more likely to have poor oral health and
limited access to dental care.
[12]
Denturist Data Needed
The Center
for Disease Control supports core activities within state and local
health departments to promote health and prevent disease. CDC supports
research to build evidence for strategies to promote oral health in
communities. [13]
Specific unbiased data is
needed showing the success and benefits to the consumer regarding
denturist services that includes time frame data on new denture
delivery, cost of services, quality of services, oral health care
services, the referral process, accessibility to a consumer bill of
rights and patient convenience of the complaint process. State
legislative bodies and federal agencies need additional data regarding
regulated denturist programs in states of Oregon, Washington, Idaho,
Montana, Arizona and Maine for consideration of legislating and
regulating the denturist profession in unregulated states and on a
national level as it is across Canada and which was recently enacted in
the United Kingdom, July of 2007.[14]
It would be beneficial if
the Dental, Oral, and Craniofacial Data Resource Center (DRC), included
denturist data. DRC is cosponsored by the National Institute of Dental
and Craniofacial Research (NIDCR) and the Centers for Disease Control
and Prevention's (CDC) Division of Oral Health, serves as a resource on
dental, oral, and craniofacial data for the oral health research
community, clinical practitioners, public health planners and policy
makers, advocates, and the general public.[15]
The
Problem:
So what’s the
problem? It’s corporate ADA, the American Dental Association’s big money
politics, waste and not being able to relate to the dental healthcare
needs of the people that are underserved, due to barriers associated
with access, economics, cultural and physical disparities. More people
are doing without dental care because of ADA’s policies.
The policies discriminating
against the economically disadvantaged Americans are those directed at
stopping services provided by denturists, dental health aide therapists
and independent practices for dental hygienists.
ADA Current Policies, Adopted
1954-2006
Dental Society Activities
Against Illegal Dentistry (1977:934; 2001:435)
Resolved,
that the American Dental Association urge constituent and component
dental societies to inform the Council on Dental Practice of society
activities which relate to combating illegal dentistry, and be it
further Resolved, that the Council on Dental Practice provide this
information to all constituent and component societies on a timely and
periodic basis, and be it further Resolved, that the American Dental
Association Board of Trustees be authorized to provide financial aid to
any constituent dental society that is faced with the imminent prospect
of a substantial effort to legalize or promote denturism or any illegal
practice of dentistry in its state through legislative action or use of
the initiative process.
Opposition
to "Denturist Movement" (2001:436)
Resolved,
that the Association vigorously opposes denturism, the denturism
movement, and all other similar activities, regardless of how they are
designated, in this country. [16]
Denturists
across America are trying to provide affordable denture care service to
the people that are economically disadvantaged but instead are forced to
use resources fighting and defending their services against injunctions
filed by state dental boards using money from the American Dental
Association. The money could be better spent on programs to help meet
dental and oral health care needs by educating and training allied
health care providers.
Legislators
go up against dentist lobbyist across the Nation to regulate the
denturist profession, for accessible and affordable denture care for
their people. The American Dental Association lobbies to beat down the
denturist profession, keeping ADA’s monopoly on dentures and discourage
competition while outsourcing dental prostheses out of the country for
higher profits.
[17,18]
Millions of
Americans suffer needlessly with oral health problems due to the
shortage of dentist and the American Dental Association’s unwillingness
to take the necessary steps needed in providing better access to
affordable dental and denture care.
With a
shortage of dentists for rural areas and states facing shortages of
dental specialties, the Bureau of Health Care Professions says that
6,701 dental providers are needed to serve 3,724 designated shortage
areas in which more than thirty million underserved people live.
[3,19] In
urban areas of the United States, there are 61 dentists per 100,000
people, while rural areas have 29 dentists per 100,000 people.
[20]
The shortage
of dentists is attributed to fewer dental schools. In 2003 the number of
dental school graduates was 4,440 down from 5,750 in 1982 with the
average age at 49 years old. The American Dental Association doesn’t
support opening new dental schools and sees no nationwide shortage of
dentists. [21]
Along with
the shortage of dentist and ADA discouraging competition, 44 million
Americans are without health insurance and 100 million are without
dental coverage. The uninsured and underserved people rely on Medicaid,
but states are cutting budgets and eliminating healthcare services.
