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Standard Does Exist
LETTERS (Continued) Standard does exist Doctor (Martin H.) Berman is to be congratulated on his excellent arti cle concerning cutting efficiency in complete coverage preparation which appeared in the November 1969 j a d a , page 1160. He especially has presented a well-documented discus sion o f the factors influencing cutting efficiency and points up some o f the problems that one faces in attempt ing to establish specifications for dental excavating burs and diamond rotary instruments. I would, however, call Doctor Berman’s attention to the fact that there does exist an American stan dard for shapes, head dimensions, and shank dimensions for dental dia mond rotary instruments. This was adopted by the A D A in 1963 and by the United States of America Stan dards Institute (now American N a tional Standards Institute) in 1966. Although it is not completely re lated to dimensions, there is a gen eral correlation between the number designations for shapes and sizes o f excavating burs and for those o f the diamond instruments. The uniform numbering system for diamond ro tary instruments was published in the December 1963 issue o f The Journal o f the Am erican Dental Association. Work continues on an internation al scale to develop a standard num bering system that will designate the size and shape of a cutting instru ment, and will be numerically re lated to certain dimensions. JO H N W . STANFORD, P h D SE CR ETA R Y , ADA CO UN CIL ON DENTAL M A TER IA LS AND DEV ICES
‘Dental therapist’ The October j a d a carried a letter to the editor extolling the use o f “dental therapists” as are used in other countries. “Dental therapists” would be a subprofessional group o f auxiliaries trained to insert and fin ish restorations. According to studies done by the U S Public Health Ser
vice at Louisville, Ky; by the US N avy at Great Lakes, 111; and by the D A U program at the University o f Alabama, these skills could be taught to dental assistants in from three to six weeks. In 1967, the U SPHS published studies in t h e j o u r n a l indicating that auxiliaries could be taught to place restorations equal in quality to those done by dentists. The concept of the “dental ther apist” is completely impractical in contemporary dental practice as structured today. It is only feasible in a clinical situation where the work load pressure provides a waiting room filled with patients. Then it becomes a question o f a dentist working for a salary. The den tist is either one professional notch above the “therapist,” or the “ther apist” is one notch below that o f the dentist— a situation that hardly adds to the stature o f the dentist as a health practitioner. In concept, it is designed to boost the production o f services. However, it will not work in the average office which has two chairs and two auxil iaries, or even the three-chair office with a hygienist. For example, the “therapist” would be unemployed during the time the dentist and his chair assistant were doing bridge work, prosthetics, endodontics, extractions, the fitting and adjustment o f bridges, crowns, and dentures. Only when the dentist was doing amalgam, silicate, or resin preparations, would it be feasible to have the therapist take over to place the fillings after the dentist had cut the preparations. This is only a small percentage of the average dentist’s work schedule. Further, should the restoration fail, who would be responsible? Re placement would, o f necessity, be free, and the cost absorbed by the dentist. Therapists would command salaries as high or higher than hygienists. In order to make this eco nomically feasible, they would have to produce three times their salaries in chargeable fees. Under the condi tions just described, this would be impossible. If dentists with “therapists” could
charge lower fees and attract union contracts and dental service corpora tion clients, it would create an un fair competitive disadvantage to the small office. Marginal practices that attempted to compete by hiring “therapists” could be bankrupted. Were “therapists” to form unions, dental practice as it is known today would vanish. In a 1967 survey o f practices in Maryland, the statistics showed that 34% of practices in Maryland had such limited demands for services that they could satisfy all demands with the help o f but one dental assis tant. By all modern standards, these are minimum dental practices which are not work saturated. The recent A D A Survey o f Dentistry provides statistics that indicate there exists na tionally a considerable percentage of practices which are not work satu rated either. Certainly, a “therapist” would be contraindicated in such practices. Since the A D A and the federal government are constantly reminding us o f an impending manpower short age, it should be pointed out that by adding a hygienist to the dental staff the office can take on an additional load of some 800 patients. The hy gienist can see an additional 2,000 patients per year. Every effort should be made to provide more hygienists, not “ther apists.” If only 50,000 o