‘Mid-level’ dental care just won’t cut it in New Mexico

Santa Fe New Mexican — Dr. Robert L Wartell –As a dentist who has cared deeply about dental public health since the 1960s, I must reply to the March 14 My View by Dolores E. Roybal titled “State’s access to dental care lacking.” The main thrust of her solution for New Mexicans is to create what she calls a “mid-level dental provider.” She does not specify what this means. However, in other states that have allowed mid-level dental providers, they are people without the eight years of education after high school that are required to become a dentist. But they are allowed by law to do extractions and fillings, among other things. They would be able to do these things after about 18 months or two years of training after high school. Proponents of mid-level care will show statistics that the care is the same as that of dentists. And that mid-level providers only do “simple” procedures. In fact, there are few simple procedures in dental care. Except for tooth cleaning and sealants, dentists provide surgical procedures. Cutting into a tooth, extraction of a tooth, and even scaling and root planing are surgery. These procedures are invasive. They require injections deep into tissues and can damage nerves and blood vessels and cause severe and even fatal body reactions. What about examinations of the teeth, gums, and oral tissues? It takes many years to learn to evaluate all of these tissues properly. It is impossible for a non-dentist to find diseases that they have never learned about, or to connect what is found in the mouth with systemic diseases and conditions. Oral cancer can kill, and it takes a dentist to find and diagnose it while it is still treatable. This is something that a technician is not trained or able to do. As in all endeavors, things go wrong. A shallow cavity turns out to be deeper than expected, and the tooth needs to have the nerve immediately removed. A tooth with a large cavity turns out to have cracks through it, and needs a crown, not the filling that was planned. An injection can result in bleeding deep within tissues, or even shock that can lead to death. Who would want to be in the dental chair of a mid-level provider when these things happen, without a dentist nearby? Imagine having a “simple” extraction, with uncontrolled bleeding resulting, and there is no dentist nearby to deal with the complications. The non-dentist has not been trained for and is not able to deal with this emergency. Ethically, how can we consign rural and poor people to a lower level of care? Don’t all New Mexicans deserve to be treated equally? New Mexico has a board of dental health care whose mission is protecting patients from substandard care by substandard dentists. Mid-level providers, with little knowledge of anatomy, physiology, and most phases of dentistry, will, by definition, provide care below that of dentists. Who wants to have dental care that is not up the standard of that provided by licensed dentists? How will the board of dental health care be able to license non-dentists for dental treatment, and yet still be able to tell fully-trained dentists that they are not good enough to treat New Mexicans? Does this make sense to you? It doesn’t to me. I am limited to 600 words. On nmDentalAccess.org you can read more of this essay, and read my ideas about solving the access problem. I welcome comments. Robert L Wartell, DDS, lives in Santa Fe.

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