Armed to the Teeth: The Fight Over Rural Dental Care


Photo: Jason Fraser/

Let's talk about teeth, baby. Slate is doing a series on the American Way of Dentistry. It's mostly good, but it gets one thing wrong. In a piece on the problems poor people face getting dental care, author June Thomas writes,

The main problem is a lack of decent low-cost options. Chester Douglass, emeritus professor in the department of Oral Health Policy and Epidemiology at Harvard's School of Dental Medicine, puts it this way: "If you want to buy a good, inexpensive car, Volkswagen proved you could do it, then other people started being able to do it." The Volkswagen of dentistry has yet to be built.

In reality, there is a Volkswagen of dentistry. Or, at least, something close to that. (A Toyota Corolla of dentistry?) Like the Bug, it's an overseas import. But, amazingly, when this program first got going in the United States, the American Dental Association sued to stop it.

Actually, scratch that. What's really amazing about this story is that the little guys won...

A decade ago, Alaskan Aurora Johnson was a stay-at-home mom with a high school education. Today, she's one of this country's first Dental Health Aide Therapists, bringing inexpensive, quality care to a very rural community. Johnson lives in Unalakleet, a coastal town 90 miles south of Nome. It is not exactly a booming real-estate market. Temperatures can dip to -50 F in the winter, freezing rivers into seasonal highways. About 750 people live there, mostly Native Americans, and, until 2005, their only access to dental care was one dentist who came in by plane once a year. Get a cavity a week later, and you were basically up a creek.

Alaska's an extreme case, but in general, it's not easy for rural Americans to see a dentist. Particularly if they're on Medicaid, which often pays far less than the going rate for dental services--as little as half in some states. And a lot of rural Americans rely on Medicaid--more than city dwellers do, in fact. With education loans to pay off and expensive businesses to run, most dentists just can't afford these low-payoff clientele. In the country, it's not uncommon to drive 30, 70, even 100 miles to get to the nearest dentist.

And that's where The Dental Health Aide Therapist program comes in. In a lot of ways, it's similar to using a Nurse Practitioner as your primary care physician. People like Aurora Johnson are recruited to serve the communities they already live in. Their training is much shorter, and less expensive, than a dentist's. But at the end, DHAT's can take care of their neighbors' basic and preventative dental health, and they can afford to charge less for their work. Johnson works with a dentist who still visits once a year and refers bigger problems and complicated procedures to him. It's a system that's worked in 42 countries. In fact, Aurora Johnson and her family had to move to New Zealand for two years while she went through her training. (Today, the Alaska Native Tribal Health Consortium---the organization behind the DHAT program---is training new therapists in Alaska.)

Unfortunately, not everybody thinks this is a good thing. In 2006, the American Dental Association sued the Alaska Native Tribal Health Consortium and the DHATs. They framed it as concern over unlicensed dentistry that could put patients at risk. But Ron Nagel, a dentist who serves as a consultant for the ANTHC, sees another motivation.

"There's a fear in the lower 48, from dentists, that this could somehow tip the rice bowl of their income," he told me. "But there's no evidence of that. If you're in private practice and you can delegate things that don't make as much money to someone who costs less, the economics suggest you could make even more money, yourself."

It's the sort of underdog case where you expect the underdog to lose. But, in Alaska, the narrative got flipped. A court ruled against the ADA in 2007 and the organization chose not to appeal.

But as dental therapist programs spread into the rest of the country, they're facing the same fight all over again. And things are more complicated this time. The Alaska program is by Native peoples, for Native peoples. Other states are looking at broader programs that would need the support of legislatures. And that means an opportunity to scare voters, and politicians, away from the idea. In Minnesota, for instance, the state dental association launched a PR campaign designed to make dental therapists out to be about as skilled and well-trained as the average snake-oil salesman. The slogan: "The last thing you want to hear when you're getting dental care is uh-oh."

In the end, Minnesota did become the second state to adopt dental therapists, but we ended up with a bi-level system. Basic dental therapists have a bachelor's degree (four years, as opposed to the two years of schooling Alaska DHATs get) and can't work if a dentist isn't in the building.

Advanced dental therapists can work alone, but have to have the bachelor's + 2,000 hours experience, complete a master's level program, and pass a board-approved exam.

