Regulation- at the Root of Dental Woes

The New York Times today reports that Americans are neglecting the health of their teeth more than ever. While the number of dentists is relatively high, 27 percent of children and 29 percent of adults did not treat their cavities — a significant increase from the 1999 and 2002 results. In a highly developed nation such as America, how could this be?

The answer posed by the article is greed on the part of dentists. By refusing to accept patients on Medicaid, the federally funded dental insurance program, dentists prevent low-income patients from receiving the care they need. But is greed the root cause of the dental problems in this country?

As of 2004, there were 175,705 professionally active dentists practicing in the United States, according to the American Dental Association. When taking population into account, that number still represents the highest ratio of dentists-to-patients for the last 30 years. So with constantly advancing technology, and plenty of well-trained professionals, why have we as a nation neglected our oral health? The answer may be found in the regulations that prevent dental professionals from treating problems before they occur.

If you’ve ever been to a dentist’s for routine care, you no doubt spent the majority of your visit in the hands of the friendly office hygienist — your first line of professional defense against tooth decay. Hygienists practice “preventative care” and their goal is to preclude the need for more extreme dental care such as filling cavities and other expensive procedures that net dentists the majority of their profits.

It may seem strange that dentists hire and work with what is essentially their competition. For hygienists in most states, they have no choice but to work under a dentist’s supervision. In most states, hygienists can’t even practice in clinics, nursing homes, or hospitals for free if they wanted to unless they are supervised by a dentist. Only Colorado and Washington authorize hygienists to practice independent of a dentist’s supervision.

This is clearly a bum deal for hygienists and patients, but it makes perfect sense for dentists seeking to maximize profit and minimize competition. If the dental field were to be deregulated, hygienists would not need to accept Medicaid, and instead could clean and examine teeth from within retail stores or clinics, accept cash, and see patients on a drop-in basis. These and other alternatives would encourage underserved patients to take better care of their teeth. The increased presence of prevention care would ultimately result in fewer cavities. Reduced need for costlier procedures would create competition with dental offices, forcing dentists to lower prices or increase quality.

No doubt, people with better insurance or higher incomes would choose to go to the high-tech dental offices, but for low-income patients, independent hygienists could be the perfect alternative. Allowing hygienists to practice without the supervision of dentists could double the country’s access to dental care, and increase the amount of bright smiles.