- Email: [email protected]
The Contributions of Dr. Gies
JADA LANDMARK SERIES Spotlighting articles from past ADA Journals that have achieved landmark status thanks to their lasting impact on dental care and the dental profession
Originally published February 1924, The Journal of the American Dental Association, Vol. 11, No. 2, 97-108 To read full article, visit www.ada.org/centennial
THE CONTRIBUTIONS OF DR. GIES Promoting standards of dental education, research Richard R. Ranney, DDS, MS r. William John Gies had amazing perspicacity and foresight. In a relatively brief presentation,1 he addressed the origins of dental education, its relationship to medical education, proprietary dental schools, dental schools’ relationship to universities, the scientific
D 248
JADA 144(3)
http://jada.ada.org
background for practice, the function of research in dental schools, interprofessional relationships, dental auxiliaries, manpower issues and the financing of dental education. In the same year, in a presentation to the American Association of Dental Schools, he added considerations of post-
March 2013
Copyright © 2013 American Dental Association. All rights reserved.
JADA
graduate dental education, dental specialties and the relationships between oral and systemic diseases.2 How many of these have been serious issues through the years, continuing to the present! A detailed examination of each of these issues is still worthy, but available space for comment is limited, so my commentary is of necessity brief. Unavoidably, it also is influenced by personal experiences. Dr. Gies strongly believed that dentistry should be an essential part of a total health service. He regretted that the attempt in 1839 to get dental content permanently into the curriculum of the University of Maryland School of Medicine failed, in spite of the fact that Dr. Horace H. Hayden had lectured on dentistry in that school between 1823 and 1825. Because it did fail, however, Dr. Hayden, together with Dr. Chapin A. Harris, in doing “the best that they could,” formed the Baltimore College of Dental Surgery (BCDS), giving “birth to dentistry as a coordinate division of health service.”1 Dr. Gies then lauded a 1924 merger of the “oldest dental school in the world” (BCDS) with a different dental school that, through other mergers, had become part of the University of Maryland in 1913. In this singular instance, Dr. Gies perhaps let his enthusiasm for the “development of a new spirit in health-service education” override the fact that the consolidation approved by the Maryland legislature in April 1924 established the Dental School of the University of Maryland, with a “status independent of the School of Medicine.”3 And indeed it has remained organizationally separate from the School of Medicine to this day, as have all other dental schools in the United States, save the one at Harvard University. Dr. Gies later concluded that dentistry “is and should remain an independent division of the health sciences.”2,4 I believe that most observers would applaud that conclusion as one that provided better general health and oral health care to the people of the United States and many other countries than would have occurred had dentistry become a
LANDMARK
SERIES
subspecialty of medicine. This is not to say that we shouldn’t continue to seek a closer working relationship with our medical colleagues in providing comprehensive health services. In his first 1924 article,1 Dr. Gies reported with approval the assimilation of a number of dental schools into universities, while warning of dangers inherent to proprietary schools and the idea that “independent dental schools could be conducted at a profit.” He decried “dental schools that frequently were founded as much for the money that could be made from them as for the educational and professional service that could be rendered through them.” He went on to say that the era of such behavior thankfully had passed. But there are signs that his caution may need to be refreshed. Today there is increasing pressure on all schools, public as well as private, to realize selfsupport as nearly as possible, if not actually to make a profit. This, in turn, causes schools, in addition to putting more resources into philanthropic fundraising, to rely heavily on raising revenue through their clinical programs. It also causes them to raise tuition to the point at which most new dentists have substantial debt when they graduate. Care must be taken not to undermine educational excellence while attempting to maximize clinical revenue. And the student debt load clearly has effects on career path options in ways that may not be in the best interests of the public or the profession.5,6 Renewed efforts to ensure adequate funding of dental education as a public trust would seem to be in order. Dr. Gies made an elegant case for research as an integral part of dental schools. It is concerning that in the relatively recent past, several research-intensive universities (such as Washington University in St. Louis, Emory University, Georgetown University, Northwestern University) closed their dental schools. Although dental research, a good deal of it conducted in dental schools, has indeed made many valuable contributions to knowledge and the improvement of practice, it remains the case JADA 144(3)
http://jada.ada.org
Copyright © 2013 American Dental Association. All rights reserved.
