What if Dentistry Was Disorganized?
The year is 1931 and Dr. Robert Whitehill shares in his WEEI (Radio) broadcast of the New England Dental Society with his take on “Organized Dentistry.” This nine-decade-old August edition of the Journal of the A.D.A. highlights concepts and truths that are evident almost a century later as seen below in the title.
Organized Dentistry
By Robert Whitehill, DDS
This editorial from 1931, written at the front end of the Great Depression, gives us much to contemplate.1 After all, as members of the dental profession, we continue to have a public to serve emerging from the Covid-19 Pandemic. We are entrusted by society with the right to some degree to self-regulate. Our self-imposed standards in Dentistry are manifest by demonstrating an accepted standard of competence, care, and most importantly ethical consideration for what best serves our patient’s individualized needs while satisfying informed expectations. This all is cemented by empathy and selfless service that goes beyond the “no harm” of the Hippocratic Oath to doing good beyond the oral cavity by serving our neighborhoods, towns, and cities.
The timelessness of Robert Whitehill’s, “Organized Dentistry” serves as the mirror for comparison and our reality sets the tone as the explorer to reflect upon what we are collectively as Dentistry.
Let us begin with his first observation, what the “world would be like were all the knowledge of dental science and dental art to be suddenly wiped out?” Today, the direct link between oral health and systemic health is a resounding absolute principle. As I and many of you can attest, more and more science emerge weekly, implicating the pivotal role of the microbiota, airway function, and dental anatomy of the oral cavity concerning general health and multiple illnesses.2
Second, in his example, he brings to realization access to care for children and adults. “Not only would the wails and cries of fretful, suffering children be heard in the land, but also parents who are now noted for their calmness and poise would find difficulty in setting a good example for the little ones.” For Texans, a recent study indicated that much work has to be done. Utilizing 26 indicators for oral health and services, Texas ranks 47th in the nation overall.3 Some of the key findings for the Lone Star State included:
- 37th for adults in poor to fair oral health
- 41st in the percentage of teens visiting a dentist in the last year.
- 50th for adults who had a dental visit in the previous year.
- Texas is dead last in percentage by having adults with the MOST “low life satisfaction” related to oral health/function.
These are gravely critical issues, which we have to collectively solve for the present and future of Texans and public confidence in Dentistry to serve the state.
We are responsible for the health of Texans regardless of public, private, academic, institutional, Dental Service Organization, or military branch in nature. The casual observer approach, or it is not my patient demographic argument, does not hold for the presence of these major discrepancies afflicting the populations in our care.
In his prophetic wisdom, Dr. Whitehill in his third item, touches upon geriatric dentistry by saying, “Then too, there would be no pretty grandmothers. There is more to dentistry than merely preventing pain.” We now know that oral function is related to both longevity and quality of life. A century ago, when our society had grandparents living in their 40s and 50s, we can appreciate twice those amounts from improved oral health and general health services.4.
Dr. Whitehill’s fourth mention deals with the social norms, the influencers of their time which are perpetuated today in the expectations of celebrities on films and in social apps. “Picture our Hollywood favorites without the pleasing contour of features that are in reality built over a foundation framework of perfect teeth.”5 The American Dream and in a sense American culture is based on what others have. The concept of health or at least the façade of health from an esthetically pleasing “B-0 bright white” room captivating smile is a clear social status symbol in the American psyche.
Fifth, Dr. Whitehill poses the question, what if Dentistry and its scope of services were absent from society? He states, “The world could do its work if no one was beautiful, and if people did have a little pain now and then…but in this land, where efficiency is the great god, it wouldn’t be considered good business.” Science on Oral Health and its impact on productivity is clear. A healthy society can thrive and uphold a strong economy. Poor oral health costs the United States economy about $45 Billion annually.6 This hits closer to home when we think of the family, staff, and even neighbors that can be sidelined by problems with their teeth.
Finally, malnutrition is an area that Dr. Whitehill addresses. Organized dentistry sees both the value and potential of oral health in children. The lack of access and utilization of care for young ones would be devastating, “…our vigorous younger generation, instead of growing taller, and stronger than the parental stock, as now seems to be the case, would be smaller, more anemic, and an easier prey to disease.” The ability to digest and obtain the optimal nutrients from our food is greatly impacted by our oral function and pain-free mastication. Decayed, misaligned, and missing teeth all detract from proper digestion and overall health.
When Dr. Whitehill summarizes organized dentistry's value in serving the public, the social pillar it represents becomes tangible. “Dentistry…has a very important place in modern life…Once we had known it and its worth, we could no more get along without it than we could without…electricity.”
So, do we contemplate, what if Dentistry was disorganized? Thankfully, the reality is that chaos and anonymity are not part of Dentistry Today. As an integrated and comprehensive body of professionals, the ADA and its state and local components have much to be proud of and reflect upon as gains. When looking at ourselves in the mirror, our work is not done and we need you to go further, yes, you, since Dentistry does not evolve in the shadows but develops through the synergy of involvement by committed members.
