Full Circle

Last month, we commented here that the world dentistry now operates within is very different from that of the 20th Century. The importance of staying well-informed on issues affecting the profession, and utilizing the available tools to do this, was stressed. This time around, we intend to explore the contemporary challenges to dental practice policy and procedures from a slightly different perspective.

In the "old days," issues of interest or concern to dentistry, such as denturism or the independent practice of hygiene, might arise and face the profession for an extended period of time. If the matter involved legislative activity, it might last for an entire legislative session or possibly be taken up and resolved in the next session. Additionally, we can recall that efforts in California to legalize initiatives such as denturism, which incorporated some of the same fervor as the safety of mercury in amalgam has during the past 12 months, would periodically reappear after efforts to bring them to satisfactory resolution by the profession had concluded.

In the past, dentistry could defend its position by educating lawmakers and the public about dangers to the quality of dental care that might be encountered if the changes sought were successfully adopted. We recall that most of the time, dentistry was very successful in these efforts. These issues might then disappear, for many years in some cases, before resurfacing again as a concern in the public sector. For example, until last year, there had not been a serious challenge to amalgam since the "60 Minutes" event of the early 1990s was resolved. While denturism has recently been on the legislative agenda in other states, we cannot recall exactly when denturism was last an issue in California, but believe it was no more recent than the early to mid 1980s.

Well guess what! Some of these "old" issues are likely to be back again this year, and with a different and stronger resolve than before. Yes, denturism, waterlines, wastewater, hygiene scope of practice, stronger standards for in-office anesthesia, and mandatory school dental screenings by nondental personnel may all turn up in the months to come. Most of these have faced the profession at least once before.

In the past, dentistry could call upon science, and in some cases good common sense, to defend against some of the changes sought against existing standards of professional practice. In cases such as denturism and hygiene practice, we usually placed

quality of care, based upon education, front and center. It would seem logical to pursue a similar line of defense when these issues rise again; but the landscape has changed requiring, at the very least, additional strategies and negotiations if dentistry is to be successful in maintaining a desired standard of care.

With each of these issues, there are reasons within the public domain to make changes that would be contrary to dentistry’s long-held positions. There is an urgency with health care issues today that places them center stage. They will not be allowed to slip into dormancy as in the past. Denturism, hygiene practice, and school screenings are all driven by the current need to improve access to care. It is unlikely that a defensive argument by dentistry questioning the quality of care of some anticipated proposals would be successful on its own merit. Such an argument will create a public relations dilemma. Can dentistry successfully speak out against a public program that has a potential to improve the access to care? We think not. Such situations may present extremely difficult, if not insurmountable, challenges to the profession.

Other issues we are likely to face will be made more difficult when the issue relates to the safety of the public. We refer to waterlines, wastewater, and anesthesia standards. Science will be extremely important in defending these issues, and up-to-date research data for each of these issues will be essential to dealing with challenges that are often emotional and sometimes filled with questionable claims of danger to the public. Initiatives in matters that would be viewed as negative to dentistry, such as waterlines and wastewater, can also be expected to be supported by the economic interest of manufacturers in the former, and recyclers and water districts in the latter.

What does this mean to the average practicing dentist? First, it means that we need to stay informed of the latest information and thinking on all of these issues so that in interactions with patients and others, we will be truly educating and not offering something that comes across as a defensive knee jerk.

Second, it means that we cannot assume that drives for new standards on initiatives such as waterlines will disappear as they seemed to do as recently as a few years ago. Through regulations, all members of the profession will be expected to make changes that will place us in compliance with anticipated new standards. In the future, such standards will likely be established, not by organized dentistry, but by agencies such as the Centers for Disease Control and Prevention. And, we can expect enforcement assistance will probably come from state regulatory agencies.

This means that we need, more than ever before, to understand that the efforts of our profession carried forward by leadership or staff must defend our interests based only upon science and quality of care. We cannot step over the line with positions that will display self-interest. Any public display of dissatisfaction with increased regulations imposed upon the business practices of the dental profession will only be viewed as self-interest and could be extremely damaging to our public relations image.

Just as with the safety of mercury in amalgam last year, it is noteworthy that other issues that have been quiet for a number of years are likely to return full circle this year. We do not expect them to temporarily disappear as they have in the past. As always, our representatives will be providing the necessary guidance and information on our behalf. However, given the overriding public concern for access and safety, we must prepare ourselves for change.

Change will not slowly nibble around us as it often has in the past, fading into our subconscious after we hurl a single successful challenge at it. We expect that changes will be proposed with greater immediacy and stronger resolve. We will depend upon the strength of our professional organization more than ever so that our position and our judgment will be made clear to those who might seek to make ill-advised changes to appropriate standards or methodologies. The road ahead will not be an easy one.