The legislation only passed this summer, so it's hard to know how, or whether, the changes will affect access to dental care. If dental therapists have to work with a dentist, what does that mean for Minnesota's isolated communities and tribal reservations where there are no dentists? If dental therapists have to have five or six years of education, what does that mean for their ability to take on Medicaid patients and bring dental care to low-income families? I don't know. But I'm hoping for the best.

Image courtesy Flickr user p_x_g, via CC.


  1. I wrote at length about the state of indigent dental care in Virginia on my blog a few years ago. One of the things that I learned in the process of researching it is that one in five Virginians don’t have a single tooth in their head. Oy. Of all of the blog entries that I’ve written in the past thirteen years, this is one of my favorites, because I still get e-mails every few weeks from somebody who cannot afford dental care, thanking me for telling people how terribly difficult it is to live your life like that.

  2. I always thought it was messed up how oral health is considered separate from general health–medical insurance does not cover dental care, though it should. I once had an infection in my gums that passed to my throat, and only then was I able to get the antibiotics to kill the infection! ::sigh::

  3. I am aware that “dental aids” work surreptitiously in some communities. Most are probably trying to help, while some are scam artists. It is a shame that they even have to exist.

  4. i dated a girl in dental school, and that’s a great place to get work done and save some serious $$$ if there’s one nearby. and the worse off your teeth are, the better, because it gives them experience to do some pretty in-depth stuff.

    but at the same time, aren’t most (non-cosmetic) dental problems entirely preventable? is it not cheaper just to teach good oral hygiene?

    1. In short, yes. And, at least with the Alaska program, that’s a big part of what DHAT’s do. Aurora Johnson does oral health education in the local schools, fluoride rinses for kids, and her presence in the community means people can actually get the twice-yearly cleanings and check-ups we’re all supposed to have to prevent decay and spit it early.

      I don’t know how involved dental therapists in Minnesota will be in this way, though it’s safe to assume they’ll be doing the check-ups and cleanings.

    2. Good oral hygiene can only do so much. Some people just have inbred bad teeth, like others are getting white or bald when they are thirty. And if you can’t afford good nutrition, you also lose.

  5. Prevention is not just good oral hygiene. It’s regular professional cleanings. It’s taking care of little problems before they become big problems. Some people have a natural acidity in their saliva that causes their teeth to rot. Some people have more sensitive or susceptible gums than other people. And many places in this country do not have fluoridated water (one of the big factors in prevention), so fluoride treatments are necessary. It’s a lot more complicated than “teaching good oral hygiene.”

  6. I work in a dental school, and with budget cuts, the dental school really isn’t much cheaper than most private dentists around here anymore. I’m posting anonymously so I don’t have to worry about losing my job.

    Several dentists on staff here have spoken out against the Alaskan Dental Health Aide program, and honestly, every one of those dentists drives a really nice car, owns a huge home in high status neighborhoods. On the other hand, the dentists who are all for this program, don’t own the hot cars or the big, high status houses. I think that alone makes it pretty obvious what the real priorities are here. As much as they try to dress it up as quality of care, that’s bullshit and we all know it.

    Trying to maintain a “cadillac level of care” is great, if people can afford it. Let’s face it, the people who go to the Dental Health Aides aren’t going to be the ones who can afford to help a dentist pay off a fancy boat or house. They’re the ones who are currently SOL because at least in this state, Medicare doesn’t cover anything but extractions and dentures, regardless of the patient’s age.

  7. Maybe not the best example (but humorous at least),
    On the VH1 show Flavor of Love, Flavor Flav sent one of the girls to the dentist to hopefully alleviate her bad breath. She had never been to a dentist before, and she was already in her mid-twenties. Had she been able to afford dental care at a younger age, the cost of the work may not have risen to the thousands. Instead of having any of the work done, she opted to wear a necklace of Life Savers. She was subsequently eliminated.

  8. What you never hear dentists say is how much of an individual’s dental health is simply subject to the vagaries of one’s genetics. We are not all born with the same tooth enamel or other particulars. There are people who take lousy care of their teeth and hardly get a cavity, and there are people who brush and floss and get fluoride and still end up losing teeth.

    The myth that good, diligent people have healthy teeth and those who lose teeth could have prevented it by doing what the dentists tell them to do is a complete lie. Dental hygiene helps, but in the end you uare stuck with whatever teeth nature gave you and that is a larger factor.

    But hey, the lie sells toothpaste.

