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The Dental Community’s Response to Reform: A Deconstruction

The Dental Community’s Response to Reform: A Deconstruction

I met Dr. Vujicic two years ago at a dental conference. I knew about him six months before that. An audio interview of him was sent to me with the caption, “you’re gonna like this.” I did. Marko is articulate and his competence is evident. But that’s not what piqued my interest. The thing that drew me in was how nonchalantly he discussed topics that felt taboo in my world. They were controversial topics, that he spoke to directly. Yet, he worked for the ADA. Which is only to say that when you work for such a large organization, you must be careful of your words, because you represent a lot of people. At the time, I remember wondering if he was like a child that was asking what a bad word meant. His comfort must rest in his ignorance. Yes, that must be it. The thought of that made me giddy with delight. See, I wanted to talk about these things. But without a space, the opportunity rarely presented itself. Then I saw him speak in person. This was when I was confronted with a second surprise. I discovered that it wasn’t that he didn’t understand the weight of his words, it was that he didn’t care. Which I thought was even more fantastic. I’m not saying he doesn’t care about the work or its consequences. I believe he cares deeply about that. But he made his role clear from the beginning. “My job is to give you the data, and interpret it from my point of you. It is your job to do with it as you please.” Wait, what? How did he just manage to toss himself into a bucket of safety one sentence into his presentation? At that point it didn’t matter. He had swept the room away and not a single Oregonian was looking back. Later, I would have a conversation with a well-known public health figure in the dental community that compared Dr. Vujicic to Madonna, stating “everyone knows him simply by his first name, Marko”.

I think that over the past ten years some of the dental community has felt thirsty. They have grown dissatisfied with a system that they felt was destined to doom, by staying exactly the same. Then walks in this data-loving, Canadian economist with a Diet Pepsi in one hand and a Wayne Gretsky analogy in the other. And over the past seven years Marko’s team has dived deeply into the American dental system to better understand what, how, and why we do what we do.

Then, in March of 2018, after feeling confident about what he had discovered during his time at the health policy institute, he wrote a guest editorial in JADA. The editorial is called “Our Dental System is Stuck.

And here is what to do about it.” In it he says that if we as a dental community want to expand access to dental care and improve the way we care for the American public in a meaningful and long-lasting way, major reforms are necessary. He then suggests four major areas of reform.

Late February, Portland, Oregon.

Under my heated blanket, and with a large glass of cab in hand, I read Marko’s thought piece. A few times, I forgot to breathe. I know that sounds dramatic, but it’s true. Also, I’m allowed to be dramatic sometimes. But this time, I wasn’t. A private practice dentist of 30 years would later describe this piece as “the most important piece of dental literature in the past 30 years”. And he was right.

It is important for the following three reasons:

  1. In the dental community (as also seen in other healthcare sectors) ideas that change or disrupt the way things have always been done, whether it is with the goal of improving or not, are rarely discussed publicly. This blocking is active, not passive.
  2. Discussions of minor changes in the dental world have been discussed before, but the kinds of reforms Dr. Vujicic suggests are major. Some would say massive.
  3. Marko and his team at the Health Policy Institute are highly respected. The research they have done is significant. And this work is at least partially if not fully tied in some way to the American Dental Association – the face and voice of the American dental workforce.

If you would like to read the editorial, here is the link. If you’d prefer it narrated for you with some periodic and relevant background and commentary, click here. This is a link to my podcast episode. To skip the intro, fast forward to 4:18.

Then, some time passes.

Each month JADA publishes a section called “Letters of Response”. These are letters from readers in response to any article published in the journal. Typically they pick one or two. In June of 2018 they picked

Cover photo of the June Issue of JADA featuring a collage of faces.
June 2018 Issue of JADA

eight. And I imagine narrowing them down to eight, was not an easy task. From what I can tell, the responses in these letters covered a wide spectrum of reactions to Dr. Vujicic’s thought piece. Some were in support, while many others were quite the opposite. The authors have differing backgrounds, representing public health, private practice, academic dentistry, medicine, oral health advocacy, and younger dentists. And while none of us can simply be defined as one of the above, it was fascinating to see how individuals that chose the same profession and experienced identical training, could not have more differing reactions.

I have deconstructed each response, offering key points, key quotes, and a short description of the author. These deconstructions can be found at the end of this post. It includes a deconstruction of my own letter, which was also published in the June 2018 JADA.

I also created a table to summarize chief complaints of those that responded and as well as suggestions, that were provided in the letters. It can also be found below.

Then, I interviewed him. Here is a link to this episode, where Dr. Vujicic talks about these reforms and many other controversial topics. Again, if you’d like to skip the intro, start at 9:45.

Now what? Well you can see from the letters of response that people are fired up, in excited, motivated, and disgruntled ways. So people are talking about it. Dr. Vujicic suggests that getting the word out about how some of these reforms are already underway will be helpful for the dental community to conceptualize how this systems change approach is truly a feasible one. The first season of Removing the Bite Block will be devoted to this endeavor, along with some other hot topics in dentistry.

The point however, is that we continue to talk. The only way for positive change to occur is if we are all taking part in the dialogue, so that those making changes in our professional understand our experiences, as well as what it is that we want our profession to become.

So keep talking about it. Send his editorial to a friend. Or if your friend quit reading after dental school, send him the podcast. If the goal is to increase access to dental care, then we must start by increasing access to our own dental community by communicating in the best ways we know how. Even if some of those ways make us feel uncomfortable. Unblock your minds to all voices and ideas. And remove your own bite blocks, so your voices can be heard.



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