The challenges of prevention
A mentor of mine once said that dentistry is a noble profession because we work hard to put ourselves out of business. He was referring to our efforts to fluoridate drinking water. Indeed, for decades dentists have fought to prevent a disease that they are paid to treat surgically.
It gives me great pride to see younger generations of dentists continue to fight the good fight. Beyond water fluoridation, we tirelessly educate the public about ways to prevent caries, periodontal disease, oral cancer, and other challenges to oral health. Being educated costs patients nothing, and it is the first level of prevention.
The second level of prevention does involve some costs. Patients—and their third-party payers—pay us for our examinations, prophies, sealants, topical fluoride applications, and other services that reduce risk for disease. In the United States, we’re quite fortunate to work with a population who understands and values these services. Sure, there are plenty of folks who skip visiting the dentist regularly and who don’t practice good oral hygiene, but the average American at least understands that they’re supposed to be doing those things. So, thanks to a population with a good dental IQ, there is demand for preventative services and a willingness to pay for them.
I see two major remaining challenges. First, unfortunately third-party payers can still control the prevention conversation for too many patients. Adults who would benefit from topical fluoride and children who would benefit from sealants may opt out of these services because their payers refuse to cover them. I see this as another patient education problem. We must create enough value for preventative services so that a third-party payer’s absence won’t cloud a patient’s judgement.
The second challenge is an educational problem for dentists and hygienists. We can become too comfortable with the traditional approach of “prophy-drill-bill,” and ignore new methodologies and materials that can reduce risk. In this issue, V. Kim Kutsch, DMD, shares his protocol for caries risk assessment and intervention (p. 68). Jungyi Alexis Liu, DDS, MS, and Kevin J. Donly, DDS, MS, discuss how silver diamine fluoride can be incorporated into our therapies (p. 65). Dr. Donly, who is the current president of the American Academy of Pediatric Dentistry, notes that their use of SDF is off-label and is more of a conservative measure than a preventative one. In another feature article, Lou Graham, DDS, lists the numerous diagnostic and preventative services that fill a one-hour hygiene appointment (p. 32).
Dentistry is indeed a noble profession, in part, because we seek to prevent disease rather than just profit from it. We seek to be conservative in our dental surgeries because we respect natural tissue. The challenges of prevention and conservation are becoming more nuanced. We must be vigilant in seeking the opportunities.
Chris Salierno, DDS