This is a message to Alex Beam, from a dentist, upon reading your “Message to Poor People from Dentists: Drop Dead.” The article can be found on the Boston Globe, here.
Your article successfully propagates the ugly stereotypes of my profession (dentists are cruel, rich, and “indifferent” to the plights of the poor) while unsuccessfully labeling us as the cause of an age-old problem in this country (the poor die without healthcare).
You failed to mention the extent of these deaths. In 2013, a study published in the Journal of Endodontics recorded 61,000 hospitalizations for dental infections between 2000 – 2008. Only 66 of these patients died. So nationally, over the course of those eight years, 0.1% of dental-related hospitalizations ended in death. If doctor’s orders truly are to “drop dead,” Americans don’t seem to be listening.
You did include the familiar story of 12-year-old Deamonte Driver, noting that his death was the “shocking outcome of dentists’ apparent indifference to the less fortunate.” Dentists were not responsible for Driver’s family repeatedly losing Medicaid coverage, bouncing in and out of homeless shelters, or lacking access to transportation and mail. Nor were we responsible for his untimely care. For an infection to spread from a tooth to the brain takes time – likely years. Driver’s death is the devastating result of what is actually cruel, rich, and indifferent in this country: insurance policies for the poor. Any dentist I know (myself included) would have extracted that poor boy’s tooth pro bono, immediately. Where I work in the Bronx, NY, we provide these free emergency interventions everyday.
To prevent any more dental-related deaths — however minuscule the number — you are advocating for grossly undertrained, uneducated midlevel providers to work on the underserved. This does not address the fact that it is not for lack of dentists — but for lack of coverage — that patients in underserved areas are not seeking treatment. Dentists will need to supervise midlevel providers regardless; our presence in underserved neighborhoods will remain a necessity.
You paint a horrific picture of the dentist, going as far as conjuring “Dr. Evil,” and dreading “terrifying” appointments. Your article suggests that dentists do not want midlevel providers to take a piece of their Medicaid pie, even when the dentists are refusing to eat it themselves. Unfortunately, because of the media — and ill-informed columns, like yours — it is an easy pill to swallow. Patients already hate the dentist, envy our perceived lifestyle, and undervalue our treatment. I’m certain that when we ask patients to open their mouths, all some of them can hear is “Open your wallet.”
To become dentists, students study for a minimum of eight years after high school. To become hygienists, students study for a minimum of two years. Dental assistants will study for even less. The hygienist and assistant would qualify as midlevel providers with some training. Ask yourself which of these practitioners you would allow in your mouth to complete diagnostic tests or invasive procedures. Ask yourself where you would take your mother. Then ask why the poor and underserved don’t deserve the same for themselves and their families.
Dentists are up in arms over midlevel providers because they are dangerous for our patients, and because they will do nothing to fix our broken insurance infrastructure. Contrary to your belief that dentists are aloof, we often care more about the patients’ teeth than they do. We beg them to take care of their smiles, warn them of all that can go wrong, attempt to schedule them even when they miss dozens of appointments. We love teeth. That’s why we’re in this profession. You have to love people a whole lot, too, before working in their mouths. No amount of money will make a daily droplet-bath in saliva and blood ‘worth it.’ We work so we can make people smile.
All midlevel providers will do is introduce a new risk factor to patients in underserved neighborhoods, possibly compromising patient safety. In regions of the country where midlevel providers are legal, research shows that they do not reduce overall rates of dental decay. A 2013 study in the Journal of the American Dental Association found that the incidence of dental caries (or cavities) did not change in the population the midlevel providers served. The only proven method of preventing disease is regular well visits, a service all insurances should cover.
Legalizing midlevel providers will have the same effect as sticking a bandaid on a festering sore. You aren’t treating the cause — you’re making it worse by impending healing, by refusing to treat the infection beneath — but it makes you feel better to do ‘something,’ even when it’s the wrong thing to do. Until social health care programs — such as Medicaid — make a commitment to help our patients get affordable, consistent access to care, we will continue to hear of patients suffering from preventable dental infections.
authentaux 