‘Dual method of payment’

LETTERS TO THE EDITOR

TH E JOURNAL devotes this section to com m ent by readers on topics of current interest to den­ tistry. T h e editor reserves the right to edit all com m unications to fit available space and requires th a t all letters be signed. Printed com m unications do not necessarily reflect the opinion or of­ ficial policy of th e Association. Your participation in this section is invited.

S im ilar pro g ra m

A F D H needs yo u r support

■ D uring recent years, our profes­ sion has been encroached upon by pri­ vate and governm ent health delivery sy stem s, and we now lie in the shadow of being treated like tradesm en as the clam or for consum er representation and control threatens our autonom y. T he m ore our profession can pro­ vide for its own future m anpow er, the less the chance is that an outside agen­ cy will do it for us. T he time has come to invest in our own future. D entistry affords all of us in private practice a com fortable living. If we are to con­ tinue to enjoy our status as self-em­ ployed professionals, the public must be made aw are that we are doing som ething about the dental needs of our com m unity with our own funds. T hè A m erican F und for D ental H ealth is the dental fund-raising or­ ganization sponsored by the A D A . T hrough it, organized dentistry will continue to provide student loans as well as reach out to the needs o f dental health, education, research, and de­ livery. T here is nothing m ore precious to us than the freedom of private prac­ tice. By supporting the A F D H , we will help to maintain this freedom . I t ’s an investm ent in our future! B U D KRASNE, DDS M IA M I

m M y sym pathy goes out to H arry E. Jam ison, w hose letter in the April j a d a (page 691) regarding M edi-Cal patients was read with great interest. In my state of South C arolina, there is a program which I suspect is similar to the one he w rote about. T he pro­ gram is sponsored by the D epartm ent of Social Services, which approves the estim ated fees subm itted on exam ina­ tion by the patient. A fter approval of these fees by the departm ent, treat­ m ent is rendered and, upon comple­ tion of the treatm ent plan (and much com plicated paper w ork), forms are subm itted to the Blue Cross-Blue Shield M edicaid Office w here fees are paid according to their determ ination —not w hat was agreed upon. I, like D r. Jam ison, can no longer afford to render services under the M edicaid Program . T he same prob­ lems exist. T he total fees are reduced some 30% to 40%, and the patient may or may not show up at the appointed tim e. A nd, paym ent is from six to eight w eeks in coming. I am now refusing additional treat­ m ent—ex cep t, of course, in those cases that already have been started. I, too, can no longer afford to operate in the red with this program . A nd, as far as I know, I am the last dentist in this area w ho is working with the pro­

gram. D r. Jam ison isn ’t alone. D entists have been getting the short end for a long tim e, perhaps because the peo­ ple who determ ine fees have not been m ade aw are of our trem endous over­ head. C A R L B. M O O R E , D D S C H A R L E S T O N , SC

‘D u a l m e t h o d o f p a y m e n t ’

m California D ental Service, a mem­ ber of D elta P lans, created by the C al­ ifornia D ental A ssociation and be­ lieved by many to be the leader in non­ profit prepaid dental plans, is now propagating a dual m ethod of paym ent to general practitioners and special­ ists. F o r many G P s, this is a bitter pill to swallow. T he G P is not allowed to charge the sam e fee as the specialist, even though he perform s the same service. This unfair practice by California D ental Service is contrary to A D A standards for prepaym ent program s, w hich state th at “ the same level of paym ent for com parable services should apply w hether perform ed by a dental specialist or general practi­ tio n e r.” I have brought this m atter to the at­ tention of the C D A and the A D A Council on D ental C are Programs. As yet, no one has responded. JAD A, V o l. 88, J u n e 1974 ■ 1239

If we let C D S blatantly disregard th e A D A guidelines, which were ob­ viously intended to protect the prac­ tice of general dentistry, w hat kind of treatm ent can we expect from private insurers? L O U IS M A R A V IG L IA , D D S SAN FR A N C ISC O

■ E d ito r’s note: T he 1973 H ouse of D elegates referred for study and re­ p o rt back in 1974 the question of delet­ ing, retaining, or modifying th e exist­ ing Standard X X II, on w hich D r. M araviglia com m ents. T he Council on D ental Care Program s has been in touch with a broad range of interested dental groups in the process of form u­ lating a recom m endation to be sent, through the Board of T rustees, to the 1974 H ouse for its judgm ent. A lthough the Council’s files do not show any correspondence with D r. M araviglia, the Council will respond to him directly on this matter.

