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Should the duties of auxiliary personnel be expanded?
SHOULD THE DUTIES OF AUXILIARY
PERSONNEL BE EXPANDED?
Affirmative JOHN
W. STONE, D.D.S., M.P.H.*
University
of Detroit,
School
of Dentistry,
Detroit,
Mich.
T
0 THE QUESTION, “should the duties of dental auxiliaries he expanded?,” my answer is an emphatic yes! We should be ever mindful that dentistry is a social phenomenon. It is out of special health need within society that this important profession has evolved. When any group presumes the momentous right to establish and enforce sanctions over some aspect of life, and so long as society recognizes the legitimacy of such claims, then truly a profession exists. The dental profession claims for itself the legal, moral, and intellectual right not only to define the terms of dental practice but to define for society the very nature of dental health and disease. The dental health problem is not a simple one. The widespread failure of the public to seek or receive adequate treatment results in the accumulation of a staggering backlog of untreated dental disease. It is estimated in the “Survey” that there are 700 million unfilled cavities. Among the 10 per cent of the children Lmder 5 years of age who visit the dentist, only 1 out of 3 is free from untreated carious lesions ; 1 out of 10 has eight or more cavities. One child out of 5 needs orthodontic treatment, and diseases of the supporting bone and gingival tissues afflict at least half of the population by the age of 50 and almost everyone 1,~ the age of 65. These dental needs have been grouped into three categories : (1) total unmet dental need, (2) potential demand for dental care, and (3) efj fective demand for dental care. ANALYSIS
OF NEED
There is one school of thought taking the position that the very best dental services obtainable anywhere in the world are presently available to any of our citizens who care to seek them. Accordingly, if people do not obtain these services, it must be because they just do not care enough about their dental health. At the other end of the philosophic scale is the other school of thought which believes that there is a significantly large portion of our population for whonl even minimal professional dental services are unobtainable. It is imperative that acceptable, workable, realistic solutions be formulated bv the profession, otherwise there is a very real risk that the problems of inail equate distribution of dentists and of dental fees will be solved by third part! interventions and political intervention. Read before the Academy of Denture Prosthetics, *Chairman, Department of Social Dentistry.
Miami Beach, Fla
Fantastic social and political changes are occurring today. ant1 inure are to be expected. I~VOLLiTION
iSOT
throughout
the world
RWOLUTION
Society, it seems, is saying that we must cease being “highly skilled tinkerers” and assume our professional role as “dental doctors.” This is an obligation which surpasses the capabilities of tinkerers. The executive role of the dentist, it seems obvious to me, is that of diagnostician, decision maker, duty delegator, and evaluator. Through the use of many pairs of trained hands, the dentist can extend the benefit of his training and experience to a greater portion of society, thus meeting more nearly his professional obligations. The medical profession has been successful in the delegation of duties to its auxiliaries. It has been so successful that there are now approximately thirteen personnel in the associated health professions employed by hospitals for each psysician with staff privileges. Obviously, this delegation has not cotne overnight or without rancor. But, apparently it has been successful because the physicians are still in charge of the healing and treating procedures provided patients. It has been suggested that activities such as placing simple restorations, polishing restorations, making impressions, and placing and removing periodontal packs might be clelegatecl to dental auxiliaries. In fact, there are those who have suggested that all of our procedures short of making injections and cutting hard tooth structure could be delegated to auxiliaries. LVith adequate training, and with proper supervision from the dentist, is there any valid reason why so-called “second class dentistry” would result? Is there any valid reason why we should continue to attempt to practice dentistry single handedly? I suspect that if we do not come up with workable answers to these questions, others will ! Delegation implies responsibility. The professional activities of the dental hygienists-activities and duties which have been delegated them by the clental professon-are an excellent case in point. Each state now recognizes Dental Hygiene as a profession, but without exception the hygienist is specifically prohibited from performing the services for which she is trained except when she works under the direct supervision of a licensed dentist. This is because it is with the dentist for whom she works that the responsibility for her activities rests. It is he who carries the malpractice insurance. Therefore, if the responsibility is the dentist’s, let him assume a realistic attitude toward the expansion of duties of his auxiliaries. We have established that there is a growing need for dental services, and that this need is likely to grow as the population explosion continues. JVe now can see that there is an absolute limit to the amount of services we can provide under the present system of practice. We can see, also, that unless we provide these services, someone else will. If we are to have these people as auxiliaries to the dental profession, we must provide the guiding matrix in which they can develop. 2985 E. DETROIT
JEFFERSON 7. MICH.
