By Mary Otto, contributing writer
October 17, 2012

Public health dentistry is one of nine specialties currently recognized by the ADA.

And amid the long list of resolutions scheduled to be considered by the House of Delegates attending the ADA Annual Session this week in San Francisco, some public health dentists say a threat is lurking: Resolution 17.

If passed, leaders of the American Association of Public Health Dentistry (AAPHD) say the resolution could prevent their organization from continuing to sponsor the board that certifies their specialty.

The new rule would penalize AAPHD for the diversity of its membership, they say -- a diversity they see as intrinsic to the practice of public health dentistry.

“We are hoping we can present an alternative resolution.”
— Catherine Hayes, DMD, DMSc,
     president-elect, AAPHD

"Dental public health, by definition, is 'the science and art of preventing and controlling dental disease and promoting dental health through organized community efforts,' " AAPHD leaders wrote to the ADA Board of Trustees during the summer. "Organized community efforts require dental public health professionals to reach beyond the practice of clinical dentistry and engage other experts in the fields of medicine, social science, and public health."

But Resolution 17 moved forward anyway.

It calls for a review by the ADA's Council on Dental Education and Licensing of the "criteria and process for the recognition of specialty sponsoring organizations." And it asserts that the privilege of voting and holding office in the specialty's sponsoring organization should be reserved for dentists who have completed accredited and approved educational programs for that specialty.

Officials at the ADA declined to discuss the matter.

"We can't comment about any resolution to be presented to the House of Delegates," a spokesperson said.

Dental therapist support a factor?

But AAPHD leaders have had plenty to say. They see their organization's long tradition of allowing nondentists to join and also serve in leadership positions as an important part of their approach to their work.

"The specialty of dental public health is unique. The population is our patient," said Myron Allukian Jr., DDS, MPH, a past AAPHD president. "We use a multidisciplinary approach."

Catherine Hayes, DMD, DMSc, president-elect of the AAPHD, agreed.

"AAPHD is reflective of the specialty. The specialty of dental public health is by nature, a broad specialty," she said.

The group has more than 870 members, a majority of them dentists. However, only board-certified public health dentists are allowed to vote on matters pertaining to the specialty's national certifying board, the American Board of Dental Public Health, according to Dr. Hayes.

An AAPHD member who did not want to be named suggested that Resolution 17 could be seen as a rebuke against the organization's publication of a series of papers highlighting proposed curriculum guidelines for the training of dental therapists (Journal of Public Health Dentistry, Spring 2011, Vol. 71:suppl s2, pp. S3-S8). That workforce model has the potential to extend needed care to underserved populations, the AAPDH has said. But the model is strongly opposed by the ADA, which asserts that only dentists should be permitted to perform irreversible procedures such as fillings and extractions.

Dr. Allukian sees Resolution 17 more broadly, as a reaction by organized dentistry to nondentists at a time when the profession is under pressure to expand access to services.

"States are changing their dental practice acts to allow nondentists to provide care because the profession is not doing it," he said.

Dr. Hayes, herself a board-certified public health dentist, said she was mystified by Resolution 17 but intends to try to prevent any potential damage it might cause.

"We are hoping we can present an alternative resolution that would allow for more time to work together to overcome any lack of understanding of our specialty," she said.