The D D S -D M D issue a I w ould like to com m ent on the let­ te r from D avid Griggs (April j a d a , page 691) concerning the use of the D D S degree versus the D M D degree. If the dentist sees his professional duties as strictly treating the hard structures of the m outh, then either of these degrees should be sufficient since both of them refer specifically to the teeth. If the dentist sees his pro­ fessional duty as the m echanistic re­ pair of dental dam age, he always will rem ain in the back row of the health professionals. T he dentist probably is the only medical practitioner who does no routine diagnostic tests to de­ term ine the etiology of the diseases he treats, other than to merely establish their presence or absence. It is unusual to find a dentist who perform s b lood, urine, or other tests to aid in diagnosing system ic influences on oral disease. M any diseases have oral sym ptom s as part of their syn­ drom e or “ cluster” effect. Leukem ia, purpura, diabetes, hypoglycemia, syphilis, and avitam inoses are only a few of the system ic pathoses that are reflected in the mouth. It would seem to me that our pro­

fessional organizations such as the A D A would strongly advise all den­ tists to routinely prescribe and inter­ p ret medical screening tests as part of their ordinary diagnostic procedures. T his would be an educational process for the dentist as well as a legal asset. It would seem that any dentist per­ forming oral procedures w ithout hav­ ing medical screening tests as back­ ground is leaving himself open to legal liability. If the dentist becomes aw are of his true responsibilities in the health field and perform s diagnosis and therapeu­ tics in a thorough and scientific fash­ ion, then the logical degree would be D O M — D o cto r of Oral M edicine.

specialization in oralogy. H ow ever, such a proposal would cut across many existing political and organ­ izational lines. A lthough such a proposal would be preferable, it is questionable how feasible it would be. A m ore feasible idea would be for the A D A to bestow a D O M (D o cto r of Oral M edicine) degree on all current and future prac­ titioners. R O B E R T S. R IC H M A N CLASS O F 1974 SU N Y A T ST O N Y BROOK D E N T A L SC H O O L

E n joys Q & A section

ROY E . S T A N F O R D , J R ., D D S Me L E A N , VA

■ I also share the concern o f D avid Griggs. H ow ever, I believe his letter only scratches the surface of the “ de­ gree dilem m a.” I believe that the only way to clear up the current confusion is to view it from an historical perspective. T he term s “ den tist,” “ d en tal,” and “ den­ tistry ” all stem from the Latin word “ d e n s,” which means tooth. T he main reason why the dental profession de­ veloped an identity separate from the medical profession is because the sole responsibility of the form er was once restricted to the repair and extraction of teeth. As it once existed, dentistry was considered purely a mechanical skill, requiring no knowledge of the human body. T he D D S degree is a direct re­ sult of this type of dental practice and, as such, is an anachronism . It is my opinion that the D M D degree is not much more valid because the term “ dental” still implies that the d en tist’s only concern is the teeth. H ow ever, the dental profession— as it exists today—does not ju st con­ cern itself with the teeth but with the entire oral cavity. Because of this, the practitioner more properly should be called an ‘‘oralist’’ and the field named “ oralogy.” Logistically, it shouldn’t even be a separate field, but rather ju st another medical specialty like ophthalmology or derm atology. T he degree should be one with an M D designation, with

m Regarding your question posed in the April j a d a (page 185) concerning the usefulness of the “ Q uestions and A n sw ers” departm ent, my response would have to be an em phatic “ yes!” I consider the reading of this section of t h e j o u r n a l a requirem ent; the topics covered always are relevant and interesting. M any tim es the infor­ mation is of th e sort that is not easily located in oth er reference sources, w hether textbooks or the periodical literature. By all means continue the depart­ m ent. Perhaps your point of refer­ ence might be to deal with questions that are on the periphery o f dentistry — controversial and unconservative subjects and treatm en ts, or questions of interest to laymen (your recent item on w ater hardness is a good example). Y ou might expand the departm ent to serve as a reference source on all as­ pects of dentistry to all of the profes­ sion. FRED s ie m o n D A L Y C IT Y , C A L IF

Im portan ce o f flu o rid e

■ W ater is m an’s m ost essential food. It contains essential food com pon­ ents, elem ents taken from the earth it contacts. F o r millions of years, m an’s w ater supply was that of running stream s, lakes, rivers, wells, and cisterns. All o f these forms w ere soil leaching, en­ riched with the m inerals from the soil

LETTER S TO THE EDITOR / JADA, V o l. 88, J u n e 1974 ■ 1241