PERSONNEL BE EXPANDED?
Affirmative JOHN
W. STONE, D.D.S., M.P.H.*
University
of Detroit,
School
of Dentistry,
Detroit,
Mich.
T
0 THE QUESTION, “should the duties of dental auxiliaries he expanded?,” my answer is an emphatic yes! We should be ever mindful that dentistry is a social phenomenon. It is out of special health need within society that this important profession has evolved. When any group presumes the momentous right to establish and enforce sanctions over some aspect of life, and so long as society recognizes the legitimacy of such claims, then truly a profession exists. The dental profession claims for itself the legal, moral, and intellectual right not only to define the terms of dental practice but to define for society the very nature of dental health and disease. The dental health problem is not a simple one. The widespread failure of the public to seek or receive adequate treatment results in the accumulation of a staggering backlog of untreated dental disease. It is estimated in the “Survey” that there are 700 million unfilled cavities. Among the 10 per cent of the children Lmder 5 years of age who visit the dentist, only 1 out of 3 is free from untreated carious lesions ; 1 out of 10 has eight or more cavities. One child out of 5 needs orthodontic treatment, and diseases of the supporting bone and gingival tissues afflict at least half of the population by the age of 50 and almost everyone 1,~ the age of 65. These dental needs have been grouped into three categories : (1) total unmet dental need, (2) potential demand for dental care, and (3) efj fective demand for dental care. ANALYSIS
OF NEED
There is one school of thought taking the position that the very best dental services obtainable anywhere in the world are presently available to any of our citizens who care to seek them. Accordingly, if people do not obtain these services, it must be because they just do not care enough about their dental health. At the other end of the philosophic scale is the other school of thought which believes that there is a significantly large portion of our population for whonl even minimal professional dental services are unobtainable. It is imperative that acceptable, workable, realistic solutions be formulated bv the profession, otherwise there is a very real risk that the problems of inail equate distribution of dentists and of dental fees will be solved by third part! interventions and political intervention. Read before the Academy of Denture Prosthetics, *Chairman, Department of Social Dentistry.
Miami Beach, Fla
Fantastic social and political changes are occurring today. ant1 inure are to be expected. I~VOLLiTION
iSOT
throughout
the world
RWOLUTION
Society, it seems, is saying that we must cease being “highly skilled tinkerers” and assume our professional role as “dental doctors.” This is an obligation which surpasses the capabilities of tinkerers. The executive role of the dentist, it seems obvious to me, is that of diagnostician, decision maker, duty delegator, and evaluator. Through the use of many pairs of trained hands, the dentist can extend the benefit of his training and experience to a greater portion of society, thus meeting more nearly his professional obligations. The medical profession has been successful in the delegation of duties to its auxiliaries. It has been so successful that there are now approximately thirteen personnel in the associated health professions employed by hospitals for each psysician with staff privileges. Obviously, this delegation has not cotne overnight or without rancor. But, apparently it has been successful because the physicians are still in charge of the healing and treating procedures provided patients. It has been suggested that activities such as placing simple restorations, polishing restorations, making impressions, and placing and removing periodontal packs might be clelegatecl to dental auxiliaries. In fact, there are those who have suggested that all of our procedures short of making injections and cutting hard tooth structure could be delegated to auxiliaries. LVith adequate training, and with proper supervision from the dentist, is there any valid reason why so-called “second class dentistry” would result? Is there any valid reason why we should continue to attempt to practice dentistry single handedly? I suspect that if we do not come up with workable answers to these questions, others will ! Delegation implies responsibility. The professional activities of the dental hygienists-activities and duties which have been delegated them by the clental professon-are an excellent case in point. Each state now recognizes Dental Hygiene as a profession, but without exception the hygienist is specifically prohibited from performing the services for which she is trained except when she works under the direct supervision of a licensed dentist. This is because it is with the dentist for whom she works that the responsibility for her activities rests. It is he who carries the malpractice insurance. Therefore, if the responsibility is the dentist’s, let him assume a realistic attitude toward the expansion of duties of his auxiliaries. We have established that there is a growing need for dental services, and that this need is likely to grow as the population explosion continues. JVe now can see that there is an absolute limit to the amount of services we can provide under the present system of practice. We can see, also, that unless we provide these services, someone else will. If we are to have these people as auxiliaries to the dental profession, we must provide the guiding matrix in which they can develop. 2985 E. DETROIT
JEFFERSON 7. MICH.