March 2013 249
JADA
LANDMARK
SERIES
that the great majority of the research in dental schools takes place in relatively few institutions. It would be wise to devise means and incentives to increase the number of schools with significant research engagements. The total number of dental schools in the United States declined, beginning in the 1980s after an exuberant federal stimulus to increase dental manpower, but that reduction in number recently has reversed markedly. Since 1997, 12 new schools have opened or are scheduled to open in 2013 (R.W. Valachovic, DMD, MPH, executive director, American Dental Education Association, written communication, 2012). None of them, however, is in what might be termed a research-intensive university. That is not to denigrate those institutions or their missions, but it is to express caution that we may be in danger of moving away from Dr. Gies’ sound admonitions about the great value of research to an excellent educational setting, and the advantages to dentistry of being integral to research universities’ missions and core values.7 In that context, it is perhaps notable that one researchintensive institution, the University of Rochester, recently rejected (or at least tabled indefinitely) a proposal to institute a predoctoral dental educational program. And to my knowledge, no other research-intensive university has recently even considered starting a dental school at a time when the number of schools is rapidly expanding. Dentistry still has work to do to achieve Dr. Gies’ goal of finding a welcome home in research-intensive universities. Dr. Gies strongly urged that dental education be the scholarly equivalent of medical education in every way. His landmark report in evaluating dental education for the Carnegie Foundation in 19264 stimulated substantial advancements toward that goal. Subsequently, prerequisites and curricula were universally enhanced, in general formats of including basic sciences and relevant medical matters. That remained the standard for decades. Dentistry can take pride in coming near to or actually realizing Dr. Gies’ goal of an intellectual pedagogical par with medicine. And in the present day, there is substantial effort to take this further through curricular innovation that takes advantage of improved knowledge of the learning process.8 But the great expansion of knowledge and professional approaches to treatment that has occurred through the years makes it very difficult to fit it all in a reasonable time frame with adequate depth of experience. Perhaps it is time now to reassess how to design educational efforts to prepare future den250
JADA 144(3)
http://jada.ada.org
tists in the best manner. Perhaps some of current standard curricular matter could be moved to prerequisites and flexibility for differing career directions introduced. However, a significant current difficulty in any reform, let alone maintenance of current excellence, is the shortage of full-time faculty for dental schools.9,10 This goes for expanding research as well as for revising and/or improving teaching. And it is disheartening to see how few dental students aspire to an academic career.11 Dr. Gies also expressed goals for postgraduate education in dentistry, including advanced training for specialties and for research training.1,2 Some of those goals have been substantially realized with modern accreditation requirements for advanced dental education programs. Some states have recognized a successful, accredited postgraduate year 1 (PGY-1) as a sufficient credential for licensure. From time to time, a mandatory PGY-1 has been discussed12,13 and still has advocates.14 With the limited time within predoctoral curricula to provide comprehensive knowledge and experience as referenced above, in my view it is time to seriously consider a mandatory year of postgraduate education prior to licensure. There currently is much discussion of accessto-care issues that, in turn, generate concern about having adequate numbers of dental professionals to address the need. Dr. Gies also realized the need in his time, but he cautioned that simply increasing the number of schools and graduates would not provide a complete solution.1 Then as now, the real problem was as much distribution as total numbers. Dr. Gies pointed out that dentists would gravitate to locations that provide the income and lifestyle that practitioners prefer rather than to rural or remote areas where need is great but rewards, at least financially, are perhaps not as great. To help with the distribution problem, present-day school admissions processes could take into account each applicant’s place of origin, as there is some evidence that those from a rural background are more likely to locate practices in rural areas than are those from urban settings.15 But, of course, that is not likely to be a complete solution. The lesson from Dr. Gies (and subsequent analysis16) is that we should not expect that increasing the number of graduates alone will solve the problem. When the number of schools and the class sizes were dramatically increased when stimulated by health manpower legislation in the 1970s and 1980s, one result was to have too many dentists in some urban and sub-
March 2013
Copyright © 2013 American Dental Association. All rights reserved.