There is much to safeguard together for our profession and its future. When considering involvement in organized dentistry, I like to think of the “iceberg principle.” As an iceberg can be contemplated by what is above the surface, there is much that takes place through involvement that is not highly publicized for Organized Dentistry. The numerous committees, delegates, and planning events that take place to protect practitioners might not be fully appreciated due to their subtle but extensive presence. Much goes on that helps direct the future of our profession and public health here in the Lone Star State thanks to “Organized Dentistry.”
To go more in-depth about what is going on “below the surface,” let us focus for the most part on the “Tripartite” Membership of the ADA. This Tripartite encompasses membership in the national organization, ADA, the state constituent society, the Texas Dental Association (TDA), and the local component society, San Antonio District Dental Society for these authors. Being a member of the ADA makes one a member of all three aspects (National, State, and Local). All three components of the Tripartite continue to expand their efforts to offer traditional services and some innovative programs that are both “tangible” and “intangible.” It is the “intangible benefits” that this author believes the best value in membership lies. An excellent value comes from the camaraderie experienced when spending time with like-minded dentists who strive to provide the highest quality and most ethical dental care to our patients, but it goes much deeper than that.
One may not directly see the benefits at a national level where the ADA has a direct effect on how the younger generation of dentists is trained and how “seasoned” professionals are kept current with advancing technology and procedures that benefit the current patient pool.
When it comes to “organization,” four commissions within the ADA serve the public and the profession. Through their purpose and mission, they help to improve and sustain the art and science of dentistry. For example, the Commission on Dental Accreditation, CODA, sets the standards for dental school curriculum development and implementation. Then there is the Commission on Continuing Education Provider Recognition, CCERP, which sets the standards for CE Providers must maintain to provide the highest quality of education to practicing dentists.7 These services provided by the ADA ensure that dental students and dentists, alike, are provided with evidence-based and current educational resources which translate to providing the highest quality treatment for the health and safety of our patients.
Additionally, advocacy efforts at both the national and state level provide a profound “intangible” benefit for organized dentistry. If not for the ADA or TDA (or any of the General Practice and specialty organizations) to whom would you turn to voice your concerns regarding legislative affairs that directly impact the way, you practice. The ADA and TDA bestow its members that voice, and that voice is recognized and meaningful for over a century. It is through the efforts of the ADA and TDA political action committees, ADPAC and DENPAC, respectively, that our voice is presented in a unified platform to our elected officials. Both ADPAC and DENPAC have an entire day strictly dedicated to their members meeting for in-person meetings with their representatives in Congress and the State Legislature. It is on these days that a member, yes you, can sit down with those that have a direct influence on our profession and discuss the various legislative issues that influence the daily operation of our practices.
One shining example of the impact of ADPAC was the support garnered to aid the Massachusetts Dental Society with the passage of Massachusetts Ballot Question 2 on the November 2022 Massachusetts ballot. MDS and ADPAC lead the charge cultivating support Question 2 which sets the medical loss ratio for dental insurance in Massachusetts at 83%. The initiative overwhelmingly passed by a vote of 71.6% to 28.4%.8 “The Massachusetts victory was a watershed moment for patients and dentistry, setting a precedent that could herald future change for dental insurance across the country," said ADA President George R. Shepley, D.D.S. "It's a shining example of where we can go in our future endeavors in dental insurance reform and what we can do to help our patients."9 To date, eleven (11) other states have introduced MLR legislation during the 2023 Legislative sessions.10
Since dentistry is mostly a state-regulated profession, the TDA PAC, DENPAC, does most of the lifting for our profession. DENPAC exists to help safeguard against counter-productive legislation and to ensure that the Texas Dental Association has a constant presence at our state capitol. When lawmakers address issues affecting the practice of dentistry in Texas, DENPAC is hard at work making your voice heard.11 In this 2023 Texas Legislative Session, the DENPAC team has been aggressively acting on our behalf advocating for Dental Insurance Reform, increased Medicaid Dental Benefits, and License Portability just to name a few. Most importantly with the change in policy at the 2023 TDA House of Delegates, DENPAC is advocating for dental hygienist-administered local anesthesia. Unfortunately, these “intangible” benefits are often not valued by many dentists. These unseen victories by organized dentistry are the highest achievements for state organizations make on behalf of all dentists, not just its members.
