Colorado dental patients face costly new regulation

If it were safe and affordable, would you be willing to get a flu shot at your neighborhood Walgreens or Rite Aid?  How about a King Soopers or Safeway?

No doubt that seems like a silly question, given that millions of Coloradoans have done just that since flu vaccines became readily available in the early 1990s.

Indeed, my local Walgreens on East Colfax not only offers in-store flu vaccinations, my daughter (age 12) can get a Human Papillomavirus (cervical cancer) shot; my mother (age 81) can get immunized against pneumonia and shingles, my son (age 17) can get travel vaccines against Yellow Fever, Thyphoid Fever and Japanese Encephalitis, and my wife (age 29-plus) can get a Tetanus booster.

Getting poked while picking up beer and Rogaine is no longer a big deal.

If on the other hand, I go to my family dentist and want to have my teeth cleaned using a mild sedative to calm my severe dental phobia, in Colorado I may soon face a serious obstacle.

The link between in-store flu shots and in-office mild sedation dentistry may not be obvious.  But it is abundantly clear to anyone who understands that medicine, public health and profit-incentives are all inextricably linked. I have studied this dynamic for many years and actively consult companies and professional groups impacted by it.

The widespread availability of immunization shots at supermarkets, pharmacies, discount retailers and even department stores has been a boon to public health in the United States.  The Centers for Disease Control and Prevention has been a particularly strong advocate.

But originally the administration of vaccines anywhere other than hospitals and doctors’ offices was stoutly opposed by many physicians and health regulators.  Opponents insisted public health was at risk. Privately, no doubt, these same opponents realized the change threatened their ability to charge the public over-priced fees for administering such shots in their own offices.

Yet time and again, the dynamic duo of “convenience” and “access to care” has proven to be uppermost in the public interest.  The more barriers state and federal regulators can remove between people and health care – without compromising safety – the more people avail themselves of such care and the less they have to pay for it.

That lesson, however, seems entirely lost on the 13-member Colorado State Board of Dental Examiners  (CSBDE) – all appointees of Governor Bill Ritter -- who on July 9th will hold an open hearing on proposed changes to a state dental regulation that will make access to quality, safe, family dental care more expensive and far more difficult for dental-phobics to obtain.

As did regulators in the early 1990s, the CSBDE promoters of this unnecessary and unwise change claim they are acting on behalf of public safety.  But the facts don’t support the need for any change to existing Colorado dental regulations, which one could fairly argue are already too complicated to foster access to care compared to the national standard established by the American Dental Association (ADA), and updated as recently as October 2007.

Rather, the CSBDE, or more precisely a few key specialists on the dental board, are pushing for the unnecessarily tougher regulation to combat what they perceive as a financial threat to their own specialty practices posed by the increasingly popular method of treating adult dental phobics known as “oral sedation dentistry.”

Without using needles or nerve-rattling intravenous (I.V.) tubes, family dentists in 39 states and all of Canada can administer a mild oral sedative – basically a time-tested pill, to adult dental patients who suffer from severe fear and anxiety and otherwise avoid seeking oral health care altogether.  These family dentists, already licensed in their respective states, typically receive extra training in oral sedation and equip their offices with extra safety equipment.

Indeed, the ADA, the leading national authority on safe dental practices, extensively reviewed and recently updated its guidelines for oral sedation, and ADA representatives voted overwhelmingly to support the procedure for everyday dentists with reasonable additional training.

As for public safety, oral sedation has been used to safely and effectively calm millions of Americans following the ADA’s guidelines and existing state regulations.  In fact, the oral sedative treatment is so much more popular than I.V. sedation for dental phobics, that it is one of the fastest growing treatment methods for adult dentistry.

And there is the rub.

Members of the CSBDE have seen oral surgeons and dental anesthesiologists losing business to general dentists who have successfully completed ADA-compliant training courses in oral sedation.  And these dental specialists understand that soon, just like doctors who used to charge $50 or $75 a visit to administer a flu shot, the wider availability of oral sedation will cut into their bottom lines.

So the CSBDE members, led by Eve Bluestein, a Boulder MD and oral surgeon, trot out the old canard that public safety is at risk and tighter regulation of oral sedation is necessary to protect public health.

Bunk!

As with flu shots that protect the particularly susceptible from serious illness and death, the continued availability of oral sedation offered by Colorado’s general dentists means that much misery and even some lives will be saved by permitting Colorado residents to get help from their family dentist rather than having to seek out and pony up for self-interested dental specialists.

The Colorado dental board’s own statistics indicate that the number of general dentists in the State is dwindling and is forecast to continue to decline.  For Dr. Bluestein and her allies on the CSBDE that is good news because it means more business and higher prices ahead for their individual specialty practices.

But for Colorado’s residents, it can only mean higher prices, longer waits and even less incentive to tend to their oral health.

The answer is to trash these unnecessary and restrictive proposed changes to the State regulation and pay attention to the very mission enunciated by the state’s Department of Regulatory Agencies:  “…what is good for consumers is good for business.

What is good for Colorado consumers is to make going to a safe, licensed, oral sedation dentist as easy and convenient as running to Albertson’s for milk and a bottle of aspirin.