As a profession we are making history right now, whether we want to or not. We will look back on the decisions we make during this time. What side of history do you want to be on?
Dental Therapy is one of, if not the most controversial topic in dentistry right now. Dr. Zeller interviews experts that support and oppose the dental therapy model in her multi-episode series.
Both educational and uncomfortable. While listening to these episodes, Dr. Zeller challenges you to stay open. First with your mind, then with your mouth.
On this week’s episode of Removing the Bite Block Dr. Zeller interviews president of the Arizona Dental Association, Dr. Robert Roda. Dr. Roda is an endodontist in Scottsdale, AZ. In April of 2018 Dr. Roda wrote an editorial that was published in the ADA news titled, “MyView: State’s Failed Dental Therapy Experiment”. At this time the state of Arizona was considering the licensing of dental therapists. In an attempt to block this bill, Dr. Roda describes his view on how, “…Dental therapists are a distraction. They solve nothing.” He also states that the Minnesota dental therapy model, “…is really nothing more than a few people standing around waving sparklers.” Dr. Zeller and Dr. Roda discuss this editorial, along with some of the following topics:
- Dr. Roda’s idea for Quality Assurance permits
- How the dental community responded to his editorial
- How some patients simple make “bad decisions”
- The power of interactive study clubs
- The Pew Foundation
- Defining “success” when providing access to care
- Getting more involved in organized dentistry
Dr. Roda received his BS in Biology (1977) and DDS degrees (1981) at Dalhousie University in Halifax, Canada and practiced as a general dentist in Nova Scotia for 10 years. He earned his MS in Oral Biology and Certificate of Specialty in Endodontics at Baylor College of Dentistry in Dallas in 1993 and became a Diplomate of the American Board of Endodontics in 1998.
Dr. Roda is a Past President of the American Association of Endodontists and the current President-Elect of the Arizona Dental Association. He is an Endodontic Consultant to the Arizona State Board of Dental Examiners, Visiting Lecturer in the Endodontic Department at the Arizona School of Dentistry and Oral Health, and Associate Editor of the Journal of Endodontics . He is a member of the American Dental Association (ADA), American Association of Endodontists (AAE), the Canadian Acadamy of Endodontics, and the Central Arizona Dental Society (CADS).
A link to his editorial published in the ADA News about the Minnesota Dental Therapy Model can be found here.
This week the Buffalo News released a story titled:
The title ALMOST says it all. But to be sure there are no questions left unanswered, two men stole a bunch of stuff from a man in Buffalo, New York. At gunpoint. A list of these items include:
- car keys
- gold tooth
The thieves were caught. Most of the stolen property was returned. I know what you’re wondering. The answer is I don’t know. The police reports were not clear about whether said gold tooth was returned to the man. But it did get me thinking.
We have all had patients that wanted to take home “gifts from the dentist”. Sometimes that means a baby tooth. Sometimes that means a decayed first molar. Sometimes that means a gold crown. Every time I ask what exactly it is they plan to do with their new swag. I have heard the following:
- make a necklace out of it
- include it in a piece of art
- melt it down, to create jewelry
- send the gold in for money
- “I keep all my children’s teeth.”
So the question is, how often do these teeth or leftover teeth accessories, get stolen, before the above plans occur? And more importantly, will insurance cover this? How does the patient send proof? Lab slips? Should I be advising patients to keep their swag in their safes at home? Do people still have safes at home?
They never taught me about this kind of stuff in school.
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:
- 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.
- 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.
- 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
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.