In 1997, Reader’s Digest published an article by journalist William Ecenbarger, titled, “How Dentists Rip Us Off.” In the story, Ecenbarger traveled to 50 different dental practices around the U.S. to assess “the consistency and fairness of American dentistry.” He found such a discrepancy between each practice’s treatment plans, it made dentists look like a bunch of clowns. Ecenbarger’s report sent shockwaves throughout our sacred and sovereign profession, appalling just about every dentist I’d ever known up to that point in my professional career. They called the story “shady journalism” and said Reader’s Digest was out to get dentists. My response was, “The author did a respectable job and showcased a weak spot in the art and science of dentistry. This is what he found. It is what it is. Deal with it! Let’s move on together and get better as a profession!”

On the night of June 26, 2012, I prepared for a little déjà vu as I watched Frontline’s Miles O’Brien report on corporate dentistry “filling the gaps in care” in a program called “Dollars and Dentists.” By now I’m sure many of you are familiar with this particular report – a few dental associations have published public responses criticizing it, many have blogged about it and I’d guess many of you watched it, too. Right now, there’s a nice message board thread about this program on Dentaltown.com (you can view the message board here: www.dentaltown.com/frontlineboard. I’ve watched Frontline’s report twice, and while I think some parts of it were fair, I do take issue with the following areas…

The Underserved
O’Brien’s view of our profession zeroes in on an overwhelming crisis in dentistry. There is a grotesque problem with access to care. Affordability of necessary dental care is also troubling; all patient subjects in the program are Medicaid recipients suffering from painful rotting teeth, and there are just too many to count. Frontline shows people waiting in lines for days – all of them in pain – hoping to obtain relief through the efforts of real dental saints like Dr. Terry Dickinson and his crew of volunteer dental professionals. These are the patients – when there isn’t a free clinic to go to and the pain gets to be too much for them – who go to the emergency room to get some relief for a couple days until the tooth starts throbbing again. This is very sad, indeed. It’s the reason why Dentaltown Magazine publishes its “Do Good” issue every May, to highlight the heroes of charitable dentistry and encourage every single one of you to do your part and volunteer what you can – donating time or money – so the underserved in America and abroad have more opportunities to get the treatment they need. When you watch the opening sequence in the Frontline program, you can’t help but feel bad for these people. It truly is desperate.

We meet one of the hopeful patients awaiting complimentary care, who volunteers his eating habits as he explains the right side of his mouth hurts so bad that he can’t eat ice cream or chips or hamburger. Right off the bat, I became concerned about the angle this report was going to take. You see, caries is a disease that is 100 percent preventable, which is not mentioned even once in the program! No wonder that poor young man’s mouth hurts – he’s eating garbage! Only once in the entire program is preventive care discussed, and only as support for why one of the charitable, Medicaid-based practices is successful. I find it unacceptable that Frontline only holds accountable the professionals who went to eight years of higher education, who studied and learned difficult clinical procedures in an academic pressure cooker, and who graduated more than $300,000 in debt because they chose to serve their fellow man. There is zero accountability of the patients who eat high-sugar, high-fat food, and who drink a Dr. Pepper when they wake up first thing in the morning. Frontline addressed the symptom, not the cause of the problem!

New York City Mayor Michael Bloomberg recently made headlines as he introduced legislation banning the sale of sugary drinks larger than 16oz. I completely agree with this move! If the people will not take responsibility for their actions – actions that lead to horrible tooth decay, obesity and diabetes – then the government is going to step in and fix the problem. To take it one step further, perhaps it is even time for a sugar tax. Maybe dentistry and diabetes should be paid for by a tax per pound of high fructose corn syrups.

On the other hand, perhaps I shouldn’t be too surprised about prevention not being the focus or even mentioned on Frontline, considering the American Dental Hygienists’ Association (ADHA) – the association in America that is supposed to be the one true champion of oral health prevention – took the opportunity to tout its controversial “mid-level dental provider” campaign instead of prevention in its public response to Frontline’s report. Speaking of mid-level providers…

Mid-level Providers and Dental Therapists
I don’t know why anyone would want to oppose a very well-trained professional, treating someone who otherwise would not get treatment.” – Christy Jo Fogarty, RDH, MSOHP, quote from “Dollars and Dentists.”