JADA
urban areas without providing needed relief to rural areas and inner cities. Concomitantly, the number of applicants to dental schools declined precipitously until more recent years, when the bulge from the “overproduction” years moved toward retirement. Resolution of the lack of oral health care in some regions of the country needs innovative solutions. Some look to expanded use of auxiliaries for help in access to care and to impact the distribution problem positively. Dr. Gies in 1924 wrote favorably of the use of dental hygienists in that regard. And, as we know, this was controversial among dentists for many years before dental hygienists became widely accepted as valuable adjuncts to a dental practice. Now there is much discussion of expanded functions for hygienists and new types of expanded-function dental auxiliaries. Some areas, notably Alaska,17 have implemented such Dr. Gies practices. Predictable opposition has arisen, justifiable in its concerns for safety of the population. Again, we can learn from Dr. Gies. The proper course is to determine carefully how auxiliaries can be used to improve access to care while also protecting against inappropriate treatment as a result of inadequate education and training, so that everyone benefits—the public and the profession. Dr. Gies’ 1924 articles1,2 and his subsequent Carnegie report4 promoted standards that served to educate three generations of dentists in the United States and Canada, and thereby provided inestimable service to their people. He further elucidated a number of issues that remain concerns today. Prominent among these are the university affiliations of dental education, its financing, interdisciplinarity, fostering research and academic careers, faculty short-
LANDMARK
SERIES
ages and access to care issues, including appropriate use of auxiliaries. Attention is perhaps also needed to reevaluating prerequisites for admission and curricular flexibility. Donoff14 suggested that it is time for “a new Gies report” or some similar mechanism to achieve progress in their resolution. At the very least, it is worth rereading Dr. Gies’ sound advice as the future of dental education and practice is pondered. ■ Dr. Ranney is a professor emeritus and the former dean, Dental School, University of Maryland, Baltimore; former dean, School of Dentistry, University of Alabama, Birmingham; a past president, American Association for Dental Research; and a past president, International Association for Dental Research. Address reprint requests to Dr. Ranney at 729 Larue Road, Millersville, Md. 21108, e-mail [email protected]. 1. Gies WJ. The dental educational problem. JADA 1924;11(2): 97-108. 2. Gies WJ. A further discussion of some problems in dental education. JADA 1924;11(11):1107-1124. 3. The Baltimore College of Dental Surgery. Heritage and History. Baltimore: Baltimore College of Dental Surgery, Dental School, University of Maryland at Baltimore; undated. 4. Gies WJ. Dental Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. New York City: Carnegie Foundation; 1926. 5. Pyle M, Andrieu SC, Chadwick DG, et al. ADEA commission on change and innovation in dental education. J Dent Educ 2006;70(9): 921-924. 6. Davidson PL, Nakazono TT, Carreon DC, Gutierrez JJ, Shahedi S, Anderson RM. Reforming dental workforce education and practice in the USA. Eur J Dent Educ 2011;15(2):73-79. 7. DePaola DP, Slavkin H. Reforming dental health professions education: a white paper. J Dent Educ 2004;68(11):1139-1150. 8. Finkham AG, Shuler CE. The changing face of dental education: the impact of PBL. J Dent Educ 2001;65(5):406-421. 9. Chmar JE, Weaver RG, Valachovic RW. Dental school vacant budgeted faculty positions, academic years 2005-06 and 2006-07. J Dent Educ 2008;72(3):370-385. 10. Walker MP, Duley SI, Beach MM, et al. Dental education economics: challenges and innovative strategies. J Dent Educ 2008; 72(12):1440-1449. 11. Okwuje I, Anderson E, Valachovic RW. Annual survey of dental school seniors: 2008 graduating class. J Dent Educ 2009;73(8): 1009-1032. 12. Formicola AJ, Redding S, Mito RS. A national system to support a mandated PGY-1 year: how to get there from here. J Dent Educ 1999;63(8):635-643. 13. Edelstein BL. Public policy consideration in adopting a mandatory PGY-1 year. Postgraduate year. J Dent Educ 1999;63(8):644-647. 14. Donoff RB. It is time for a new Gies report. J Dent Educ 2006; 70(8):809-819. 15. McFarland KK, Reinhardt JW, Yaseen M. Rural dentists: does growing up in a small community matter? JADA 2012;143(9): 1013-1019. 16. Guthrie D, Valachovic RW, Brown LJ. The impact of new dental schools on the dental workforce through 2022. J Dent Educ 2009; 73(12):1353-1360. 17. Willard M. The Alaska native tribal health system dental health aide therapist as a dentist-centric model. J Am Coll Dent 2012;79(1):24-28.
