Some thoughts on helping those with little income

Dr. Bill Dickerson is a valuable asset to our profession, but I hope we all are clear-headed enough to recognize that his logic is truly flawed if he thinks premium prices in all markets will also serve the poor. Those serving the top parts of an economically segmented market cannot serve the poor, short of providing charity service. Their needs are completely different from the affluent. Feeding and sheltering their families will always be more important than high-quality dentistry. Low-cost ex

Barry Parish, DDS

Benicia, Calif.

Dr. Bill Dickerson is a valuable asset to our profession, but I hope we all are clear-headed enough to recognize that his logic is truly flawed if he thinks premium prices in all markets will also serve the poor. Those serving the top parts of an economically segmented market cannot serve the poor, short of providing charity service. Their needs are completely different from the affluent. Feeding and sheltering their families will always be more important than high-quality dentistry. Low-cost extractions, low-cost fillings, and removable prosthetics can be examples of high-quality dentistry for this population. Staying pain-free is one of their highest priorities. Yes, I`m sure nearly every one of them would choose a full-mouth reconstruction, like the young man in the article, if they could afford it, but they can`t.

That case would not have been done if Dr. Dickerson hadn`t done it for free. The patient`s mother was literally begging for the funds to do anything but dentures because she had the values, but not the means. What does that tell you about high-cost dentistry for the poor? Dr. Dickerson cannot provide for his family and provide the type of dentistry at costs the poor can afford.

There is nothing wrong with providing low-cost dentistry to the poor. It even sounds absurd to have to state this, but with more of us using terms like "low-quality" for amalgams, extractions, and dentures, the angels of our profession who are meeting the basic needs of the poor are made to seem inferior. God will bless them even if we disdain them.

Can`t we all remember the amazingly beautiful carvings, polished to a high luster from those few who truly mastered amalgam procedures? Quality is a product of skillful mastery, and cost is a product of both the material and skill. Dr. Dickerson knows that low-quality adhesive dentistry exists. That is why we need him so much.

The charity case he presented was impressive and yet self-serving. It was a nice piece of marketing for his teaching facility, and that is not meant to be pejorative. I truly believe Dr. Dickerson is helping us when he says we must charge for excellence, and elevate the value of high-end dentistry for the great middle class that can afford it, but still choose low-cost dentistry. He is asking us why we feel compelled to continue to offer this to a market which can afford better materials.

The change is happening. The "big American smile" is a phenomenon that is growing. People in other countries already can recognize us by our perfect smiles, as well as our prodigious waistlines. This is a very wealthy country and, if we as a profession want to elevate our dentistry, we must do what every other industry does - market.

I personally do not belong to the ADA because it refuses to do this. I spend my dues on marketing. If the ADA starts a serious national marketing campaign, I`ll join.

Not many of my colleagues believe that we must keep fees down and do less-quality dentistry to serve the poor. Most of my friends feel that they must conform to one rather large "800-pound gorilla" that has us file fees with them, because they have the lion`s share of the insurance market. Regardless of what our consultants and teachers say, nearly everyone accepts insurance, and it is the primary force in the market which keeps so many of us from providing the middle class with more high-end dentistry.

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