AAO President-Elect's Report
Dr. Mel B. DeSoto
I visited four of the eight AAO constituent annual meetings this Fall along with attendance at the ADA meeting. The visits to constituents other than my home SWSO were very interesting as they all operate slightly differently and each has a unique culture. The specialty of orthodontics is the uniting force that bonds the eight together and makes the differences insignificant. The most common concern at each constituent was orthodontic education. The high cost of an orthodontic education, the recruitment and retention of orthodontic faculty, and the effect of new funding methods for orthodontic residency programs is nationwide. The AAO has addressed all of the issues and is working with governmental agencies, Congress, the AAOF, and the Commission on Dental Accreditation to solve the problems while avoiding antitrust issues.
There are always many issues facing the profession of dentistry at any one time. An issue might not directly involve orthodontics but tremors from it can greatly impact our specialty. Access to care has become the main issue in dentistry as it is has been in medical care for some time. Some of our institutions that in the past were only involved with education of dentists and with licensing procedures to protect the public are now actively involved in the access to care issue. The American Dental Educators Association (ADEA) is composed of the educators who run, operate, and teach in dental schools and post graduate programs. ADEA appointed a commission to study the access to care issue and it made the following recommendations. As a condition of being accepted to a dental school, every student would be legally obligated to work one year in a public dental facility after graduation before being allowed to begin an independent practice of dentistry. The recommendation includes making this required one-year service residency in a public facility a part of the of accreditation requirements of every dental school. In the same vein, The State of New York now requires that any new applicant for a license to practice dentistry must have practiced one year in a public facility before taking the State Board exam. ADEA is also advocating that affirmative action in admission policies be a requirement in the accreditation process of all dental schools. The expectation is that producing a higher percentage of minority dentists will expand the access of care to a greater number of underserved minorities.
Many dental and governmental agencies are advocating international accreditation of dental schools throughout the world that will allow the graduates of these international accredited schools to take State Dental Examinations with the same status as graduates of U.S. accredited schools. The Commission on Dental Accreditation (CDA), ADEA, and the ADA are all in favor of international accreditation. The CDA is currently working on proposals to implement international accreditation. This process would not only allow foreign born and educated dentists to right to take State dental exams without additional training but would also include Americans who graduate from these schools outside the U.S. The State of California has passed legislation that partners with a dental school in Mexico and grants licenses to graduates of that school to practice in underserved areas in California. These proposals and/or actions are intended to increase access to care by increasing the number of dentists and/or by mandating service in a specific area.
The expansion of the number of dentists is only one method being pursued. Some groups are advocating that what is needed is permitting lesser-trained individuals to perform some of the current procedures that are now limited solely to dentists. The Dental Hygienists Association is in favor of an expanded duty hygienist who will be permitted to perform simple extractions and restorations. They are petitioning government agencies for legal change to permit them to perform these expanded duties. In New Zealand, there is an 18-month in length Dental Therapist training program that only requires a high school education as a prerequisite. The Dental Therapist can legally perform simple extractions and restorations. The State of Alaska is asking for federal funding and legislation that will send Native Alaskans to New Zealand for such training. They will then be placed in remote Alaskan villages where they will be permitted to perform simple extractions and restorations with only a yearly supervisory visit from a dentist. The ADA strongly opposes the part of the program that permits the irreversible procedures. It was a heavily debated issue at the October ADA meeting. The legislation is still pending in Congress which chose not to act on it during the election year.
(continued on page 3)I visited four of the eight AAO constituent annual meetings this Fall along with attendance at the ADA meeting. The visits to constituents other than my home SWSO were very interesting as they all operate slightly differently and each has a unique culture. The specialty of orthodontics is the uniting force that bonds the eight together and makes the differences insignificant. The most common concern at each constituent was orthodontic education. The high cost of an orthodontic education, the recruitment and retention of orthodontic faculty, and the effect of new funding methods for orthodontic residency programs is nationwide. The AAO has addressed all of the issues and is working with governmental agencies, Congress, the AAOF, and the Commission on Dental Accreditation to solve the problems while avoiding antitrust issues.
