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About Denturism
Denturism (Denturitry) Practice in the United States of America
The US has the largest and most technologically powerful economy in the world. In this market-oriented economy, private individuals and business firms make most of the decisions. US firms are at or near the forefront in technological advances, especially in computers and in medical, aerospace, and military equipment; their advantage has narrowed since the end of World War II. Long-term problems include inadequate investment in economic infrastructure, rapidly rising medical and pension costs of an aging population, sizable trade and budget deficits, and stagnation of family income in the lower economic groups [1]. The dental market in the United States is mainly private, with a small percentage of public funded dentistry. Prices for private treatment are not set by a particular body, as this could constitute price fixing, which is against state and federal law. Dental records are frequently transferred between dentists at the request of a patient. Patients who are unhappy with their treatment can complain to the complaints officer of the dental or denturist regulatory board. In some states, dentists and PCDs are registered and regulated by the same Board; in other states they are separate. Denturists receive extensive formal training, and work independently of dentists and charge directly for their services [2].
In 1980 the ADA advocated the development of inexpensive techniques (the Triad-system) to reduce the cost of services as a method of reducing the impact of Denturists in the provision of services at much lower cost. Dental clinics were opened in Oregon, Maine and Arizona and operated by Dentists to provide a low cost denture service in
competition with privately practicing Denturists [3]. These clinics were financially supported and subsidized by the ADA, but this did not, however, end the popularity of Denturists and these clinics have since closed and the counter- offensive failed [4]. In the States of Idaho (1982), Montana (1984) and Washington (1994) the profession of Denturism have since been legislated bringing the USA total to six and in a number of other states of California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey,
Oklahoma, Pennsylvania, Tennessee, Texas, Wyoming, etc major battles have been going on for some time, some more intense than in others. This appears to be a turf war determined by vast sums the ADA are prepared to spend on lobbying/defending dentists rights, and the general public are the losers, being denied from having any choice in
getting dentures from alternative providers.
You may be inclined to ask, if denturism is so advantageous to the public, why hasn't the profession been instituted into more than six states? In many parts of the world Dentists are regarded as the oral health professionals with the widest field of knowledge and appointed in all decision-making positions that relates to public oral health care. From this position of trust dentists can divert or smother any competition to their profession and have successfully frustrated oral health human resource development in many countries of the world [5]. The enactment of denturism laws has not been successful in more US states because denture practice in each state is controlled by the state board of dental examiners, usually made up of 5-7 dentists. In essence, the states give dentists, themselves, the power to control anything that has to do with the oral cavity, even if it involves a conflict of interest with denturists. The main cause of the problem have been brought to light many years ago by the PEW Commission and discussed in-depth by the American Denturist Advocacy Council on their website and can be reviewed at http://www.usdenturist.com/cry_out.htm
The ADA, has contended that denturism is illegal in most US States and although they have campaigned for the right to practice independently in many states, most of these campaigns have failed for good reason.
The "good reasons" why the majority of United States have so far been unsuccessful in convincing the legislators to legalize denturism, is about control by the American Dental Association (ADA) and is about "good business," and not about good Dentistry. The so-called "good reasons" that Organized Dentistry use as an excuse to resist the establishment of alternative denture providers can not be substantiated, simply because it is a red herring. The powerful ADA and the various States Dental Associations is extremely aggressive and authoritarian in their approach to resist any encroachment on Dentists' monopoly. US Dentists are using their control over State Dental Boards to manipulate all decisions related to oral health matters in favor of Dentistry. Non-substantiated health scares have been invented to intimidate the legislator and the public [6]. Furthermore, the ADA have succeeded in preventing the recognition of the Canadian Denturist qualification (widely regarded as the global benchmark qualification) and managed to have the provision of dentures by non-dentists made a felony [7]. In the state of Florida, for example, where the denture business is worth 300 million dollars a year, the ADA’s lobby (who contribute 11 million dollars a year to hire lobbyists to push their agenda at legislative level) have succeeded in making it a felony for a Denturist to construct dentures for a member of the public. If convicted, the Denturist is liable to receive a sentence of up to 10 years in jail. This has not dissuaded those interested in furthering the cause of Denturism or diminished their determination to have their qualification recognized and establish legal recognition for their popular service. USA Denturists numbers are not great, maybe one or two thousand, but they are truly seen as David up against the 145,000-member strong ADA Goliath [8].
