some conditions affecting dental profession

8/10/2019 some conditions affecting dental profession

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SOME CONDITIONS AFFECTING THE DENTAL PROFESSION

FRANK M. LOTT, C.B.E., D.D.S., M.Sc.D., PH.D.

University of Southern California, School of Dentistry, Los Angeles, Calif.

I

T IS an established precedent in the Academy that a President, after having been

a Fellow for a number of years, should have some suggestions for the ad-

vancement of the Academy, the field of prosthodontics, or the dental health of the

pleople. I have chosen to discuss some of the conditions that may affect the future

o;F our profession, and to offer some suggestions that may be of assistance in

eiforts of our Academy to attempt to solve the problems in the best interests of the

people and the profession.

Rumors and reports follow each other on the subject of medical care of our

people on a state, federal, or combined basis. Dental care is included by inference,

of course. There can be only three sources for these activities: the medical pro-

fession, the people themselves, or the political parties.

0I:IGIN OF SOC[ALIZED PLANS

Organized medicine does not want a socialized plan as evidenced by everything

we have heard and read, but it has declared itself ready to cooperate in any scheme

for extending its services on any sound basis without governnzent control.

The people have originated none of the publicity on the subject.

It is a significant fact that in all of the provinces of Canada where a hospitaliza-

tion plan is in effect, the plan has always been introduced by politicians. It is a

subject of tremendous importance from various standpoints and yet the individual

citizen of Canada has never had an opportunity to vote on it because no provincial

or federal election has ever been fought on this issue.

CONDITIONS LJXADING TO LEGISLATION

Let us attempt to analyze the conditions that caused politicians to enact this

legislation. Individually, the politicians are loyal citizens who conscientiously wish

to improve the living conditions of the people. Collectively, however, they are

members of a party who possess the same feeling, but with the additional desire

to remain in power.

A common political move is to pass an important item of legislation before

an election in order to strengthen a record of service, and thus encourage a favor-

able vote. A second powerful motive is to forestall similar moves by the opposition.

-___

Presidential address read before the Academy of Denture Prosthetics in Miami, Fla.,

May 5, 1963.

*Chairman of the Prosthodontics Department.

987


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J. Pros. Den.

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An individual politician may be a studious,

conscientious person who will

study the reports on other countries with experience in this subject, and feel that

such an important project should be approached with the greatest of preparation.

On the other hand, he may be badly biased by reports or personal experience with

unreasonably high fees, and be quite ready to follow party policy. Or, again, he

may be emotionally motivated by an earnest desire to help the needy. The following

quotation from an address by a prominent Canadian executive illustrates the im-

portance of this latter motive. In describing the campaign there for free hospital-

ization, he stated that practically every politician could cite a hardship case in his

constituency that would benefit greatly by such coverage. He continued that the op-

position, affected by the same attitude, simply let the ruling government put free

hospitalization in and talked about it afterwards.

In these situations, the individual will support the party policy regardless of

any advice on the professional position.

The greater the political emergency, the less comprehensive will be the plan,

and the smaller the opportunity for the profession to participate in the preparation.

In Canada, in one province under discussion, there was no time. According to an

important opponent it took most thinking people completely by surprise. It came

over the horizon like a steam roller that the politicians from all parties declined to

check.

Let us be under no delusion that this could not happen in this country. Political

prognosticators are openly stating that the emphasis in Washington this year will

be on taxes and next year on Medicare, as it has now come to be called. This pro-

gram will include dental care, of course.

DENTURIST LEGISLATION

Permission to construct dentures was granted, years ago in Europe, to groups

with less training than dentists as a feature in socialized plans. The principal rea-

son was reported to be that it offered a more economical type of service. The

standard of service, although stoutly defended by these groups, never convinced the

authorities of its quality, and one country after another has returned to the stand-

ard of the dental graduate. A typical example is that of Germany.

The origin of this second level of denture service in this country seems to have

been due to a clamor by technicians in various areas against the fees enjoyed by

dental graduates as compared to the fees paid by these same dental graduates to

technicians for their part in denture construction.

The unconvincing statement that their skill and knowledge are superior to that

of the dental graduate is often made, but their strongest claim is that they render a

satisfactory service for a lower fee. There may be instances where a technician

of unusual skill can secure a superior result to that of a dental graduate who is

lacking in conscientiousness or care, but, in general, it is impossible to agree that

a person with training only in the mechanical phases of dentistry can equal the

results of the dental graduate with his many hours of instruction in the basic

subjects, a feature so essential in the treatment of a patient beyond the mechanical

steps of producing a denture after the work in the mouth has been completed.


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It is, nevertheless, a fact that some states have granted validity to these claims

by issuing licenses to these men who have become known as denturists.