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Copyright © 2012

Last Updated hh 10/29/2012 1:37:01 PM

1 comment so far ...
10/28/2012 8:27:09 PM
This is another example of "if you cannot win, change the rules".  It amazes me that these transparent actions to marginalize any other healthcare professional or discipline from having input into solutions to the access to care issues in this country do not cause members of the ADA to stand up and say ENOUGH!  Dental Public Health professionals are uniquely qualified to speak, with authority, about this problem yet they are at risk of having their voices silenced.  When will the bully tactics end?  When will those who KNOW that the ADA's tactics are not in the best interest of the public band together and say "ENOUGH".
These tactics were used to strip dental hygiene professionals from formally using the term "dental hygiene diagnosis".  Those of us in dental hygiene know and understand that we are LEGALLY bound to and DO provide a DHDx every day.  The DHDx is inextricably linked to our Standard of Care, the ETHICAL and LEGAL standard we are held to.  
The minutes from the CODA meeting July 30-31, 2009 clearly outline that the change in terminology of Standard 2-17 was carried out in spite of the thoughtful and complete investigation of the topic by the Review Committee on Dental Hygiene Education.  CODA Commissioners proposed and adopted changes to Standard 2-17 that were in direct conflict with those made by the committee assigned to provide a recommendation on the issue.  CODA Commissioners stated the assertion of the RC DHE that DHDx and DH TXN Plan MUST remain in the terminology "failed to address concerns regarding misuse of standards in legislative advocacy".  In turn, Standard 2-17 terminology was changed as per the Commissioners desires.  The terminology was changed NOT because RDH's are unable to or lack the intellectual and educational capacity to provide a comprehensive DHDx, they do so every day.   The change was made so they cannot say they provide a DHDx.
Call this bully tactics, conflict of interest, power grabbing, misuse of power; what ever you want.  It is wrong on every level yet it continues to happen.  
I have to believe that most dental professionals do not subscribe to these beliefs but feel unable to have their voice heard by their organization.  Now the dedicated professionals working in Public Health dental health care are being targeted because they had the audacity to speak in opposition to the ADA's policy statements regarding the expansion of the dental health care workforce.  They will even go after their own when need be.
When will it be enough?  When will the dedicated professionals within this organization look to their leadership and say, "enough"?  All dental health care professionals must collaborate with each other and other members of their clients collaborative healthcare team to ensure the clients needs are the focus of ALL decisions made.  Excluding or marginalizing vital members of this team will only weaken the process of care and put the clients wellbeing at risk.
Below is the section of the CODA meeting minutes addressed above for your reference.
July 30 and 31, 2009
Call To Order: The Chair, Dr. James Koelbl, called a regular meeting of the Commission on Dental Accreditation to order at 1:00 P.M. on Thursday, July 30, 2009, in the Hillenbrand Auditorium of the ADA Headquarters Building, Chicago, for the purpose of reviewing educational programs. This portion of the meeting was conducted in closed session.
Roll Call: Dr. Bruce Barrette, Dr. Paul Casamassimo, Dr. Heidi C. Crow, Dr. Bryan Edgar, Mr. Gary Gann, Dr. Vincent J. Iacono, Dr. Donald R. Joondeph, Dr. Mel L. Kantor, Dr. James Koelbl, Dr. Lee Koppelman, Ms. Kathleen Leonard, Dr. Patrick J. Louis, Dr. Logan Nalley, Ms. Anna Nelson, Dr. Larry Nissen, Dr. Reuben N. Pelot III, Dr. Jason Pickup, Dr. Robert Ray, Dr. Michael Reed, Ms. Mary K. Richter, Dr. E. Les Tarver, Mr. Kenneth C. Thomalla, Dr. J. Steven Tonelli, Dr. Sharon Turner, Dr. Christopher Wenckus, Dr. B. Alexander White, Dr. Ronald D. Woody, and Dr. John M. Wright
Dr. Richard Buchanan and Dr. Karen Kershenstein, were unable to attend.
In addition to the staff of the Commission, Dr. Marie Schweinebraten, ADA Trustee Liaison and representatives of the Commission on Dental Accreditation of Canada (CDAC) attended. 
Report of the Review Committee on Dental Hygiene Education: Committee chair: Ms. Kathy Leonard. Committee members: Dr Susan Crim, Ms. Susan Ellis, Dr. Paula Friedman, Dr. Timothy Halligan, Dr. Laura Joseph, Mr. James McKernan, Dr. Reuben Pelot and Mr. Mark Schorr, Esq. Staff Member: Ms. Gwen Welling, manager, Dental Hygiene Education, CODA. Commissioners: Dr. James Koelbl chair, CODA and Dr. Les Tarver, vice-chair, ex-officio; Guests: Ms. Catherine Elliott and Ms. Colleen Schmidt, representatives of the American Dental Hygienists’ Association (ADHA) attended the policy portion of the meeting. The meeting of the Dental Hygiene Education Review Committee (DH RC) was held July 14-15, 2009 in the Association Headquarters Building.
Consideration of Comments on the Proposed Revisions of Dental Hygiene Accreditation Standard 2-17: At its February 2008 meeting, the Commission on Dental Accreditation directed that the Dental Hygiene Review Committee (DH RC) consider Resolution 39-H from the October 2007 American Dental Association House of Delegates Annual Session. The resolution urged the Commission to reconsider the use of the term “dental hygiene diagnosis” within DH Standard 2-17 and to revise the Standard to more accurately reflect the scope of training and licensure of the dental hygienist in providing dental hygiene care to patients.
At its July 9-10, 2008 meeting, the DH RC carefully reviewed the current Standard and developed proposed revisions. The proposed revision to Standard 2-17 was considered at the July 31, 2008 Commission meeting. After careful deliberation, the Commission directed a further change in the wording from “dental hygiene treatment plan” to “dental hygiene treatment needs.” Additionally the Commission directed that the newly proposed revisions to the Dental Hygiene Education Accreditation Standard 2-17 be circulated to the communities of interest for review and comment by July 1, 2009. Accordingly, the proposed revised standard was distributed to the communities of interest for comment.
At its July 14-15, 2009 meeting, the DH RC carefully considered written comments received over the past year from various communities of interest. Additionally the review committee considered comments from open hearings conducted at the ADA Annual Session, October 2008, the ADEA Annual Session, March 2009, the ADEA Allied Directors’ Conference and the ADHA Annual Session, June 2009.
In doing so, the review committee reached a consensus that Standard 2-17 more accurately represents dental hygiene education with the terminology “dental hygiene diagnosis” and “treatment plan” in the standard as it has been since 1998. The review committee believed that inclusion of these terms strengthens dental hygiene educational principles as well as clarifies the dental hygiene process of care. In order to provide a descriptive overview of the role of dental hygiene process of care, the review committee recommended that an intent statement be added to the Standard to clarify that the dental hygiene process of care is part of the overall treatment plan developed by the dentist for comprehensive dental care.
A motion to amend the proposed, revised Standard 2-17 was made which removed the terms “dental hygiene diagnosis” and “dental hygiene treatment plan” from the standard and the “definitions section” of the dental hygiene standards. Concern was expressed by several Commissioners that the DH RC discounted the comments received by other communities of interest and that Standard 2-17 was revised based solely on comments received at the ADHA open hearing in June 2009 and that the recommendation failed to address concerns regarding misuse of standards in legislative advocacy. The Commission voted to adopt the amended, revised Standard 2-17; however, the Dental Hygiene Commissioner called for a motion to reconsider for the purpose of considering a further amendment to the amended, revised Standard 2-17. The motion to reconsider was accepted by the Commission, and the subsequent amendment to Standard 2-17 essentially returned the language of the standard to that which was originally sent to the communities of interest for comment following the July 31, 2008 Commission meeting (Appendix 26) .
Commission action: The Commission adopts the amended, revised Dental Hygiene Accreditation Standard 2-17 (Appendix 26) for implementation on January 1, 2010.