Now on to the “tangible benefits” every dentist could take advantage of in choosing to be a member. As a part of organized dentistry doors open to many programs and services that help provide positive financial outcomes. For instance, ADA Membership Advantage partners with various vendors who offer significant discounts to ADA members that directly affect the profitability of their practice. The benefits include lower credit card processing fees, discounts on auto leasing and home mortgage, discounts on patient financing options with CareCredit, and increased patient marketing and communication services, just to name a few.12 Both the ADA and TDA produce excellent journals in JADA and the TDA Journal that provide quality content that can be used daily in practice. These are all positive gains that affect the quality of care and the bottom line of any dental practice.
When surveying members about the greatest “tangible” benefit, at the top of most lists is quality CE programs that most often come at a significantly discounted rate. Local component meetings are often free or simply the cost of the meal for their members. Then there is the TDA Meeting where a multitude of course subject matters are offered to member dentists and their staff. The TDA has even gone further in developing its app called Dental Concierge. Dental Concierge allows a provider to obtain many if not all the courses required for license renewal such as Opioid, Human Trafficking, OSHA, and Risk Management training. TDA has also partnered with the Pankey Institute to provide content for the app. In addition, the app provides access to several world-renowned speakers for a nominal fee.
Like the ADA, the TDA has also developed similar partnerships that help its members succeed professionally. In 1984, TDA Perks was founded as a way for TDA members to cut their office expenses and increase practice profitability. “Our discounts on vendor products and services collectively save TDA members over $1,000,000/year”, said Donovan Osio, General Manager of the TDA Perks Program. From TDA Perks Supplies to OSHA and HIPPA Compliance Training to Electronic Prescription services, TDA has fostered partnerships that provide a monetary benefit to your practice. On the business side of dentistry, TDA has collaborated with various vendors to enhance the patient experience at the dental office, website development and maintenance, dental claims processing, dentist insurance, and financial planning. The list goes on and on. However, perhaps the most lucrative partnership for member dentists this past year was with ERC Specialists, a TDA Perks Partner who specialized in businesses filing for the Employee Retention Credit. According to Mr. Osio, “ERC Specialists have filed expected returns for almost 300 member dentists totaling over $18,600,000.” I encourage every reader of this article to browse the TDA Perks website, https://tdaperks.com/, to see the return on your investment in “Organized Dentistry.”
As members of “Organized Dentistry” let us value our responsibility to steward the oral health and the well-being of our communities. The solidarity resulting in success lies in your, mine, and every dental professional’s participation. Involvement is the key to relevance and adaptation to make our profession appreciated and resilient as push past the century-and-a-half mark. TDA has been around since 1871. As an old proverb goes, “When the stakeholders grow comfortable in the complacency of apathy their opponents figure out how to make do of them at the stake.”
Organized dentistry today embodies engagement, communication, resolve, and results to improve lives. As Oral Health Professionals, we all have something to offer, whether one or all of the three “T’s”. The “three T’s” are comprised of our time, our talents, and our treasure. Individually they stand for our involvement in our dental association, the use of our skills that we can contribute to the well-being of fellow Texans and our financial backing for both community programs and legislative awareness. Texas and Dentistry is ready for further “Organization” are you?
Sources:
- Whitehill, R., Organized Dentistry, August 1931, Journal American Dental Association. https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S1048636431880296/first-page-pdf
- Kapila YL. Oral health's inextricable connection to systemic health: Special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions. Periodontol 2000. 2021 Oct;87(1):11-16. doi: 10.1111/prd.12398. PMID: 34463994; PMCID: PMC8457130.
- McCann, A., 2023’s States with the Best & Worst Dental Health. WalletHub. February 1, 2023.
https://wallethub.com/edu/states-with-best-worst-dental-health/31498#expert=Carissa_Regnerus
- Watanabe Y, Okada K, Kondo M, Matsushita T, Nakazawa S, Yamazaki Y. Oral health for achieving longevity. Geriatr Gerontol Int. 2020 Jun;20(6):526-538. doi: 10.1111/ggi.13921. Epub 2020 Apr 19. PMID: 32307825.
- Abbasi MS, Lal A, Das G, Salman F, Akram A, Ahmed AR, Maqsood A, Ahmed N. Impact of social media on Aesthetic Dentistry: General Practitioners' Perspectives. Healthcare (Basel). 2022 Oct 17;10(10):2055. doi: 10.3390/healthcare10102055. PMID: 36292502; PMCID: PMC9602612
- Glogowski, K., How employee oral health impacts your business. Delta Dental of Illinois, October 14, 2022.
- ADA Website, 2023 (Accessed May 25, 2023)
- Ballotpedia, 2022 (Accessed May 25, 2023)
- Garvin J. Massive Massachusetts Win Sets Stage for Insurance Reform.
ADA News. Dec 28, 2022.
- Olsen C. Medical Loss Ratio Bill Introduced in Rhode Island. ADA News. 2023 May 22.
- TDA Website, 2023 (Accessed May 28, 2023)
- ADA Website, 2023 (Accessed May 28, 2023)
https://www.adamemberadvantage.com/endorsed-programs
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