    1. This is so true. I had terrible dental hygiene growing up, but never got a cavity. Same for my sibs. We inherited teeth that seem to shed plaque. Today at 50, still no cavities, but at every visit the dentist still wants to take x-rays because ‘we can’t see cavities between the teeth without them’. Hello? What a waste of money! I won’t do it, even though my dental insurance pays for a set each year. I won’t let my daughter (no cavities) get them either.

  9. it’s my understanding that a routine cleaning is possible without ever seeing a dentist, that an experienced dental hygienist can carry out the picking, plaque removal, and buffing on their own. so i ask, why a dentist would have a problem with something soo trivial, and essentially below their skill set? because it’s not occurring at THEIR practice? but if they don’t care to open a practice an hour out of nome, than whose fault is that?

    is their money really being made in something that takes >20mins to do? if the hygienist finds anything, they get referred to a dentist for the actual work. i’ve had two really awesome dentists, but i find the rest extremely greedy. upon asking my last one for advice on which whitening strips to buy, the $20 rembrandt or the $30 crest, he was more than happy to give me literature about the $800 in-office whitening he highly recommended. he also works at harvard dental and drives a maserati. jerk.

  10. “The myth that good, diligent people have healthy teeth and those who lose teeth could have prevented it by doing what the dentists tell them to do is a complete lie. Dental hygiene helps, but in the end you uare stuck with whatever teeth nature gave you and that is a larger factor.”

    Absolutely and utterly false.

    There are situations in which tooth loss is almost inevitable; head and neck and radiation treatment, fragile diabetics and immunocompromise.

    In a reasonably healthy person there is simply no meed to lose teeth. Education is the key- proper hygiene and diet. People control their fates dentally. A good many people are just too lazy to floss and they pay the price.

    1. Beg to differ–I’m 65, haven’t had a cavity in 20 yrs., cleanings and checkups every 6 mo., brush, floss 4 times daily — still one by one my teeth are getting loose and falling out. Loss of bone–had 3 cousins with full dentures in their 20’s. Genes.

  11. The much bigger racket is that we have had the technology for decades to make most dentistry irrelevant. Most tooth decay is caused by opportunistic bacteria that show up to munch on the sugary goodness in the microscopic leftovers in your mouth. They excrete acid which rots your teeth: your saliva (unless you are an Alien/Human hybrid like Ripley) is not naturally acidic enough to eat through bone. An Intelligent Design that! ;-)

    It’s a simple matter to monkey with the bacterial cultures in your mouth to install non-acid shitting bacteria which will push the others out. It’s little different from eating pro-biotic yogurt to fiddle with the cultures in your gut. The procedure has been doing Stage 3 tests (many patients over a long period of time) for about 25 years now. No problems of any kind have shown up but the “investigation” will doubtless continue until all of the dentists have paid off all of their loans.

  12. I pulled a broken tooth out myself, no joke, held mantra = if I can do this I can get over ex-girlfriend no problem – but need some dental hookups now boyhowdy – the new layout makes me type like this – I hear it’s very web 2.0

  13. as a dentist living and working in New Zealand, I found this article, and some of the responses to it, very interesting. Despite the presence here of dental therapists, I work in a rural area where the waiting time to see a dentist is measured in months. Naturally, those who can afford it travel a couple of hours to see a dentist of they have an acute problem that can’t be treated locally in time.

    Despite what some of the respondents think, as a profession we are very aware of the variable susceptibility to dental diseases within the population. Sure, some people never look after their teeth nor diet and still have fairly healthy mouths, but I have never seen (in 25 years of practice) anyone who has a high susceptibility to decay or gum disease not show significant improvements in their dental health with properly maintained oral hygiene and diet. Dental diseases (well, at least tooth decay and gum disease) are the 2 most common diseases in the world, and, by and large, preventable. Some rather unethical studies in Vipeholm, Sweden in the 1950s demonstrated that teeth do not decay in the absence of sugars, and that sugars cannot cause decay in perfectly clean mouths. Take what you will from that.

    The provision of dental care to the standard that is regarded as acceptable in developed countries is expensive. More than some people can afford. The provision of prevention is inexpensive, painless and dull. It requires changes in habits and foods that, for many, are sacrifices too precious to commit to in the long term.

    This is not good news for those of us (myself included) who have to be almost obsessive in their dental and dietary habits in order to stave off the ravages of caries, but the alternative is, in my opinion, far worse.