Some unfortunate conditions have developed. In one province in Canada, the

applicants for licenses were allowed to use, as qualification, evidence that they had

been serving the public for a required number of years in defiance of the local

dental practice act. In other words, the government not only condoned breaking

the law, but actually gave the culprits their blessing in the form of a license for

having done so. The occurrence was described locally as the equivalent of granting

to acknowledged thieves a license to steal. This same government decided later

that denturists should pass an examination, but the latter boycotted it. Thus, they

continue to defy authority and render lower grade service while dentistry looks on

in impotent anger. In another instance, technicians secured legislation to construct

dentures provided the mouth procedures were done by a dentist. To the discredit

of our profession, certain dentists were engaged to assist in this manner. Thus, we

are beset with a certain amount of disloyalty in our own profession.

ATTITUDE OF THE PROFESSION

Let

us

not accept, with apathy or resignation, these inroads on prosthodontics,

because they will increase in number and in extent of demands until an answer is

found. The increasing audacity of some of these attacks is shown by the example

in one state where there is now an attempt to

effectively eliminate all laboratory

procedures from the legal definition of practice of dentistry.

It should be apparent to all that we must do something besides explaining our

superior training and continually raising our fees.

We cannot declare ourselves neutral by inactivity. Party exigencies will cause

our politicians to formulate a plan. Outside pressure, such as that exerted by the

denturist, will increase the danger, and, if dentistry remains silent, it will be

left in futile anger as were the medical profession and the insurance companies in

Canada in the campaign described.

Let us not blame the politician. In the province of Quebec, an important poli-

tician stated in a campaign that he hoped the initiative would come from the med-

ic;ll profession itself; otherwise, it would be faced with an accomplished fact.

The diffic:ulty of making our profession realize the speed with which changes

may come is shown by the example in another province of the fact that organized

medicine did not resist. Many doctors were too busy ; there was no liaison between

the insurance companies and the medical profession.

ROLE OF GOVERNMENT

We cannot maintain our professional position intact.

Let us remember that government is omnipotent. Dental practice acts and

licenses created the dental profession to care for the people under specified condi-

tions that gave our profession a virtual monopoly. But this status is not unalterable.

If government should decide that present legislation is not suitably meeting the

requirements of the public, the laws can and will be changed.

This should not stir the profession to an antagonism that the government

should not and cannot assume this viewpoint. We should regard our profession as


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LOTT

J. Pros. Den.

Sept.-Oct., 1963

a department of the government that is comparatively unadministered except for

the existence of the dental practice acts, but still entrusted with the responsibility of

caring for the public need. Then it becomes obvious that politicians have every right

to expect our cooperation.

One dislikes to hear the general statements that we must fight any change in

our status. The politician is our friend who needs help to create an efficient dental

plan for broader coverage of the people. We should inform him comprehensively

of the standard of service the people deserve for their own tax money. We should

inform him about an adequate coverage for the various social groups and the prep-

arations necessary to fulfill these requirements. And these standards, this coverage,

and the preparations should be the best in the world today. Our country can af-

ford it if any government can, and the politician and the dentist will be patriotically

proud of their accomplishment.

A DENTAL PLAN

All of this means that a dental plan should be formulated by dentistry, with the

assistance and blessing of the American Dental Association, and with liaison to state

and/or federal government in order to secure mutually satisfactory alterations. Not

one word should be said about the virtues, the rights, the hopes, and, certainly not

the demands of the profession. Service to the people should be the sole topic. Such

cooperation will not fail to react favorably to the prestige of our profession and

the personal benefit of its individual members because we shall have earned it.

This was amply proved to your President during his period of administration

of the Canadian Dental Corps in World War II. For example, any request to the

Adjutant-General for increased personnel or rank because the Dental Corps was

an important service that merited more consideration was met with dubiety and

hesitation. On the other hand, when a submission requested conditions to make

possible any increase in the efficiency of treatment of the soldier, it met with quick

and willing approval.

DENTAL SERVICE CORPORATIONS

The dental world is stirring around us. In Canada where social conditions are

fairly comparable, for instance, the formation of Dental Service Corporations has

begun as provincially chartered, nonprofit organizations established by the profes-

sion to provide prepaid dental care to voluntary groups and government welfare

recipients, and postpaid dental care to the public at large.

The dental profession also has formed an organization, Canadian Dental Serv-

ice Plans, Inc., that provides postpaid dental care, accounting services, and even

administration of provincial plans.

The Canadian Dental Association has a Dental Service Committee that is en-

couraging the spread of the Dental Service Corporation to all provinces, a clear-

ing house for information on prepaid plan developments, financial support for

meetings, and the establishment of funds for the development of service plans.