[22] People
lacking health insurance are less likely to have a regular source of
care and access needed dental care.
[23]
With the American Dental Association doing
business as usual and operating in the same ways it has for decades;
resisting attempts by denturists and other allied health care providers
from moving forward in their profession, the ADA limits the healthcare
providers ability to be educated, licensed and regulated to provide
independent services to the underserved community in need of oral health
and denture care.
Dentists alone can not bring about the needed
change to correct the disparities in access to dental health and oral
health care.[24]
It will take a needed attitude change by the American Dental
Association’s leadership in delegating independent recognition to
denturist, dental health aide therapist and dental hygienist. It is
necessary for these professions to have independent boards to act in the
public’s best interest regarding access and affordable care.
The American Dental Association can better serve
the American people by implementing changes in policies and consider
recommendations by the Pew Taskforce
[25] and CLEAR,
Council on Licensure, Enforcement and Regulation.
[26]
Call for Action
The American
Dental Association continues to disregard needed change to better meet
dental and oral health needs of the American public. The ADA continues
to disregard recommendations by the Surgeon General’s “Oral Health in
America” Report of 2000 and the goals set in the follow-up 2003 report,
National Call to Action to reflect those of Healthy People 2010. Please
consider the following goals and recommendations from the Surgeon
Generals Report:
Those goals are:
To promote oral health.
To improve quality of life.
To eliminate oral health disparities.
[27]
The goal of
moving society toward optimal use of its health professionals
[denturist] is especially important in a society that has become
increasingly mobile, especially since the oral health workforce has
projected shortages that are already evident in many rural locales. [27]
State
practice act changes that would permit, for example, alternative models
of delivery [denturist] of needed care for underserved populations, such
as low-income children or institutionalized persons, would allow a more
flexible and efficient workforce. [27]
Further, all
health care professionals, whether trained at privately or publicly
supported medical, dental, or allied health professional schools,
[denturist colleges] need to be enlisted in local efforts to eliminate
health disparities in America.
[27]
“Nonetheless, no matter how well meaning and constructive local, state,
and regional efforts at changing perceptions have been, the best route
to overcoming the cultural, historical, legal, and structural
impediments to accepting oral health as essential to general health and
well-being may be to create a broad awareness and education program that
would be coordinated at the national level. Such a program supported by
a broad coalition of patient and consumer groups; private and public
research and practitioner organizations could achieve collectively what
no one group has yet been able to achieve singly.”[27]
Improving
access to oral health care
-
Promote and apply [denturist] programs that have demonstrated
effective improvement in access to care.
-
Create an active and up-to-date database of these programs.
-
Explore policy changes that can improve provider participation in
public health insurance programs and enhance patient access to care.
-
Ensure an adequate number and distribution of culturally competent
providers [denturist] to meet the needs of individuals and groups,
particularly in health-care shortage areas.
-
Make optimal use of oral health and other health care providers
[denturist] in improving access to oral health care.
-
Energize and empower the public to implement solutions to meet their
oral health care needs.
-
Develop integrated and comprehensive care programs that include oral
health care and increase the number and types of settings in which
oral health services are provided.
-
Explore ways to sustain successful programs.
-
Apply evaluation criteria to
determine the effectiveness of access programs and develop
modifications as necessary.
[27]
Conclusion
“The adult
population in need of one or two complete dentures will increase from
33.6 million adults in 1991 to 37.9 million adults in 2020.
[28]
Denturists
are on the frontlines as health care providers serving those with
disparities and having the opportunity to perform a preliminary medical
and dental history, oral examination for healthy tissue and referral
services.
It’s in the
public’s best interest to regulate the denturist profession in all
states to better serve the oral health and denture care needs of the
people. The record of safety and quality denture care service has been
recognized in the regulated states of Oregon, Washington, Idaho,
Montana, Arizona and Maine.
The denturist
profession looks forward to the long term goal of national recognition
and regulation for public access to denturist services in providing
affordable and accessible denture care and at the same time making
available access to oral healthcare for the underserved.
"Of all the forms of inequality, injustice in health care
is the most shocking and inhumane."
Martin Luther King, JR.