JADA 144(3)
http://jada.ada.org
Copyright © 2013 American Dental Association. All rights reserved.
March 2013 251
Originally published February 1924, The Journal of the American Dental Association, Vol. 11, No. 2, 97-108 To read full article, visit www.ada.org/centennial
THE CONTRIBUTIONS OF DR. GIES Promoting standards of dental education, research Richard R. Ranney, DDS, MS r. William John Gies had amazing perspicacity and foresight. In a relatively brief presentation,1 he addressed the origins of dental education, its relationship to medical education, proprietary dental schools, dental schools’ relationship to universities, the scientific
D 248
JADA 144(3)
http://jada.ada.org
background for practice, the function of research in dental schools, interprofessional relationships, dental auxiliaries, manpower issues and the financing of dental education. In the same year, in a presentation to the American Association of Dental Schools, he added considerations of post-
March 2013
Copyright © 2013 American Dental Association. All rights reserved.
JADA
graduate dental education, dental specialties and the relationships between oral and systemic diseases.2 How many of these have been serious issues through the years, continuing to the present! A detailed examination of each of these issues is still worthy, but available space for comment is limited, so my commentary is of necessity brief. Unavoidably, it also is influenced by personal experiences. Dr. Gies strongly believed that dentistry should be an essential part of a total health service. He regretted that the attempt in 1839 to get dental content permanently into the curriculum of the University of Maryland School of Medicine failed, in spite of the fact that Dr. Horace H. Hayden had lectured on dentistry in that school between 1823 and 1825. Because it did fail, however, Dr. Hayden, together with Dr. Chapin A. Harris, in doing “the best that they could,” formed the Baltimore College of Dental Surgery (BCDS), giving “birth to dentistry as a coordinate division of health service.”1 Dr. Gies then lauded a 1924 merger of the “oldest dental school in the world” (BCDS) with a different dental school that, through other mergers, had become part of the University of Maryland in 1913. In this singular instance, Dr. Gies perhaps let his enthusiasm for the “development of a new spirit in health-service education” override the fact that the consolidation approved by the Maryland legislature in April 1924 established the Dental School of the University of Maryland, with a “status independent of the School of Medicine.”3 And indeed it has remained organizationally separate from the School of Medicine to this day, as have all other dental schools in the United States, save the one at Harvard University. Dr. Gies later concluded that dentistry “is and should remain an independent division of the health sciences.”2,4 I believe that most observers would applaud that conclusion as one that provided better general health and oral health care to the people of the United States and many other countries than would have occurred had dentistry become a
LANDMARK
SERIES
subspecialty of medicine. This is not to say that we shouldn’t continue to seek a closer working relationship with our medical colleagues in providing comprehensive health services. In his first 1924 article,1 Dr. Gies reported with approval the assimilation of a number of dental schools into universities, while warning of dangers inherent to proprietary schools and the idea that “independent dental schools could be conducted at a profit.” He decried “dental schools that frequently were founded as much for the money that could be made from them as for the educational and professional service that could be rendered through them.” He went on to say that the era of such behavior thankfully had passed. But there are signs that his caution may need to be refreshed. Today there is increasing pressure on all schools, public as well as private, to realize selfsupport as nearly as possible, if not actually to make a profit. This, in turn, causes schools, in addition to putting more resources into philanthropic fundraising, to rely heavily on raising revenue through their clinical programs. It also causes them to raise tuition to the point at which most new dentists have substantial debt when they graduate. Care must be taken not to undermine educational excellence while attempting to maximize clinical revenue. And the student debt load clearly has effects on career path options in ways that may not be in the best interests of the public or the profession.5,6 Renewed efforts to ensure adequate funding of dental education as a public trust would seem to be in order. Dr. Gies made an elegant case for research as an integral part of dental schools. It is concerning that in the relatively recent past, several research-intensive universities (such as Washington University in St. Louis, Emory University, Georgetown University, Northwestern University) closed their dental schools. Although dental research, a good deal of it conducted in dental schools, has indeed made many valuable contributions to knowledge and the improvement of practice, it remains the case JADA 144(3)
http://jada.ada.org
Copyright © 2013 American Dental Association. All rights reserved.