    1. Thanks for commenting!

      As a prone-to-cavities person, let me assure you, I do appreciate dentists and what they do. I don’t mean this post to be anti-dentite, but more just to draw attention to what I see as some (not all) dentists’ confusing decision to oppose a program that helps fill in gaps in care they, themselves, aren’t able to manage.

      I’m curious, from your perspective in New Zealand, how are dental therapists viewed? What kind of work do people with this training do — i.e., is there any truth to US opponents’ claims of substandard care and dangerous risks? How does having dental therapists around impact your practice?

  14. I’ve noticed, just anecdotally, that it seems that people who grew up drinking non-homogenized/pasteurized milk (generally people who live within close proximity to a dairy) have fewer cavities. Just wondering whether anyone else has seen this, and maybe even done a study. I’m guessing, if this is so, that there are proteins in milk (caseins?) that break down under that high heat, that otherwise would help protect growing teeth. Especially since products like Recaldent have recently come on the market…

    Anyway, all of this is tied to the article in that I wonder if ensuring their kids drink fresh-from-the-cow milk might be a really cheap way for rural parents to improve the dental health of their kids?

    1. Possibly, but what about the fact most “natural” dairy milk still retains much of it’s fat. Perhaps that is helping to cancel out the sugar/bacteria issues. Or that good bacteria in the milk is helping dissolve the sugar/starch before the bad bacteria can digest it?

      Besides most people drink skim milk with seems worthless to me.

      The lowest I go is %2.

      I never was one much for dental hygiene but it seems I’m lucky. So far no cavities… I wonder if I have that Fluorosis as well? I grew up with well water and had to take a fluoride vitamin everyday. Well water is so tasty…

  15. My sister and I have a dental condition called Dental Fluorosis. I am told that it was brought on either by 1) occasionally swallowing toothpaste as a child, or 2) drinking overly fluorinated well water as a child. We spent a large part of our formative years living in a rural local, and her fluorosis is considerably worse than mine, and she is younger, so I think the bigger contributing factor was the well water.

    Flurosis gives our teeth a “banded” or blotchy consistency, but apparently has also imbued them with an uncanny ability to resist decay. Something about the consistency of my teeth’s enamel makes them fairly impervious to caries.

    As with any super power, there is a downside, and that is they look like shit to begin with. It’s my gift; it’s my curse. Such is life.

  16. Don’t know what its like anywhere else, but in this city of about 500,000, trying to find a dentist’s office that is open on Friday is like searching for a virgin in Atlantic City. In other words, they make so much money Monday – Thursday, they don’t have to bother working 5 days a week.

  17. Since the effort in the Lower 48 will be to increase the price of education to make low cost dental care unfeasible, why don’t we have no-cost dental schools set up in rural areas for students from these areas? These can be staffed by retired dentists volunteering their educational services. Think of it as a Dentists Without State Borders. The communities can provide accommodations for the dentists who will then help them to have enough dental practitioners who can afford to remain in the community. Same for doctors or physician assistants. Some guy in the city who has to pay off mega bucks can have some of his loans dismissed by serving as doctor in charge for a group of three dental/medical assistant. Why price rural areas out of health care when ways can be found to provide them with it, create jobs, and help people reduce their loan burden?

    1. That will never work in the US. It smacks of Socialism. The big, harry evil “ism” of the month. Plus, it makes too much sense being a reasonable simple solution.

      The military will pay for medical and dental degrees for qualified candidates. Perhaps a requirement could be written into those contracts for the resulting dentist to set up shop in a rural area near a domestic base for fulfilling the inactive duty time period. It would maybe start filling some of the gap. After you’ve established a practice, it’s harder to just pick up and move away.

  18. In Western Australia we have this service for children aged 5 to 16. Totally free provided by our govt and the clinics are at the schools.
    As a dental therapist I am able to do fillings, extractions, x-rays etc. We have a supervising dentist that attends once a week for patients with more complicated work (root canals) that we are not trained to carry out.
    This system provides a much needed service to keep the children dentally fit as many parents cannot afford to keep their childrens’ mouths in good health as well as their own. Highly recommend this style of service for any community. You always have a choice- go private, or go public.

  19. Well, since I may be the resident dentist here I’ll voice a couple of thoughts here. First – this a problem. No question or doubt about it. The solutions aren’t quite so easy (or easy to agree on). I agree the therapist idea and others like it are certainly worth pursuing.