References
1. Oregon Health
Licensing Agency,
http://www.oregon.gov/OHLA/DT/DToverview.shtml
2. College of
Denturists of Ontario, Denturism and the Scope of Practice,
http://www.denturists-cdo.com/index.cfm
3.
Shelly Gehshan, Foundations’ Role In Improving Oral Health: Nothing to
Smile About, Health Affairs, vol. 27, no.1(2008):281-287
4. National Conference
of State Legislators, Where Have All the Dentist Gone,
http://www.ncsl.org/index.htm
5. National Call To
Action,
http://www.surgeongeneral.gov/topics/oralhealth/nationalcalltoaction.htm#intro
6. “Oral Health in
America”, A Report of the surgeon General, (2000)
7. Bates Technical
College, Tacoma, Washington, Denturist Program Curriculum,
http://www.bates.ctc.edu
8. George Brown
College, Toronto, Canada, IDEC program, International Denturist
Education Center,
http://www.georgebrown.ca/healthsciences.org
9. Teresa A. Dolan, D.D.S., M.P.H.;
Kathryn Atchison, D.D.S., M.P.H.; Tri N. Huynh, D.D.S. Access to Dental Care Among Older Adults in the United States,
http://www.jdentaled.org/cgi/content/abstract/69/9/961
10.
http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/ToothLoss/ToothLossAdults20to64
11.http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/ToothLoss/ToothLossSeniors65andOlder
12. Clemencia M.
Varguas, Janet A. Yellowitz, and Kathy L. Hayes (2003 134). Oral health
status of older rural
adults in the United States. J Am Dent Assoc, 479-486.
13. Center for Disease
Control,
http://www.cdc.gov/oralhealth/
14. Stephen Hancocks,
OBE, The Putting Down of Towels, British Dental Journal, April 2007,
vol. 202, No 8, 433-497,
http://www.nature.com/bdj/journal/v202/n8/index.html
15. DRC, Dental, Oral,
and Craniofacial Data Resource Center,
http://drc.hhs.gov/
16. ADA, American Dental
Association,
http://www.ada.org/prof/resources/positions/doc_policies.pdf
17. Lab Management
Today, WWW.LMTCOMMUNICATIONS.COM, outsourcing, Nov-Dec, 2007
18. Gordon J.
Christensen, D.D.S., M.S.D., Ph.D., Dental Laboratory Technology in
Crisis, JADA, Vol 36, No.5, 653-655.
19. Health Resources
and Services Administration, Bureau of Health Professions, Selected
Statistics on Health Professional
Shortage Areas, as of June 2007, Rockville, Md. HRSA, 2007.
20. Eberhardt MS.
Health, Urban and Rural Health Chartbook, 2001.
21. Alex Berenson,
Boom Times For Dentists, but Not for Teeth, The New York Times, Oct.
2007.
22. Allan J.
Formicola, D.D.S., Marguerite Ro, Ph.D., Stephen Marshall, D.D.S., M.P.H…,
Strengthening the Oral Health Safety Net: Delivery Models That Improve
Access to Oral Health Care for the Uninsured and
Underserved Populations, American Public Health Association, May 2004,
Vol. 94, No 5, 702-704.
23. Alberto J. Caban-Martinez,
David J. Lee, Lora E. Fleming, Dental Care Access and Unmet Dental Care Needs
Among U.S. Workers: The National Health Survey, 1997 to 2003, JADA,
2007, 227-230.
24. ADA, American Dental
Association,
http://www.ada.org/prof/resources/topics/topics_access_whitepaper.pdf
25. Pew Task Force,
http://www.pew.org
26. Council on
Licensure, Enforcement and Regulation, Kara Schmitt and Benjamin
Shimberg,
Demystifying Occupational and Professional Regulation.
27.
http://www.surgeongeneral.gov/topics/oralhealth/nationalcalltoaction.htm#intro
28. Chester Douglass,
DMD, PHD, in January 2002 Journal of Prosthetic Dentistry article.
"Regulating the denturist profession across the Nation in providing
affordable denture care for Americans is the little thing we can do to
help with the current healthcare crisis Americans are dealing with.
People are healthier and more productive when they have a denture that
functions properly."
Gary W. Vollan L.D.
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