Lamster and Formicola Respond

Abstract

Giddon et al. suggest that as midlevel dental providers (MLPs) are introduced, confusion can occur regarding who is a dentist and who is an MLP. They suggest that a name change is in order and that “oral physician” be used to differentiate doctoral-trained providers (dentists) from others who do not receive this level of education. The authors reference our recent editorial,1 which introduced reports from the 2010 Dunning Symposium, a meeting held every few years at the Columbia University College of Dental Medicine with a focus on the role of dentistry in society. In fact, an article by Lamster and Eaves,2 also from this symposium, included a discussion of the arguments for and against the name change from “dentist” to “oral physician” and reviewed the case made by others regarding a name change. This subject was specifically included because it relates to the topic being discussed—expansion of health services in the dental office. In the United States, MLPs are a new class of dental providers that have been proposed to address access to oral health care concerns. They will provide a limited range of basic but nonreversible procedures. MLPs receive considerably less training than dentists and would provide services in areas and locations where dental care services are not readily available. These providers would work under the indirect supervision of a dentist. In the United States, MLPs have been introduced on a very limited basis.3,4 Although Lamster and Eaves2 do not draw any conclusions regarding the desirability of using the term “oral physicians,” let us address the argument made by Giddon et al. First, the introduction of MLPs in the United States has encountered considerable resistance, and widespread introduction is not imminent. Second, the name change question would likely complicate the more substantive issue raised,2 which is the desirability of expanding the scope of dental practice to include primary health care activities. Third, as midlevel providers have been introduced in medicine with appropriate identification, patients have not been confused by the role filled by midlevel providers (e.g., physician assistants and midwives) versus the role filled by physicians. Giddon et al. feel passionately about the importance of this name change.5 Perhaps a more prudent approach would be to implement changes in clinical care and determine how these changes impact the health of patients and the mix of services provided by dentists. If benefits to patients’ health are realized and interaction between dentists and other health care providers increases, perhaps a name change would be indicated. Then the debate could be reexamined with a focus on the substantive issue of improving health, not on avoiding confusion.