Exploring: Preventive Care
Dentistry is Health Care That Works! Patient Access to Care: Dentistry’s Achilles’ Heel or Golden Opportunity? By Dan D. Dunwody III, DDS February 21, 2009 In these uncertain times, the effectiveness, benefits and the values of many of our institutions will be examined. Healthcare is now considered a commodity by government entities, big business, and the insurance companies. Thus far, oral healthcare has, by and large, maintained a preventive, patient centered focus by the design of the dental professionals, clinicians and educators who have preceded us. Oral healthcare works. Crisis healthcare delivery by the medical profession has treatment choices made by bottom line accounting practices. Years ago, the medical profession agreed to accept a greatly reduced fee to treat persons of limited means. Their advocacy groups fought hard to encourage all the doctors to participate and have the government raise indigent fees. When the fees reached a certain level, the doctors participated. However, there was an unintended consequence of this act of benevolence. The insurance companies informed the doctors that if they could accept this fee for indigents, then they must accept a similar fee for all patients or the doctors would be discriminating against their insured. If the doctors did not participate, the patients would be directed by the insurance companies elsewhere to someone who would accept the fees. With the best of intentions, medical care has gradually become a commodity. The major decisions on patient care, (i.e., the type of care delivered, when and how) are based on the entities’ bottom line payment for delivering such care. When the patient care decisions are removed from the individual patient and the doctor’s treatment is dictated by others, an invitation for mediocrity, rather than the improvement of health care services, is created. Changes occur each day, driven by the planning of ready, fire and then aim. How would you like to be a part of that future? The model of oral healthcare is primarily proactive and preventative in nature, rather than reactive and crisis oriented. Did this happen accidentally? Certainly not! Dentistry has created methods to prevent the major oral diseases of decay and periodontal disease through continuing education of the public, fluoridation, sealants and periodic health examinations.
In this photo: (clockwise) Kathy Huber, Dan Dunwody, Ken Hutchinson, Dick Singer, Doug Torbush, Paula Cady, and Karyn Stockwell. Paula Cady (center) who is a hygienist and organizer of the Hebron Community Clinic, is receiving a check from the Pierre Fauchard Academy Foundation Grant.
The oral healthcare model has been nurtured by the dental profession. One of the great preventive movements began with the fluoridation of Grand Rapids, Michigan water in 1948. A fifteen year study of water fluoridation in Grand Rapids demonstrated a 50%-67% reduction in dental decay of primary teeth and 35% in the permanent teeth. By 1980, 37% of in a sample of 40,000 school children were free of decay. By 1987, the number of decay
Dental Explorer | Second Quarter 2009
Exploring: Preventive Care free children had risen to 50%, as sealants, and fluoride releasing dentifrices contributed to the improvements. For every $1 invested in fluoridated water, an estimated $38.00 is saved in dental costs. The average cost of fluoridating the water in a community over a person’s lifetime is reportedly less than the cost of one restoration. In 1999, the CDC named fluoridation of drinking water as one of the “great U.S. public health achievements of the twentieth century”. By 2006, approximately 70% of the U.S. population water supplies are fluoridated by adjustment or natural occurrence. Imagine the benefits if the last 30% were fluoridated. (see sources 1,2) Moderate and severe periodontal incidence decreased from 10% to 5% for adults less than 65 years of age and from 27 to 17 percent for those adults older then 65. Tooth decay has decreased from 35% to 27%. What a great achievement for our profession!
