A recent article in The Daily Kos entitled “The Great American Toothache” suggests that the solution to the shortage of dentists in some areas of the United States is to enable dental technicians to perform fillings and dental extractions. While this solution sounds logical on the surface, I disagree that it is a solution for the following reasons:

Dental technicians as the title implies are dental mechanics. They do not have the education or clinical credentials to treat patients without direct supervision of a doctor. While it’s true that dental disease, including tooth decay, is more rampant in economically depressed areas, so is the prevalence of other diseases (diabetes and oral cancer as examples), which underscores the importance of a doctor’s presence.

Not only do many systemic diseases have oral manifestations, but also there are very real situations in which a patient’s health status can be assessed by visual inspection prior to the actual dental exam. A patient’s pallor, skin tone, gait; the color of his nail beds or the sclera of her eyes may yield signs of serious illness. Dentists are doctors with the training and education to screen the health of people who present for “routine ” care. In fact, dentists are often the only health professional a person might see, especially in economically depressed areas.

Efforts could be made to encourage young dentists to practice in underserved areas perhaps by offsetting the exorbitant cost of a dental education with a commitment to serve, much the way the National Health Service operates.

Everyone deserves proper professional care with appropriate oversight.

There is a place for dental technicians, but not at the potential expense of a patient’s health. When a person presents to a hospital emergency room, it may be a triage nurse who does the initial screening, but it is a doctor who makes the diagnosis and treatment decisions.