To be perfectly honest, I have to agree with Ms. Fogarty who was featured in the Frontline report. The reason why comes down to the very simple concept of price segmentation. China is the classic example of price segmentation. China has 1.3 billion people. You have two-year dental schools for the 49 percent of their country that is rural and poor, and they have four-, five- and six-year programs for the 51 percent of China that lives in the big urban areas and can afford a higher quality of care. There is not a one-size-fits-all model of dental care in China, and there shouldn’t be one in America.

One-size-fits-all is also the reason communism doesn’t work. Karl Marx thought everyone should have integrity, purpose and meaning to get up every day to earn an equal share, but it was flawed. You can’t have one guy work 80 hours a week and another guy show up to work every day two hours late and drunk on vodka and expect everyone to be happy to earn the same. There’s no incentive for the first guy to work as hard as he does, and there’s no incentive for the lazy drunk to actually pull his own weight if he knows someone else is going to pick up the slack. To have a one-size- fits-all, dentists-only model for 313,000,000 Americans is ridiculous. Just because something looks good on paper doesn’t mean it works.

There are areas in Alaska the size of Rhode Island that don’t have a single dentist. And when someone asks if we can send in some dental therapists because there’s nobody up there, dentists go ballistic. We dentists think our system is superior, and I agree! It is! But what we all need to finally comprehend is some form of dental care is far better than no form at all. I think Frontline is spot on here; mid-level providers do have a place in this system.

Profitability and Bonus Systems
The Frontline program was critical of management of the corporate dental practices that had insisted on the billing of $15,000 per day. Nowhere in Medicaid’s billing charts is a charge for a dentist to sit down with the patient’s parents and explain what’s going on in the mouth of their child. That cost has to be rolled into something. We all can’t be charitable doctors all the time. We’re sitting on a mountain of debt just to be able to provide patients with our services. We need to recoup our costs and we need to make a profit in order to keep our doors open. This goes for any dental practice. O’Brien’s report goes on to demonize bonus systems of these corporate dental entities. This is sad for health care because a bonus system is standard in sales for every single business in America. If you paid salesman on a car lot an hourly wage, they’d all be sitting in the back playing cards. But when you pay them a percentage of sales, they’ll stand out in 115-degree heat and pouring rain to entice you to buy a car. People always chase incentives, but whenever you introduce an incentive in health care, people question your motives. We all have bills to pay. I can see how the incentive can get out of hand, however, when dentists only see the bottom line instead of the patient sitting in front of them, that is wrong. You need a bustling practice, but you also need to keep your patients in mind. It’s also why, as a non-Medicaid-only practice, you need to present treatment plan options with the pros and cons of each option. It’s why you need to say, “OK, you can get a denture at this price today, but here are the limitations and problems you might face down the road. Or, you can finance implants, and this is what your quality of life will be in five, 10 and 20 years down the road.”

All in all, Frontline’s report didn’t open my eyes to any specific atrocity other than this country needs an oral health public awareness campaign, and it needs it yesterday! So, because your associations and leaders are busy not representing you and squabbling over things that don’t matter, what are you going to do to help improve the overall dental health of America? I’ve got an idea! How about you grow your dental practice so you can treat more people, because we are doing a terrible job explaining that the number-one disease in children – caries – is totally, without a doubt, preventable! There is also a lot of good, charitable work being done all over this country and abroad. I urge you all to get involved. Take a weekend each quarter at the very least and volunteer for people like Drs. Terry Dickinson and Jerome Smith. Get out of your comfort zone and change the life of someone who can’t afford it. If you want big change, you need to start changing small things. Get Started.

Read Townies’ discussion on the PBS Frontline “Dentists and Dollar” programs here.