f the more than 100,000 dentists in practice to day could add a hygienist to their practices and thus enable them to add an additional 800 patients to their practices, more than 40 m illion new dental patients could be treated with out educating one extra dentist or building one additional new office. In his letter to the editor which appeared in the October j a d a , Bruce L. Douglas stated that “w e need den tal nurses (therapists) in the United States.” H e praises the system in C o lombia and says “a similar system would fit into our own system o f den tal and paradental education.” D oc tor Douglas is a professor o f commu nity dentistry at the University o f Illinois. I submit that this contention is en tirely in error, and that anyone fa LETTERS TO THE EDITOR ■ 269
‘Dental therapist’ The October j a d a carried a letter to the editor extolling the use o f “dental therapists” as are used in other countries. “Dental therapists” would be a subprofessional group o f auxiliaries trained to insert and fin ish restorations. According to studies done by the U S Public Health Ser
vice at Louisville, Ky; by the US N avy at Great Lakes, 111; and by the D A U program at the University o f Alabama, these skills could be taught to dental assistants in from three to six weeks. In 1967, the U SPHS published studies in t h e j o u r n a l indicating that auxiliaries could be taught to place restorations equal in quality to those done by dentists. The concept of the “dental ther apist” is completely impractical in contemporary dental practice as structured today. It is only feasible in a clinical situation where the work load pressure provides a waiting room filled with patients. Then it becomes a question o f a dentist working for a salary. The den tist is either one professional notch above the “therapist,” or the “ther apist” is one notch below that o f the dentist— a situation that hardly adds to the stature o f the dentist as a health practitioner. In concept, it is designed to boost the production o f services. However, it will not work in the average office which has two chairs and two auxil iaries, or even the three-chair office with a hygienist. For example, the “therapist” would be unemployed during the time the dentist and his chair assistant were doing bridge work, prosthetics, endodontics, extractions, the fitting and adjustment o f bridges, crowns, and dentures. Only when the dentist was doing amalgam, silicate, or resin preparations, would it be feasible to have the therapist take over to place the fillings after the dentist had cut the preparations. This is only a small percentage of the average dentist’s work schedule. Further, should the restoration fail, who would be responsible? Re placement would, o f necessity, be free, and the cost absorbed by the dentist. Therapists would command salaries as high or higher than hygienists. In order to make this eco nomically feasible, they would have to produce three times their salaries in chargeable fees. Under the condi tions just described, this would be impossible. If dentists with “therapists” could
charge lower fees and attract union contracts and dental service corpora tion clients, it would create an un fair competitive disadvantage to the small office. Marginal practices that attempted to compete by hiring “therapists” could be bankrupted. Were “therapists” to form unions, dental practice as it is known today would vanish. In a 1967 survey o f practices in Maryland, the statistics showed that 34% of practices in Maryland had such limited demands for services that they could satisfy all demands with the help o f but one dental assis tant. By all modern standards, these are minimum dental practices which are not work saturated. The recent A D A Survey o f Dentistry provides statistics that indicate there exists na tionally a considerable percentage of practices which are not work satu rated either. Certainly, a “therapist” would be contraindicated in such practices. Since the A D A and the federal government are constantly reminding us o f an impending manpower short age, it should be pointed out that by adding a hygienist to the dental staff the office can take on an additional load of some 800 patients. The hy gienist can see an additional 2,000 patients per year. Every effort should be made to provide more hygienists, not “ther apists.” If only 50,000 o f the more than 100,000 dentists in practice to day could add a hygienist to their practices and thus enable them to add an additional 800 patients to their practices, more than 40 m illion new dental patients could be treated with out educating one extra dentist or building one additional new office. In his letter to the editor which appeared in the October j a d a , Bruce L. Douglas stated that “w e need den tal nurses (therapists) in the United States.” H e praises the system in C o lombia and says “a similar system would fit into our own system o f den tal and paradental education.” D oc tor Douglas is a professor o f commu nity dentistry at the University o f Illinois. I submit that this contention is en tirely in error, and that anyone fa LETTERS TO THE EDITOR ■ 269