I was recently asked to be a part (albeit small) of a documentary being put together by a colleague on the training of dental hygienists to apply SDF (silver diamine fluoride) and GIC (glass ionomer cement) directly to teeth to halt, and in the case of GIC when used as a sealant, to prevent tooth decay. For all intents and purposes, “miracle drugs” when it comes to dental care. The saying going around among those “in the know” in modern dental care is “Ya don’t need a dentist to apply this stuff.”
The implications for access, cost, quality in dental care are considerable, enough to signal the end of dentistry as it has been known since when, 1840, with the founding of the Baltimore College of Dentistry?
It is not an exaggeration to draw parallels to the eradication of smallpox:
- The smallpox vaccine was highly effective, cheap, easily handled, easy to apply, and hardly painful. Ditto with SDF and GIC, and no pain, period.
- Administering the smallpox vaccine did not require a hypodermic needle or a pneumatic injector, just a simple prick of the skin with the famed bifurcated needle, designed to carry the precise amount of vaccine, costing only $0.005. SDF is applied with a microbrush – no drill involved – costing maybe a nickel, and just a gloved finger for applying GIC as a sealant, simple hand tools when being used to build back tooth structure. Often no traditional – and costly - crown is needed.
- A virtual worldwide army of inoculators consisting of anyone from health care aides to teachers to tribal elders was readily trained in administering the vaccine and in data collection. They could be deployed rapidly to contain an outbreak. Physicians and nurses comprised only 1%-5% of the entire worldwide workforce. The latest BLS statistics show 221,600 dental hygienists currently practicing in the U.S., with a job outlook for 2024-34 of 7%, much faster than average. Think of what it would mean for access to care if state practice acts were modernized to take full advantage of their capabilities.
- Thus, this ages-old scourge of humankind was eradicated through science made simple in application, and the appropriate organization to put that science to full effect. I tell my colleagues, you guys and gals keep working the science and clinical treatment angle, I’ll keep at it with regard to the organization, financing, and management of care, and together we will knock off another age-old human scourge.
- It’s already happening. Two young, enterprising pediatric dentists have just opened their tenth – that’s right, TENTH – location in New Hampshire, Vermont, Maine, and Massachusetts based on what’s currently being called “the medical management of caries (cavities)” using SDF, GIC, and suitably trained hygienists. The state Medicaid offices love them for the coverage they can offer to Medicaid beneficiaries and the savings to the state, and they’re taking over the market. I’ve lost track of the tens of thousands of patients they now have. And they continue to grow.
- Oh, a bit of advice… don’t advise a child or grandchild to go into dentistry just yet, there’s gonna be a lotta bloodletting in reworking dental education to get the right kind of practitioner doing the right kind of things. Graduating currently with over $400,000 in debt and no job prospects isn’t a comfortable spot to be in.
Contact Harris at: [email protected].