Sunday, July 01, 2012

Academy of General Dentistry and American Dental Association Responces to “Dollars and Dentists” Program on PBS

Considering the Academy of General Dentistry (AGD) and the American Dental Association (ADA) are in the same building in downtown Chicago, my mouth actually fell open when I read this statement from the AGD.

Academy of General Dentistry Responds to “Dollars and Dentists” Program on PBS

AGDChicago (June 27, 2012)—On Tuesday, June 26, the PBS “Frontline” documentary series aired “Dollars and Dentists,” a special program that investigated what it referred to as the “broken nature of the dental care system” in the U.S. According to the PBS piece, more than 100 million Americans currently do not have dental insurance and cannot afford treatment. “Dollars and Dentists” attributed this lack of patient care to the Medicaid system, stating that it did not provide enough of a profit margin to dentists treating children at Medicaid rates. The segment implied that there are very few solutions available to solve this access to care problem. However, extensive analysis conducted by the Academy of General Dentistry (AGD) and other dental organizations has found that this is not the case.

“Dollars and Dentists” showcased the plusses and minuses of high-production dental franchises, which many claim will help to decrease the cost of care for Medicaid rates. The AGD shares the concerns voiced by “Frontline” that, as a business model, dental franchises that focus on quantity before quality may not be in the public’s best interest.

“I am concerned by business models that emphasize production quotas and do not individualize treatment for every patient,” says AGD President Jeffrey M. Cole, DDS, MBA, FAGD. “The focus becomes the company’s revenue rather than personalized care. Each patient deserves the type of time and attention provided by the traditional dental team business model, which promotes better oral health.”

In the “Academy of General Dentistry (AGD) Barriers and Solutions to Accessing Care” white paper, the AGD renews its call for proven dental care solutions and quality care, which were originally outlined in its 2008 “White Paper on Increasing Access to and Utilization of Oral Health Services.” The AGD calls for an increase in Medicaid reimbursement rates, greater efforts to improve oral health literacy and education, expansion of water fluoridation, and the creation of loan forgiveness programs for dentists working in underserved areas, among numerous other solutions that preserve the focus of providing quality care to each individual patient.

“Although complex in nature, this issue is not so complex that it cannot be solved,” says Dr. Cole. “The dental community needs the cooperation of key decision-makers to help organized dentistry move forward and implement the solutions that will lead to better oral health for all Americans. That is what any dentist—and any AGD member—would want.”

Contact: The AGD public relations department at 312.440.4974 or

Note: Information that appears in General Dentistry, the AGD's peer-reviewed journal, AGD Impact, the AGD's newsmagazine, and related press releases do not necessarily reflect the endorsement of the AGD.

American Dental Association Statement on PBS Frontline’s ‘Dollars and Dentists’

ADAWashington, D.C.—The American Dental Association appreciates the mounting media interest in what Surgeon General David Satcher, M.D., famously called a “silent epidemic” of oral disease.  Unfortunately, the situation has improved little since Dr. Satcher wrote those words in 2000.  The needless suffering caused by untreated dental disease that could have been prevented or easily treated in its early stages is unacceptable.  Coverage by PBS’s “Frontline” and other media can increase awareness of this ongoing tragedy and, we hope, the political will to do something about it. 

We regret, however, that “Frontline” chose to title its program “Dollars and Dentists,” and devoted so much of its air time to the debate over allowing so-called “dental therapists” with as little as 18 months post-high school training to perform surgical procedures like extractions and pulpotomies (drilling through the hard tooth surface and removing soft tissue). The ADA believes therapists’ training does not adequately prepare them to do so. This is especially true for the populations in greatest need, in which many people suffer from co-morbidities like diabetes and obesity, or for children with rampant decay and the accompanying chronic infections.

We also are concerned that “Frontline’s” focus on allegations of Medicaid fraud and abuse may create negative and erroneous impressions about the larger sphere of Medicaid providers.  Of course, any dentist in any practice setting should adhere to the profession’s self-imposed ethical standards, and should be subject to the laws and regulations of the state in which he or she practices.  But we must not let a few bad actors tarnish the work of thousands of honest, caring dentists who treat Medicaid patients, often for breakeven or even negative revenues.  They do so because they feel a responsibility to provide care to people whose economic circumstances would otherwise prevent them from receiving it.  Further, many dentists who cannot afford to participate in Medicaid or wrestle with its often onerous paperwork instead treat needy patients for free.  One estimate has U.S. dentists providing some $2.6 billion in free or discounted care in a single year.

There are right ways and wrong ways to improve access to dental care in America. The right way is to understand that while oral health care is essential, the ultimate goal is oral health.  The right way is to recognize that there are multiple barriers that impede tens of millions of Americans from attaining optimal oral health, including geography, culture, language, poverty and, in the larger sense, a societal failure to value oral health.  Taking on just one of them won’t work; we must continue to approach the problems holistically.  The wrong way is to invest solely in therapist programs that other countries have used for decades, with little appreciable effect on their rates of oral disease.

The country will never drill, fill and extract its way to victory over untreated dental disease. A public health system based primarily on surgical intervention in disease that could have easily been prevented is ill conceived and doomed to fail. Until we shift the focus to oral health education and disease prevention, the country will fail to meet the needs of those who face the greatest barriers to good oral health.