The federal government has appointed a Royal Commission with both medicine

and dentistry represented on it. This last activity appears to be the most logical

of all, because it assures the profession that its advice will be considered.


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CONDITIONS AFFECTING DENTAL PROFESSION

991

There appears to be no doubt that all this activity has resulted from the igno-

miny of not having been consulted when legislation began on socialized treatment,

and the profession is apparently determined not to be caught unprepared in the

foture.

SURVEY OF DENTISTRY

The government in this country has been active to a certain extent. In 1957,

at the request of the American Dental Association, the American Council on Educa-

tion appointed a commission to study and report upon the dental situation from all

angles. The personnel on this Commission consisted of four dentists and twelve other

persons from a wide variety of vocations.

There were also four subcommittees each

composed of seven dentists. Each of these four groups reported upon one of the

following subjects : dental health, dental practice, dental research, and dental educa-

tion. The four dentists on the Commission apparently acted as a central group to

collate the information submitted by the four subcommittees and present it to the

Commission for consideration and approval.

This whole arrangement drew the complimentary statement in the Summary

that This willingness of dentistry to expose itself to inspection indicates a matur-

ity and conscientiousness deserving high praise.

This Commission completed an extensive report that was published in 1961

under the title, The Survey of Dentistry,2

and a report in 1960 called Summary

Report of the Commission.

This Summary Report was the subject of a resolution from our Academy

to the American Dental Association last year, noting that some of the recommenda-

tions were unacceptable without the approval of the profession as a whole. Further,

it urged that all members of the profession, especially their representatives in the

constituent societies and to the American Dental Association, should be asked to

make a thorough study of the Survey

before any action occurs on the recom-

mendations.

The receipt of the resolution was acknowledged by the American Dental As-

sociation, and nothing further has been heard regarding it or any other action by

the Association on the Survey. However, our 4ssociation has been active otherwise.

HEALTH CARE LEGISLATION

The Cotmcil on Legislation, with Dr. Besdine of Brooklyn as Chairman, main-

tains a staff in Chicago and representation in Washington. Last year, Clinton P.

Anderson and Cecil R. King simultaneously proposed to introduce health care bene-

fits into the Social Security program.

Dr. Besdine presented a statement of our Associations viewpoint before the

House Ways and Means Committee and, later, instituted a letter-writing cam-

paign to congressmen requesting their opposition to it. This year, this Anderson-

King bill is still in the Ways and Means Committee and an unfavorable vote is

expected on it.

It is satisfying to know that the Atnerican Dental Association is represented at

Washington, that our representatives are being given opportunities to present our


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Sept.-Oct., 1963

professional viewpoint, and that, so far, we are holding the line, so to speak. The sit-

uation should not be allowed to remain here, however, because it tends to create the

ugly impression that we are merely opponents of any effort to help the people and

we lose favor with the government and the public.

We should be prepared to present an improved course of action to show that

we, too, are attempting to help. In other words, our Association should present a

plan of its own. This may be in preparation, but, in the meantime, just as is occur-

ring in Canada, there can be no harm in an independent group working on a pro-

posal, especially if it will be reconciled with our American Dental Association

Council on Legislation before its possible presentation to American officialdom. So

far, however, the main groups active in the field are the unions and the denturists.

They do not hesitate to present their views and there is no reason why we should.

ORAL HEALTH COMMITTEE

Our Oral Health Committee has put much effort into a study of this subject,

and will attempt to reach an acceptable conclusion on the subject of dental man-

power at this meeting.

This is only one phase of this great subject, however, and it is now strongly

urged that this Academy should request our Oral Health Committee to broaden its

study to include all recommendations of the Survey of Dentistry,l to investigate

other possible sources of information, and to form a course of action for the approval

of the Academy as a policy.

The necessary additional personnel and other requirements should be fully

discussed, and adequate facilities should be placed at the disposal of the Committee.

Particular attention should be paid to the dissemination of our findings to our

fellow dentists, and to an efficient approach to government to ensure a thorough

consideration of our efforts.

It is further urged that work should begin immediately. The present quiet on

this prelegislation front may be very ominous, and no time is to be wasted. The ex-

perience of the dental profession in Canada clearly shows that it is too late after

the politician has begun to move.

There is no greater service that we can render to our country and our profes-

sion at this time.

REFERENCE

1. Hollinshead, B. S., director : Commission on the Survey of Dentistry in the United States :

The Summary Report, Washington, D. C., 1960, American Council on Education,

p. vii.

2. Hollinshead, B. S., director: Commission on the Survey of Dentistry in the United States:

The Survey of Dentistry. The Final Report, Washington, D.C., 1961, American

Council on Education.

1628 BRAE BURN RD.

ALTADENA, CALIF.

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some conditions affecting dental profession