The American Dental Association (ADA) passed a resolution that the Association vigorously opposes denturism, the denturism movement, and all other similar activities, regardless of how they are designated, in the USA. They further resolved that when the words denturist, or denturism, and all synonymous terms are used in American
Dental Association publications, the terms should be accompanied by a brief but prominent footnote indicating that a denturist is a person who is educationally unqualified to practice dentistry in any form on the public, and further resolved, that constituent societies act in concert with the American Dental Association. Another resolution reads that the American Dental Association Board of Trustees be authorized to provide financial aid to any constituent dental society that is faced with the imminent prospect of a substantial effort to legalize or promote denturism or any illegal practice of dentistry in its state through legislative action or use of the initiative process [9]. It does not make rational sense to prosecute a qualified denturist for practicing dentistry, when he is in fact better qualified than a dentist for the procedures involved in making dentures. Why are all dental technicians, oral hygienists and dental chairside assistants not also accused of practicing dentistry, when they also carry out procedures that are included in the broad definition of dentistry? Quite simple – these categories provide services that enhance dentists’ income, while denturism is perceived by dentists as being in competition with them! Would it not make more common sense to change the definition of practicing dentistry to what dentists is actually trained for and qualified to practice. The money they are so keen to spend would be better invested on community projects such as expanding training facilities for denturists who can provide affordable oral health services.
Opposition to Denturism
The major objection to denturism is presented as the lack of denturists for the complete examination of the mouth and proper fitting of the teeth and it is also presented that Denturists are not competent to diagnose cancers or other diseases within the mouth, to screen for underlying disease, or to recognize when structural problems of the mouth (such as unseen broken-off roots of teeth) can lead to injury if not corrected before the
installation of dentures [10]. This is of course a complete distortion of the truth! Denturists are trained extensively for a proper examination of not only the oral cavity, but also of the head and neck region, assessment of any manifestation of pathology for
referral and also for tissue and bone assessment. They are in addition expertly trained for assessment of Denture stability, structural integrity of the denture and bite, review oral hygiene care, and to counsel denture wearers concerning any procedures, present or future. The unsubstantiated cancer scare is really becoming quite an anachronistic bore. In this current millennium, dentists must start realizing that all citizens are not completely
ignorant any more, and does not panic every time they hear medical terminology. Dentists and denturists alike do not diagnose oral cancer – it is referred to an Oral Pathologist! All members of the Oral Health Team must move forward together, in a spirit of mutual respect, to champion the only real cause worth tackling, that of the oral health and well being of their communities. That goal can best be achieved by all categories doing their very best in their own expert capacities and by removing outdated and unjustified restrictions and monopolies! In some countries it is becoming normal to see Dentists, Denturists, Hygienists, Therapists and other OHHR and Specialists in group practices to serve all the various dental needs of their communities. Cooperation and referrals between dentists and denturists is becoming routine. Those who refers their patients to the other profession also benefits by receiving more patients on referral from them.
The US Federal Trade Commission sent all state governments a letter of recommended rule-making; encouraging them to institute the profession of denturism in their state, after conducting a five year study. In most legalized states denturists are not restricted in the services that they can provide (i.e. full and partial dentures) and are permitted to
own denturist and dental practices. As the President of the National Denturist Federation USA stated: "Denturists are trained stand-alone practitioners who are in direct competition with dentistry for that market which is referred to as Removable Oral
Prosthetics."
[1] The World Factbook 2007 compiled by the Central Intelligence Agency (CIA)
[2] The Dental Liaison Committee in the EU (Manual of Dental Practice 2004)
[3] DENTURISM – A NEW PROFESSION. A Report by the SA Federation of Dental Technicians 1990 Authors: C du Plessis & DF Malherbe
[4] MacEntree MI. The Denturist movement in Canada. Part II: ACCEPTANCE IN EASTERN CANADA. Journal of the Canadian Dental Association, Vol 8. – 1981
[5] http://www.usdenturist.com/cry_out.htm
[6] DF Malherbe, LA Steyn, C Du Plessis, Z Fatagodien. Clinical Dental Technology: A Quest For Equity In Oral Health Care by The Society for Clinical Dental Technology,
1998 Ó. Motivational Report to the SADTC, Minister of Health and the Department of Health.
[7] The Federal Denture Act (Section 1821 of Title 18, United States Code)
[8] THE LEGISLATION OF DENTURISM: A FIGHT LED BY FEW, June/July 2004 www.lmtcommunications.com/article/denturism.asp
[9] [DPH] In the News: Montana – Current Policies of the ADA. This book contains major policies adopted by the American Dental Association House of Delegates from
1954 through 2004 that are still in effect in 2005, except for policies that appear in the Association’s Constitution and Bylaws and Principles of Ethics and Code of
Professional Conduct.
[10] Stephen Barrett, M.D. The Problem of Denturism. The Dental Watch
[11] E Van den Eeden (2007) "Denturists – The Solution to America’s Denture Crisis". Michigan Denture Reform Committee.
[12] www.usDENTURIST.com/Federal Trade Report
Unfounded perception of Professional encroachment:
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