There are always many issues facing the profession of dentistry at any one time. An issue might not directly involve orthodontics but tremors from it can greatly impact our specialty. Access to care has become the main issue in dentistry as it is has been in medical care for some time. Some of our institutions that in the past were only involved with education of dentists and with licensing procedures to protect the public are now actively involved in the access to care issue. The American Dental Educators Association (ADEA) is composed of the educators who run, operate, and teach in dental schools and post graduate programs. ADEA appointed a commission to study the access to care issue and it made the following recommendations. As a condition of being accepted to a dental school, every student would be legally obligated to work one year in a public dental facility after graduation before being allowed to begin an independent practice of dentistry. The recommendation includes making this required one-year service residency in a public facility a part of the of accreditation requirements of every dental school. In the same vein, The State of New York now requires that any new applicant for a license to practice dentistry must have practiced one year in a public facility before taking the State Board exam. ADEA is also advocating that affirmative action in admission policies be a requirement in the accreditation process of all dental schools. The expectation is that producing a higher percentage of minority dentists will expand the access of care to a greater number of underserved minorities.
Many dental and governmental agencies are advocating international accreditation of dental schools throughout the world that will allow the graduates of these international accredited schools to take State Dental Examinations with the same status as graduates of U.S. accredited schools. The Commission on Dental Accreditation (CDA), ADEA, and the ADA are all in favor of international accreditation. The CDA is currently working on proposals to implement international accreditation. This process would not only allow foreign born and educated dentists to right to take State dental exams without additional training but would also include Americans who graduate from these schools outside the U.S. The State of California has passed legislation that partners with a dental school in Mexico and grants licenses to graduates of that school to practice in underserved areas in California. These proposals and/or actions are intended to increase access to care by increasing the number of dentists and/or by mandating service in a specific area.
The expansion of the number of dentists is only one method being pursued. Some groups are advocating that what is needed is permitting lesser-trained individuals to perform some of the current procedures that are now limited solely to dentists. The Dental Hygienists Association is in favor of an expanded duty hygienist who will be permitted to perform simple extractions and restorations. They are petitioning government agencies for legal change to permit them to perform these expanded duties. In New Zealand, there is an 18-month in length Dental Therapist training program that only requires a high school education as a prerequisite. The Dental Therapist can legally perform simple extractions and restorations. The State of Alaska is asking for federal funding and legislation that will send Native Alaskans to New Zealand for such training. They will then be placed in remote Alaskan villages where they will be permitted to perform simple extractions and restorations with only a yearly supervisory visit from a dentist. The ADA strongly opposes the part of the program that permits the irreversible procedures. It was a heavily debated issue at the October ADA meeting. The legislation is still pending in Congress which chose not to act on it during the election year.
These diverse groups are advocating increasing the number of dentists via international accreditation, making mandatory assignments of practice locations for a period, dictating the ethnic make-up of the dental population, and/or permitting more procedures to be performed by lesser-trained individuals to solve the perceived distribution problem. Consideration of safety to the public has not been a primary consideration by any of these groups who maintain that it will not compromise the safety of the public. They do not recall the reason why barber poles are red and white and why strict education requirements of dentists were mandated in the nineteenth century. The dynamics of these trends will affect the public, our dental colleagues, and our specialty in the coming years. Orthodontics will not emerge unscathed if all of those proposals are implemented. The AAO is actively working with our fellow dental organizations to ensure that any adopted changes will not dismantle the greatest dental delivery system in the world and that the public will not have to settle for substandard care. You can you help us by contributing annually to the AAOPAC, which helps us elect members to Congress who share our concern over quality care first. AAOPAC has been very successful but is limited by support of less than 10% of our members. Be active in your local and State dental associations. Lastly, we all need to look beyond our insular practices, which seldom extend beyond a fifty-mile radius and realize that outside agencies can change our practices as quick as any new technology.