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LETTER TO THE EDITOR |
University of Florida College of Dentistry Gainesville, FL 32610 imjor{at}dental.ufl.edu
The US Surgeon General's report on "Oral Health in America in the Year 2000" has precipitated much discussion, including two recent Guest Editorials (Mandel, 2001; Seldin, 2002) and a letter to the Editor (Barnett, 2002) in the Journal of Dental Research. The Report has been followed up by an NIDCR plan to reduce and eliminate disparities in the oral health of large populations in the US. The plan follows the established pattern of research with the potential for a more community-oriented approach. However, it lacks an important component: practice-based research (Mjör and Wilson, 1997).
As pointed out by Seldin (2002), the implementation of a plan to reduce these disparities will involve the dental work force. Optimal oral health for all Americans, as for populations anywhere, must be rooted in everyday clinical practice. If not, the infrastructure of the effort will be lacking, and the results will have no real impact in practical terms. Theoretical models and basic-science-designed research will not trickle into general dental practice by itself.
Regardless of the course taken, implementation must start with a work force that will be actively involved on a day-to-day basis. The American Dental Association (ADA) and State Dental Associations must be involved. In its report on the "Future of Dentistry", the ADA has pointed out the complexity of the problems related to distribution of the work force and funding for dental health care, and the situation throws some doubt upon the practical outcome of the challenges outlined in the Surgeon General's Report.
State Dental Associations should be the initiators of a plan to assist in solving the disparities in oral health care. Even smaller units, like District Dental Societies, may be the best option to try out any plan and to assess the practical implications. The approach cannot be an all-or-none approach, but a gradual building up of a system that should be modified based on clinical/practical experience. The initiation of any system will be inherently unfair because it cannot cover everybody, even at the local level, at the same time. It is important in the initial phases that those involved be fully covered according to the plan, rather than smaller increments of treatment being performed in a "here and there" approach. In this way, experience can be gained both by the work force involved and by the individuals treated.
Although committees may outline the basis and criteria for an initiative to solve disparities in oral health care, the effort is primarily a practical issue that needs funding. State funding, private donations, and industry are potential funding sources. Voluntary work by clinicians and dental teams represent a valuable indirect funding source.
Barnett (2002) suggests that the dental industry should be part of the national oral health plan, including assistance in the development and circulation of patient educational materials and in the search for and dissemination of effective preventive programs. In addition, a practice-based approach could serve two important functions: (1) to provide service to a needy population and (2) to provide realistic clinical information to manufacturers of dental devices to qualify and supplement data from controlled experimental investigations. Such a "corrective" to the data obtained from controlled clinical trials is urgently needed, because the results from such trials deviate markedly from those in practice-based studies (Mjör, 2001). Thus, important payback to the participating companies will be relevant clinical feedback on their products obtained under realistic conditions.
REFERENCES
Barnett ML (2002). Letter to the editor. J Dent Res 81:157.
Future of dentistry (2001). Chicago, IL: Health Policy Resource Center, American Dental Association.
Mandel ID (2001). A national oral health plan: implications and opportunities for research and academia (editorial). J Dent Res 80:2040–2041.
Mjör IA (2001). The basis for everyday, real-life operative dentistry. Oper Dent 26:521–524.[Medline]
Mjör IA, Wilson NHF (1997). General dental practice: the missing link in dental research. J Dent Res 76:820–821.
Seldin LW (2002). Get your shoes on?! A response from a practicing dentist (editorial). J Dent Res 81:156.
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