    Where I went to dental school, the cost was cheaper, sometimes significantly cheaper than outside dentists. It can be a great resource with the caveat that what you save in $ you’ll pay for in time. The quality was great, your work will be supervised by licensed dentists who tend to be sticklers for making sure the work is A+. We also did volunteer trips to nearby Indian reservations and rural mountain communities to help those who truly lacked access to care.

    As for the idea of the rich dentist, it is a well paid profession. But please keep in mind that we have all spent an extra 4+ years in college beyond basic undergrad (that’s 4 less years making money) and our student loans can be $300-$400,000+ by the time we graduate (which works out to about $45k/year for 20 years!). Add the loss of income together with the loans and we’re down over half-a-mil before any of us even earned a paycheck! Still think we should work for cheap? Most of us can’t even afford to even if we want to. And why do many take Friday off? My office opens at 7:30am and we see patients until 5pm. Add in lab and paperwork time and you’re at 40 hours/week in 4 days. It is intense, stressful work ever hour of every day.

    As for hygienists being able to do the work. Well, sure, they can do a cleaning and I suppose nobody need supervise that. But it’s not the cleaning, it’s the diagnosis of problems and how to treat that you pay a dentist for. Finding a small cavity and getting a $100 filling right away is worth it if you avoid the root canal and crown later, right? Or maybe you can wait and watch it too… If you think that training comes quick and easy then trust your hygienist for all your dental advice – and I do love ALL my hygienists.

    We are constantly overrun by people claiming that bad teeth “run in my family”. The reality tends to be more that bad (eating) habits run in a family than bad teeth. Sure genetics and fluoride can make a big difference as can the exact micro-flora inhabiting your mouth, but it’s a well documented fact that a healthy diet and diligent brushing and flossing lead to healthy teeth and gums.

    I’ll close with this. While there are sharks out there in any business, you are free to go to whoever you want. If you think a dentist is trying to rip you off, ask questions. Give them a chance to explain. If you don’t like the answer move on. Get a good referral from a friend or coworker (although really, how would you know if they’re good or not until 5 years later when all your fillings fall out?) not 1-800-DENTIST or the Penny Saver. There are plenty of us out there who will spend our entire careers trying to put ourselves out of business by teaching you how to avoid getting cavities in the first place.

  20. One of the less-discussed reasons for high-priced dentistry might be the common practice of creating Taj Mahal stand-alone office buildings in which to operate dental clinics. Before the nineteen-seventies, most dentists operated out of walk-up offices in downtown bank buildings, with an assistant and a receptionist. The idea of a dentist with a fleet of assistants using star-wars equipment is a fairly new idea.

  21. Who put dentists in charge anyway. The American Dental Association is just a union created to protect the best interest of dentists and it has way too much power. Sometimes the ADA seems no better than other groups formed to protect corporations such as the American Council on Science and Health. The ADA is heavily funded by corporations that benefit from dentists placing sealants, mercury, fluoride – all scientifically proven to be harmful to health

    The millions of dollars derived from corporations gives the ADA the political clout to get laws passed or not passed for the benefit of dentists – not the American public – such as fighting against dental therapists.

    The GAO reported yet again that 6.5 million children on Medicaid are not getting dental care. At a hearing held Wednesday, people are dancing around the problem.

    It’s simple. Either Mandate that dentists treat all patients who show up at their door or allow other vialbe groups to do so.

    This problem has been studied, reported, researched for years. Committees have been formed, symposiums have been attended, more reports have been written and more congressional hearings are held.

    What to do? What to do?

    Dentists love mandates because they are behind virtually every mandate to add fluoride chemicals into the water supplies, which as you can see, is NOT hurting their bottom line. Otherwise they would be at the forefront of telling your that fluoridation is ineffective at reducing tooth decay and harmful to health.

    Congress has to get a backbone and mandate dentists to do the job the government has subsidized them to do. Dentists did NOT do it on their own.