March 2013 249
JADA
LANDMARK
SERIES
that the great majority of the research in dental schools takes place in relatively few institutions. It would be wise to devise means and incentives to increase the number of schools with significant research engagements. The total number of dental schools in the United States declined, beginning in the 1980s after an exuberant federal stimulus to increase dental manpower, but that reduction in number recently has reversed markedly. Since 1997, 12 new schools have opened or are scheduled to open in 2013 (R.W. Valachovic, DMD, MPH, executive director, American Dental Education Association, written communication, 2012). None of them, however, is in what might be termed a research-intensive university. That is not to denigrate those institutions or their missions, but it is to express caution that we may be in danger of moving away from Dr. Gies’ sound admonitions about the great value of research to an excellent educational setting, and the advantages to dentistry of being integral to research universities’ missions and core values.7 In that context, it is perhaps notable that one researchintensive institution, the University of Rochester, recently rejected (or at least tabled indefinitely) a proposal to institute a predoctoral dental educational program. And to my knowledge, no other research-intensive university has recently even considered starting a dental school at a time when the number of schools is rapidly expanding. Dentistry still has work to do to achieve Dr. Gies’ goal of finding a welcome home in research-intensive universities. Dr. Gies strongly urged that dental education be the scholarly equivalent of medical education in every way. His landmark report in evaluating dental education for the Carnegie Foundation in 19264 stimulated substantial advancements toward that goal. Subsequently, prerequisites and curricula were universally enhanced, in general formats of including basic sciences and relevant medical matters. That remained the standard for decades. Dentistry can take pride in coming near to or actually realizing Dr. Gies’ goal of an intellectual pedagogical par with medicine. And in the present day, there is substantial effort to take this further through curricular innovation that takes advantage of improved knowledge of the learning process.8 But the great expansion of knowledge and professional approaches to treatment that has occurred through the years makes it very difficult to fit it all in a reasonable time frame with adequate depth of experience. Perhaps it is time now to reassess how to design educational efforts to prepare future den250
JADA 144(3)
http://jada.ada.org
tists in the best manner. Perhaps some of current standard curricular matter could be moved to prerequisites and flexibility for differing career directions introduced. However, a significant current difficulty in any reform, let alone maintenance of current excellence, is the shortage of full-time faculty for dental schools.9,10 This goes for expanding research as well as for revising and/or improving teaching. And it is disheartening to see how few dental students aspire to an academic career.11 Dr. Gies also expressed goals for postgraduate education in dentistry, including advanced training for specialties and for research training.1,2 Some of those goals have been substantially realized with modern accreditation requirements for advanced dental education programs. Some states have recognized a successful, accredited postgraduate year 1 (PGY-1) as a sufficient credential for licensure. From time to time, a mandatory PGY-1 has been discussed12,13 and still has advocates.14 With the limited time within predoctoral curricula to provide comprehensive knowledge and experience as referenced above, in my view it is time to seriously consider a mandatory year of postgraduate education prior to licensure. There currently is much discussion of accessto-care issues that, in turn, generate concern about having adequate numbers of dental professionals to address the need. Dr. Gies also realized the need in his time, but he cautioned that simply increasing the number of schools and graduates would not provide a complete solution.1 Then as now, the real problem was as much distribution as total numbers. Dr. Gies pointed out that dentists would gravitate to locations that provide the income and lifestyle that practitioners prefer rather than to rural or remote areas where need is great but rewards, at least financially, are perhaps not as great. To help with the distribution problem, present-day school admissions processes could take into account each applicant’s place of origin, as there is some evidence that those from a rural background are more likely to locate practices in rural areas than are those from urban settings.15 But, of course, that is not likely to be a complete solution. The lesson from Dr. Gies (and subsequent analysis16) is that we should not expect that increasing the number of graduates alone will solve the problem. When the number of schools and the class sizes were dramatically increased when stimulated by health manpower legislation in the 1970s and 1980s, one result was to have too many dentists in some urban and sub-
March 2013
Copyright © 2013 American Dental Association. All rights reserved.
