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Washington State Dental Association


Dr. Timothy Wandell
WSDA Editorial Board

This past year I was asked to be on the board of the Washington Chapter of the American College of Dentists. I almost said no, since my near-term goal is to ski a little more, golf a little more, fish a little more and boat a little more. Ive always liked the Colleges and the Tri-college CDE day because I like the people who are involved and respect them greatly. I accepted because the primary thrust of the ACD is ethics, and ethics is something, I believe, our profession must seriously and continuously work on.

Every day we are confronted with little incremental ethical decisions that affect our delivery of care. I believe there is ideal care and ideal care. Ideal care would be that care that allows that patient to receive the care that is ideal for them. Of course, within that statement it is implied that it would be ideal and that economics is considered. I fear that ideal is all too often only crowns, implants, etc. with no options or consideration of all factors that may affect the patient. While that may be excellent treatment, it may be more than the patient wants or can afford. Sure, some people buy Chevys and some buy Lexuses, but car salesmen are not delivering healthcare. We are.

I recently attended a class on mini-implants by Mark Murphy. His premise was that while many of his edentulous patients could not afford implants and FPDs, they could afford several mini implants with attachments to a lower denture and end up with an excellent treatment result. Not cheap, but probably 20-30 percent of the cost of ideal treatment. Im not knocking the excellent care that implants and crowns can provide, but I fear that too often we forget how to best treat people including economics. Maybe thats not an ethical dilemma for some, but it is for me. We seldom see courses on how to economically deliver excellent care. Usually, its how to make the best case presentation for the $20k+ treatment plan.

There may be unintended consequences of only providing ideal care; and that is, who will be left to provide the lesser routine care? Our legislators, both state and national, are attempting to seize that ground by allowing lesser trained and cheaper providers to do it. It seems as if many ideal providers dont mind giving up that ground. Gee, I bet that if a recession hit, much of the ideal care would be turned in to ideal care. If that care is being provided by cheaper providers, it may be hard to regain it.

While we can all stand on principle and say that DSHS doesnt cover our overhead, that its slow to pay, that its under-funded in general; we still have a general moral obligation to provide dental care to the citizens of Washington. We can do that by working in free clinics, accepting DSHS, or donating care within our offices. The political benefit will be that we will be seen as contributing to the access solution not the access problem.

Now that Ive alienated all of the high-end restorative practices in the state, let me say that I have no quarrel with you. I dont question your ethics either. Perhaps Im a bit jealous. After every implant/restorative course that I attend, I race home eager to apply my new knowledge only to get to add a new tooth to a clicker.

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