Prevention and access to care are vital. Are we going to have the best care or just the most care? We will answer that question by our actions, or lack there of. So far each of us has a choice! Over 60 years ago, dentistry began eliminating the major oral diseases through prevention and wellness, while incrementally improving the best oral health care in the world. Unfortunately, these benefits are distributed less evenly to some demographic, racial and ethnic groups. In children aged 6-11, 36% of American Hispanics experienced decay versus 19% of decay experience for non-Hispanics. Also decay was 3 times as prevalent in children ages 6-11, below the federal poverty line, as compared to those above it. Approximately 60% of the population visited a dentist from 1999 to 2004, down from 66% from 1988 to 1994. Economic times do effect health care utilization. The April 2007 ADA News reported that 12 year old Deamonte Driver, a Maryland Medicaid patient lost his life due to complications following a dental abscess. In America, we can do better! In the U.S. Surgeon General’s 2000 report on Dental Oral Health Care, Surgeon General David Satcher reported, “during the last fifty years there have been dramatic improvements in oral health and most middle aged and younger Americans expect to retain their natural teeth over their lifetime.” Furthermore in the report he called for “a national partnership to provide opportunities for individuals, communities and health professions to work together to maintain and improve the nations oral health care’’. To ignore oral health problems leads to needless pain and suffering, complications that can devastate well being and create financial and social costs that significantly diminish the quality of life and burden
Dental Explorer | Second Quarter 2009
American society. He felt that ‘together we can affect the changes needed to maintain and improve oral health for all Americans and remove known barriers that stand between people and oral health services’’. The important goal is to “improve oral health for all Americans”. Prevention and access to care are vital. Are we going to have the best care or just the most care? We will answer that question by our actions, or lack there of. So far each of us has a choice! Does the dental profession want to be considered a part of crisis oriented health care and subjected to bottom line accounting and practice standards of care statistically created by insurance companies and the government contractually, bureaucratically and/or legislatively at the expense of individualized patient care? Each individual practitioner will have to decide how much they would like to proactively participate in providing access to care by becoming active in dental associations, our voice to the public and institutions. If not, be prepared to observe as others continue advocating raising the percentage paid for Medicaid, et al. now at ~55% of fees in Georgia and ask you to accept these patients into your practice. Surely the clerical workers of the insurance companies will follow, dictating the usual and customary treatment for our patients. This should not occur. According to GDA President, Mark Ritz, 77% of us now depend on the insurance companies in our practice. Slowly but surely the dental profession will join crisis care professionals in the quagmire of treatment diagnosis and delivery controlled by outside entities for their best interests, not the patient’s, and compensated when and according to bottom line requirements of that institution and it’s officers. The alternative is to press forward as those early pioneers did, continue our preventative focus on oral disease, work towards 100% fluoridation and step forward to provide pro bono services to help the less fortunate. We should work to continue the blessing and privilege of patient centered decisions and provide optimal care for each of our patients, individually suited to their needs and desires. What will be the legacy of the current members of our profession? Are we going to maintain the public trust and leave oral healthcare service better than we found it? Make a choice while you can! Many of you may disagree with me and are probably skeptical of this opinion. For those of you who now ask, how can I make this happen? Commit to participate and volunteer pro bono services at your local indigent health care clinic or even better follow the example of my good friend, Dr. Eddie Pafford and his colleague, Dr. Neil Browning who provide pro bono treatment several times a year. Patients are triaged at the Hebron Dental Clinic by volunteer dental professionals. After hours, Drs. Pafford and Browning, along with their team, provide care for indigent patients in their office efficiently and effectively without liability concerns. Just consider how many patients each of us could relieve from pain and suffering with that kind of commitment. Smiles Work! Healthy attractive smiles are far more employable and essential in today’s workplace.
Patients are triaged at the Hebron Dental Clinic by volunteer dental professionals. If each of us contributes pro bono time, knowledge, skill and judgment, to help the underserved, the U.S. public oral health services will continue to be incrementally improved. Patient centered optimal oral health care will continue to maintain the public trust and the dental profession’s standard of care. Call your local and state dental associations and volunteer pro bono service at local clinics or in your own office. Be part of the solution rather than a member of the status quo.
The primary statistical references are as follows: 1-The 2007 CDC/NCHS 2007 press release on oral health care 2-Fluoridation Facts 2005 ADA publications 3-The 2000 NIDCR, US Surgeon Generals Report on Oral Health
Professional CV GDA Honorable Fellow Fellow of International College of Dentists Fellow American College of Dentists Pierre Fauchard Academy Board Certified American Board of Orthodontics For more C.V. information, visit www.dunwodyorthodontics.com
Thanks for your consideration of my view and the help of ADA and GDA staff with references, my wife, Dr. Janet S. Dunwody, with the content of this information, and Dr. Amy Sawyer with editing. Respectfully submitted, Dan D. Dunwody III, DDS
This article was first published in the Atlanta Dental magazine, the Dental Explorer - Second Quarter 2009. April 1, 2009 - June 30, 2009.
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Dental Explorer | Second Quarter 2009