JADA
urban areas without providing needed relief to rural areas and inner cities. Concomitantly, the number of applicants to dental schools declined precipitously until more recent years, when the bulge from the “overproduction” years moved toward retirement. Resolution of the lack of oral health care in some regions of the country needs innovative solutions. Some look to expanded use of auxiliaries for help in access to care and to impact the distribution problem positively. Dr. Gies in 1924 wrote favorably of the use of dental hygienists in that regard. And, as we know, this was controversial among dentists for many years before dental hygienists became widely accepted as valuable adjuncts to a dental practice. Now there is much discussion of expanded functions for hygienists and new types of expanded-function dental auxiliaries. Some areas, notably Alaska,17 have implemented such Dr. Gies practices. Predictable opposition has arisen, justifiable in its concerns for safety of the population. Again, we can learn from Dr. Gies. The proper course is to determine carefully how auxiliaries can be used to improve access to care while also protecting against inappropriate treatment as a result of inadequate education and training, so that everyone benefits—the public and the profession. Dr. Gies’ 1924 articles1,2 and his subsequent Carnegie report4 promoted standards that served to educate three generations of dentists in the United States and Canada, and thereby provided inestimable service to their people. He further elucidated a number of issues that remain concerns today. Prominent among these are the university affiliations of dental education, its financing, interdisciplinarity, fostering research and academic careers, faculty short-
LANDMARK
SERIES
ages and access to care issues, including appropriate use of auxiliaries. Attention is perhaps also needed to reevaluating prerequisites for admission and curricular flexibility. Donoff14 suggested that it is time for “a new Gies report” or some similar mechanism to achieve progress in their resolution. At the very least, it is worth rereading Dr. Gies’ sound advice as the future of dental education and practice is pondered. ■ Dr. Ranney is a professor emeritus and the former dean, Dental School, University of Maryland, Baltimore; former dean, School of Dentistry, University of Alabama, Birmingham; a past president, American Association for Dental Research; and a past president, International Association for Dental Research. Address reprint requests to Dr. Ranney at 729 Larue Road, Millersville, Md. 21108, e-mail [email protected]. 1. Gies WJ. The dental educational problem. JADA 1924;11(2): 97-108. 2. Gies WJ. A further discussion of some problems in dental education. JADA 1924;11(11):1107-1124. 3. The Baltimore College of Dental Surgery. Heritage and History. Baltimore: Baltimore College of Dental Surgery, Dental School, University of Maryland at Baltimore; undated. 4. Gies WJ. Dental Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. New York City: Carnegie Foundation; 1926. 5. Pyle M, Andrieu SC, Chadwick DG, et al. ADEA commission on change and innovation in dental education. J Dent Educ 2006;70(9): 921-924. 6. Davidson PL, Nakazono TT, Carreon DC, Gutierrez JJ, Shahedi S, Anderson RM. Reforming dental workforce education and practice in the USA. Eur J Dent Educ 2011;15(2):73-79. 7. DePaola DP, Slavkin H. Reforming dental health professions education: a white paper. J Dent Educ 2004;68(11):1139-1150. 8. Finkham AG, Shuler CE. The changing face of dental education: the impact of PBL. J Dent Educ 2001;65(5):406-421. 9. Chmar JE, Weaver RG, Valachovic RW. Dental school vacant budgeted faculty positions, academic years 2005-06 and 2006-07. J Dent Educ 2008;72(3):370-385. 10. Walker MP, Duley SI, Beach MM, et al. Dental education economics: challenges and innovative strategies. J Dent Educ 2008; 72(12):1440-1449. 11. Okwuje I, Anderson E, Valachovic RW. Annual survey of dental school seniors: 2008 graduating class. J Dent Educ 2009;73(8): 1009-1032. 12. Formicola AJ, Redding S, Mito RS. A national system to support a mandated PGY-1 year: how to get there from here. J Dent Educ 1999;63(8):635-643. 13. Edelstein BL. Public policy consideration in adopting a mandatory PGY-1 year. Postgraduate year. J Dent Educ 1999;63(8):644-647. 14. Donoff RB. It is time for a new Gies report. J Dent Educ 2006; 70(8):809-819. 15. McFarland KK, Reinhardt JW, Yaseen M. Rural dentists: does growing up in a small community matter? JADA 2012;143(9): 1013-1019. 16. Guthrie D, Valachovic RW, Brown LJ. The impact of new dental schools on the dental workforce through 2022. J Dent Educ 2009; 73(12):1353-1360. 17. Willard M. The Alaska native tribal health system dental health aide therapist as a dentist-centric model. J Am Coll Dent 2012;79(1):24-28.
JADA 144(3)
http://jada.ada.org
Copyright © 2013 American Dental Association. All rights reserved.
March 2013 251