  22. Hello everyone,

    As a practicing dentist for the last 29 years, I am happy to offer some perspective on dentistry today.
    First, let me begin with dental school costs. When I graduated from dental school, my total expenditure was around $60000 for 4 years, a princely sum in those days, but doable with summer work, work study jobs, and loans. The same school today would cost….. are you ready? around $350000. Is that not ridiculous? If you have a wealthy family, ( I did not) ok but for a regular student? Now, let me tell you about dental reimbursement. My insurance company fees have not doubled in 29 years, but staffing costs have gone up 4 times, supplies 4 times, laboratory costs 4 times plus, and technology costs through the roof. Dentists must own their hospital and get reimbursed ridiculously. It is difficult to offer the latest and greatest technology in such an environment unless you are willing to take a pay cut each year, and if your dentist accepts insurance reimbursement only and tells you that he is offering the latest technology I can tell you he is lying through his or her teeth, and I would challenge anyone on that assertion. Oh, and did I mention regulations? The state where I live has instituted various regs over the years to “protect” the public, i.e., to give jobs to new agencies which only grow and metastasize over the years to extract additional fees for the state.
    Add to this the cost of continuing education, and if you are a true professional you need to spend money on this which amounts from about $200 a day lecture to $100000+ to learn about implants and supply your office with the necessary equipment.
    Laboratory costs are another matter. That crown or bridge or veneer in your mouth can cost anywhere from $40 a unit to $1500 which the regular fees being in the $200 to $400 range. Which do you want in your mouth?
    I hope this has been illustrative of what we as dentists face, and if you want the best for your mouth, ask questions accordingly.

  23. I used to work in a jail. You would not believe the number of people who were arrested, and then had to go to the dentist.

    Once people are in the state’s care (imprisoned) we are required to pay for medical care, including dentistry. This meant that some people would come in the jail with teeth and leave with NONE. They got the bottom of the barrel care, no meds (unless antibiotics were essential to keep them from death). If a tooth was a problem, or looked like it might become one, it was pulled– often without any pain meds.

    Folks would talk to me with blood pouring from their gums after visiting our rural dentist, who had a contract with the city. I also suspected there was a pleasure/pain thing with him. Little shop of Horrors kind of thing (Steve Martin’s character).

    Anyway, point being- poor folks get fucked, either in the system or without it.

  24. Two comments from Alaska. 1) It’s not unheard of for Alaskans to get their teeth taken care of during travel to the lower 48 because it’s cheaper. I used to live in Fairbanks and on one visit to my hometown of Portland, I went to see my old family dentist for a cleaning. In the waiting room was a couple who looked oddly familiar. They were from Fairbanks.
    2) A friend of mine married an Australian who had been practicing dentistry for years in his country and they have settled in Fairbanks. He has found it so difficult to get certified in the states that he simply travels back to Australia for a few months each years, makes his loot, and then comes back.
    Alaskans seriously believe that there is a dentistry cartel in this state.

  25. I’ve been brushing my teeth with handmade peppermint soap (and it has to be handmade, not mass made. There is a difference!). You can find them at health food stores or online at places like etsy.

    I’ve noticed less tartar and gum bleeding. It’s a good way to care for your teeth.

    “In the book, “Nutrition and Physical Degeneration” written by Weston A. Price, DDS and his wife Florence sometime before 1939, the couple reveal the results of their studies of communities in Switzerland, the Hebrides and tribes of Indians in Alaska. They found that these isolated people, whose diet consisted of only natural food, had about 1/15th the decay as people who ate refined carbohydrates.” – Inspired Living

    Also avoid fluoride. It’s not good for you at all!

  26. I get cleanings four times a year from a dental hygienist. Once or twice a year, the dentist comes in and pokes around a bit, telling me what the x rays (if any said) and if everything looks good, and doing fillings if necessary (not often). So I’m completely baffled as to why a therapist trained to do cleanings/preventative care who works in an area where there is no regular dentist is a threat to anything. If this position can keep gums and teeth healthier through the year, and let the dentist do the heavy lifting during the annual visit, isn’t everyone better off? And isn’t it similar to the model that already exists (except that hygienists work in a dentist’s office)?

    1. My last dentist let the hygienist do everything and then came in to make a cameo appearance. I ended up with problems because he wasn’t paying attention. My current dentist does the cleanings himself. He knows exactly what’s going on with my teeth and gums because he just spent 20 minutes going over them micron by micron.

      Every good dentist that I’ve ever had did his own cleanings. The ones who have a host of hygienists are not dentists so much as business managers, and lately they’re mostly salespeople for pricey cosmetic dentistry products like veneers and teeth-whitening.

  27. Hey Maggie,

    Thanks for the kind words about my series. One point of information: I did mention dental health aide therapists and other mid-level providers in the final entry, “Healthy Teeth for All.”


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