Keeping Dentistry in the Hands of Dentists



Our healthcare system is changing. Millions do not have adequate or even any health insurance. Pressure mounted from all sides, and what has happened? The government has stepped in to influence how healthcare is administered. Any change that affects medicine in this country will soon affect dentistry as well. With the unemployment rate very high and employers lowering benefits, fewer and fewer people are able to obtain the dentistry they need and want. This applies to urgent care and elective care as well. Dental care is often deferred or eliminated altogether. We all see this in our practices. Empty chair time, slower schedules, and lack of acceptance of treatment plans are affecting our productivity and bottom lines. The needs, however, have not gone away; only the ability to have the dental work.

This is when we in organized dentistry must take the initiative and resolve these issues. We must not let outside influences mandate how dental treatment is given or even what treatment is rendered. A good example of this is Medi­care, for medical treatment. While wellintentioned at first, at this point, the government plan dictates what care will be given, how much the practitioner will be reimbursed, and how it will be delivered. There is no other show in town for the elderly. We absolutely do not want this for dentistry. While you may think that because Medi­care does not cover dentistry, it will have no effect on our practices, but it very well may. Private sector insurance takes its cues from Medicare and standards are set this way. It is very possible to have this filter into dentistry, as we are a small segment of healthcare (compared to medical care) but nonetheless a significant one.

The people of the United States need dental care, and if we cannot provide this care on our own, then someone else will. Will it be midlevel providers? Mandated dental care from the government? I don’t know the answer, but the care must be delivered, and we need to figure out how to do this from the inside, not the outside.

The major issues affecting dentistry were documented almost 11 years ago. The US surgeon general’s 2000 report on the status of oral health in America identified 2 major barriers to obtaining adequate oral health­care: access and cost. This is still true, if not even more so, today. We need to directly address these formidable problems. We, the US dental care providers—not a governmental or other outside program—should determine what we can do, how to best serve our pa­tients, and how much we are going to be paid for doing it. The issue of access is a formidable one. There are many groups of people for whom access to dental care is a difficult issue as well as affordability of care.

Dental treatment is seldom catastrophic, but there are many people who develop dental problems, typically in­fections or severe pain from caries, who do not have the resources to obtain or be able to afford care. Each of us as dentists has the obligation, either through the privilege of our dental licenses or our own ethics and values, to provide some amount of pro bono care to the most needy and most indigent. It does not have to be a lot—maybe a couple hours a month in a free clinic or in our own offices. This will make a difference and help prevent major health issues and excessive burdens on hospital emergency room visits for dental issues. This will impact all of our healthcare costs.

Dentists by nature are problem solvers. We have the ability to assess situations for our patients and come up with innovative methods to solve these problems. One example of innovation is a process I have been working on for several years. A few years ago, after being forced to retire prematurely due to back problems, I decided I wanted to give back and find a solution to a problem I had seen during my career. As an oral and maxillofacial surgeon, I removed thousands and thousands of teeth, creating the need for full dentures. I saw the emotional, physical, and psychological devastation that often occurred, not to mention the financial burdens created for many people. To address this problem, I developed a method of making full dentures in one hour at one third the cost of conventional dentures. No lab is needed, and it can be done anywhere, even outside of the dental office. This approach offers the ability to do dentures in nursing homes, public health clinics, senior centers, in rural areas without regular dental care, and even in underserved urban areas. Easily learned, it is a technique that dentists can use in all aspects of denture patient care. It addresses the patients who have been wearing dentures for many years and have not replaced them due to finances. It addresses the patients who have retained teeth that should have been removed but weren’t because dentures were unaffordable. It also addresses the homebound and nursing home residents for whom access is the major issue. We know of course that lack of dentition causes a decrease in proper nutrition, causing an increase in chronic disease and then an increase in overall healthcare costs.

We are now providing these dentures for the Virginia Missions of Mercy program, a philanthropic program based in Richmond, Va, and administered through the Virginia Dental Association (Terry Dickinson, DDS, executive director), which provides free dental care to those without access to care and the ability to pay for that care. Mission of Mercy relies on donated supplies and equipment, with volunteer dentists and ancillary staff. The applicability of the onestep denture was clearly shown at 2 recent Mission of Mercy clinics in Virginia, where an average of 90 to 100 dentures were completed in one weekend clinic with 2 or 3 dentists and one lab technician. Instead of creating the “dental im­paired” by just removing teeth, they can be replaced and allow better nutrition, lower level of chronic disease, lower overall healthcare costs while increasing quality of life. About 2,000 patients were seen those weekends and hundreds of thousands of dollars of dentistry was performed by about 200 volunteer dentists performing all aspects of dentistry. This is a basic way for our profession to give back, help those who truly need it, and maintain control of our profession. We can provide the necessary care and as long as the people receive the care they need we will not be pressured or controlled by outside forces.

Giving back not only helps others but helps ourselves as well. We cannot help but feel good about reliving pain and helping those who cannot help them­selves. There are also benefits for our practices. We learn to develop more efficient techniques, gain notoriety among our peers, and can actually increase the level of activity in our practices. Each person who we help has friends, relatives, coworkers, and other acquaintences who often be­come patients of our practices. It is a winwin situation for all.

Dental volunteerism is im­portant, but it goes well beyond that. The solution will come from new methods of treatment, new systems of delivery, and new approaches to patient care. We can’t wait for research to solve the issues. They are current issues and we need to deal with them right now. We, as dentists, are creative problem solvers always seeing new challenges cropping up clinically and figuring out how to solve them. As with the onevisit denture, there must be innovative methods of care and we need to find them. In the 10 years since the US surgeon general’s report on oral health, not much has changed. It is still a matter of access and cost. We must change that now.

In our private practices, we can apply newer techniques such as a onestep denture. We can develop more efficient processes and procedures to provide less expensive, very adequate treatment. These efficiencies will come through our own thoughts and “what ifs” as we encounter unusual and difficult clinical situations. Maybe it is the way we use our auxiliaries or maybe even the way we book our schedules. Let’s face it—some aspects of dentistry are very expensive for much of the population, especially the currently underserved populations. Better endodontic techniques, better periodontal procedures, and faster restorative procedures are all important. More efficient and less expensive procedures will bring in more patients, fill more chairs, and serve a greater segment of the population. By serving more of the population, we will be under less pressure from the outside and can maintain the independence we all envisioned when we went into dentistry in the first place.

We, as dentists, have the ability to control our destiny. It is incumbent on us, each one of us individually and as a profession as a whole, to create the vision for dentistry’s fu­ture. I hope this Viewpoint will in­spire creativity and inno­vation to keep dentistry as the shining example of health­­­care. We must stay inno­va­tive, caring, and available for all who need us so we can remain independent and free of outside influence.

Dr. Wallace is a boardcertified oral and maxillofacial surgeon with 25 years of private practice in the Chicago area. He is president of Larell Surgical Consultants, consulting in dentistry and oral and maxillofacial surgery to major medical insurance companies. He is the developer and founder of the Larell One Step Denture. He works with philanthropic organizations and private practitioners to adopt the one step denture system. He can be reached at


Disclosure: Dr. Wallace is the founder and CEO of The Larell One Step Denture.