Introduction

External Influences on Dentistry

Alan L. Felsenfeld, DDS

Copyright 2001 Journal of the California Dental Association.

Recently, I had the opportunity to interview a young man who was applying for admission to the University of California at Los Angeles School of Dentistry. His father and one of his brothers were physicians, and two other brothers were somewhere in the medical education process. When I asked him why he desired dentistry rather than medicine as his career, his reply was surprising. The student indicated that he felt that in the dental profession there would be "fewer people looking over his shoulder" as he worked. I felt this was an interesting reply, but I did not want to discourage him by saying that he was in for a rude awakening when he completed dental school.

Most of us entered dentistry because we envisioned ourselves practicing in private offices with complete control over our environments, our patient care, and the management of our businesses. While this may have been true 50 years ago, today everyone who is actively practicing dentistry is well aware of the myriad of agencies -- governmental and private -- that influence our professional lives. The CDA Council on Dental Research and Developments is charged with monitoring some of these external influences and with recommending and carrying out activities to ensure these outside elements enhance and improve the profession.

This issue of the Journal of the California Dental Association is intended to heighten awareness of the regulations and circumstances that may appear to burden us in the practice of our profession. The following well-respected authors have contributed informational articles that are intended to educate the membership as to some of the areas that we need to focus upon to ease the onus of the oversight of outside groups.

Cathy Mudge contributes discussion of the legislative pathway for regulatory issues from CDA’s Government Relations Office. She delineates the agencies that potentially affect dental practice and the forces that empower them to regulate or legislate. The role of the media and public organizations is also considered.

An issue that has grabbed the attention of California dentists this year is Proposition 65. This is a state-only law that many members have grappled to understand because our knowledge and experience tells us the law doesn’t make sense. CDA General Counsel Linda Seifert provides answers to some of the questions frequently asked of CDA in recent months. Her article, however, is not the last you will hear on this topic as legal negotiations continue among the concerned parties.

Bill Johnson, an environmental engineer, and Teresa Pichay, coordinator of the Council on Dental Research and Developments, present a paper on the relative pollution of wastewater by amalgam and mercury from dental offices. The problem is defined, and the regulatory concerns are elaborated. Suggestions are provided that potentially will ease for practitioners the transition to wastewater regulatory compliance.

Eve Cuny presents a general discussion of the impact of regulatory agencies on dental practice as well as resources that are available to help us. One organization that is growing in influence and recognition as a valued resource to the practitioner is the Organization for Safety and Asepsis Procedures. As a member of this organization’s board of directors, Ms. Cuny is particularly qualified to discuss its role in the practice of dentistry.

Finally, one of the more difficult areas of influence on dental practice is the ethical aspect. This reflects an individual interpretation of what is correct or acceptable for the patient or dental practice. While this aspect of dental care is not regulated, broad community values do influence it. Bruce Peltier, who is a recognized and respected authority on this subject, discusses ethical considerations for the dental profession.

It would be nice to think that dentistry is not under the watchful eyes of outside entities. It would be nice but naive. We do not practice in a vacuum, and we must accept the regulatory and legislative influences on our daily lives. Inspections of dental offices can be made by numerous agencies, including but not limited to Cal/OSHA, the Department of Health Services, the Dental Board of California, and numerous insurance companies. Local governmental bodies that deal with environmental issues such as waste or fire and safety hazards may also evaluate our offices.

Are we as dentists unaware of the regulatory requirements for practices? No. Can we as dentists improve the environment in which we practice to protect ourselves, our staffs, and the community? Certainly.

So what about this poor student who interviewed for admission to UCLA and did not want to have anyone looking over his shoulder as he practiced? Well, it is clear that he will learn soon that his chosen profession is not the ideal environment he envisioned. And he also will become aware of and learn to manage the regulations and other external influences that affect his practice. Be assured that the California Dental Association is constantly monitoring the regulatory and legislative influences on our profession and working to make sure their approaches are pragmatic.

Contributing Editor

Alan L. Felsenfeld, DDS, is an associate professor of oral surgery at the University of California at Los Angeles School of Dentistry. He is also the chairman of CDA’s Council on Dental Research and Developments.