ISSUES

Licensure Reform

Licensure is the process whereby a state grants dentists the legal authority to practice dentistry. The current system of licensure exams with the use of a live patient is controversial and flawed.

 

We stand by the American Dental Association (ADA), the American Dental Education Association (ADEA), the Student Professionalism and Ethics Association in Dentistry (SPEA) and many dental school deans across the country, among others, who believe that to protect the public, maintain the integrity of the profession of dentistry and ensure that only competent dental school graduates can gain a dental license, performing exams on human subjects in a high-stakes, one-shot scenario must end.

According to the ADEA, "ethical and practical questions about the use of human subjects, regional variations in examinations and results, and the reliability and validity of the exams have been some of the sources of concern." ASDA's white paper details the major shortfalls of the current licensure examination process.

Student Debt

ASDA considers the growing student debt crisis a top priority and advocates for financially sustainable, long-term solutions. With dental school tuition nearly doubling since 2000, new dentists are faced with substantial amounts of debt after graduation, which can jeopardize their ability to choose their preferred career path. Rising educational costs might also discourage potential students from pursuing dental school altogether.

 

ASDA urges lawmakers to consider measures that would alleviate the excessive burden of educational debt, allow for refinancing when interest rates change and remove barriers for dental students wanting to pursue careers in public service. ASDA continues to lobby following issues:

 

  • HR649: Student Loan Refinancing Act - This act would allow denists to refinance their federal student loans at any time during the life of the loan.

 

  • HR4223: POST GRAD Act (Protecting Our Students by Terminating Graduate Rates that Add to Debt Act) - This would make students pursuing graduate and professional degrees eligible to recieve Federal Direct Subsidized Loans.

 

 

Dentistry and Health Care

The repeal and replacement of the Affordable Care Act (ACA) by the proposed American Health Care Act (AHCA).  The AHCA passed in the House on May 4th with a vote of 217-213 and has been sent to the Senate.  The American Health Care Act is the House of Representatives Republican plan to repeal and replace the Affordable Care Act. Some of the changes included in the bill are outlined below:

 

  • Limits Medicaid expansion

    • Thirty-one states opted to expand Medicaid coverage under the Affordable Care Act.

    • The bill sunsets this option by 2020.

  • Converts federal Medicaid funding to a per capita allotment

    • Currently states are guaranteed federal funding for eligible enrollees with no pre-set limit.

    • The per capita allotment would set a limit on how much the federal government would reimburse per enrollee.

  • Allows states to opt-out of covering essential health benefits and to charge higher premiums to individuals based on health status

    • States can seek a waiver that enables them to do this in order to increase savings or reduce average premiums.

  • Increases the annual tax free contribution to Health Savings Accounts (HSA’s)

 

The Action for Dental Health Act of 2017 unanimously passed in the House on June 29th. This legislation calls for Congress to authorize additional oral health promotion and disease prevention programs. This bill would allow for organizations to qualify for oral health grants to expand outreach and education of children and adults and aid in finding their dental home.

Barriers to Care

Barriers to care include anything that limits or prevents people from receiving adequate health care. In the case of dental care, the most common are financial hardship, geographic location, pressing health needs and poor oral health literacy. Language, education, cultural and ethnic barriers may compound the problem. In many cases, multiple issues are involved. To access the necessary care for their dental needs, patients may require transportation, oral health education and/or financial assistance.

 

Barriers to care can leave patients with serious conditions that threaten their overall systemic health and quality of life. As of June 19, 2014, there were 4,900 Dental Health Professional Shortage Areas (HPSA). It would take 7,300 additional practitioners to meet every HPSA community's need for dental providers.

 

ASDA does not support the use of midlevel providers to solve the barriers to care issue.

Midlevel Providers

ASDA identifies a midlevel provider as an individual, who is not a dentist with four years of post-collegiate education (three years in the case of University of the Pacific School of Dentistry), who may perform irreversible procedures on the public.  Due to barriers to care issues, midlevel provider pilot programs have begun to enter the mainstream world of dental health care.  ASDA encourages an opposition to midlevel provider legislation.

Amalgam

Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. It contains a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness. Depending on treatment needs, it is one material available to dentists and patients when considering restorative options.

 

ASDA's policy I-5 on Amalgam Restorations states: "It is the position of the American Student Dental Association that, based on available scientific data, the continued use of amalgam as a restorative material does not pose a health hazard to the nonallergic patient. The removal of clinically serviceable dental amalgam restorations solely to substitute a material that does not contain mercury is unwarranted, improper, unethical and intentional misrepresentation to the patient."

 

The EPA requires all dental offices which drain into publicly owned wastewater systems to have amalgam separators.

Water Fluoridation

Education on benefits of fluoridation is a part of most, if not all, of our dental school curriculums. The ADA has endorsed water fluoridation and fluoride-containing product usage as safe and effective measures for preventing tooth decay. Efforts by the ADA, coupled with the efforts of dentists and other health organizations, has led to a continual increase in the number of communities that have opted for fluoridating their water supplies. However, there are areas in the United States that do not have appropriately fluoridated water systems. From Jan. 2011 through May 2012, 43 states have experienced activity to initiate, retain or defeat fluoridation programs.

 

In April of 2015, the U.S. Department of Health and Human Services updated its recommendation for the optimal fluoride level in drinking water to prevent tooth decay to a single level of 0.7 milligrams per liter of water. The previous recommendation was a range from 0.7 to 1.2 milligrams, issued in 1962. The change resulted from the increase in access Americans have to other sources of fluoride such as toothpaste and mouth rinses in the last 53 years.

 

ASDA encourages the fluoridation of community water supplies as a scientifically-proven safe and effective means of preventing dental decay as recommended by the U.S. public health service.

 

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