The Problem of Denturism

Stephen Barrett, M.D.

Dental laboratory technicians are trained to construct and repair oral appliances such as crowns, bridges, and dentures. Most train by apprenticeship; others attend educational programs of 1 to 2 years. Some of these programs are accredited; others are not. Dental laboratory technicians usually work under a dentist's direction, either in the dentist's office or in a commercial laboratory [1]. The National Board for Certification, an independent board established by the National Association of Dental Laboratories, offers certification in dental laboratory technology. Certification, which is voluntary, is available in five specialty areas: crowns and bridges; ceramics; partial dentures; complete dentures; and orthodontic appliances.

Denturism

Denturists are a relatively small number of technicians who provide dentures directly to the public. In the United States, denturism is illegal in most states. In addition, the Federal Denture Act (Section 1821 of Title 18, United States Code) makes it a criminal act to market in interstate commerce any denture or other dental prosthetic appliance that has not been made or legally authorized by a licensed dentist [2]. The major objection to denturism is that complete examination of the mouth and proper fitting of the teeth often require skills that denturists lack. Denturists are not competent to diagnose cancers or other diseases within the mouth, to screen for underlying disease, or to recognize when structural problems of the mouth (such as unseen broken-off roots of teeth) can lead to injury if not corrected before the installation of dentures. In 1991, the Arizona dental board noted that complaints concerning the state's denturists were many times more common than complaints about the state's dentists [3].

Denturists have campaigned for the right to practice independently in many states, but most of these campaigns have failed. Denturists are allowed to practice independently only in Oregon, Idaho, Montana, and Washington [4]. Those in Maine, Arizona, and Colorado can practice under the supervision of a licensed dentist. However, in 1991, investigators hired by the Arizona Dental Association found that only three out of the state's 13 denturists advised callers to see a dentist before visiting them [3]. Denturists assert that they can fit dentures as competently as dentists and more cheaply. However, six years after the Canadian province of Ontario began regulating denturists, the fees quoted in their fee guide were similar to those of dentists [5].

The educational requirements for licensing are fairly consistent throughout the six states where denturism is legal. All six require a minimum of a two-year degree plus an examination for licensing or certification. In addition, Idaho and Oregon require a two-year internship with a licensed denturist and Montana requires a one-year internship [6].

The American Dental Association is strongly opposed to denturism and has encouraged dental societies to sponsor community programs in which professionally acceptable dentures can be offered to financially disadvantaged individuals at a reduced cost. Programs of this type exist in most states. In addition, low-cost care may be available from dentists whose fees are comparable to those of denturists. Nearly half of dentists responding to a 1994 ADA survey reported that they offered free or discounted care to people with low incomes [7].

References

  1. Medical, dental, and ophthalmic laboratory technicians. Occupational Outlook Handbook. U.S. Department of Labor, Bureau of Labor Statistics Web site, Aug 4, 2006.
  2. FDA Compliance Guide 7124.07. Sec. 315.100 Dentures; sale in interstate commerce of dentures by persons not licensed to practice dentistry. Revised Aug 1996.
  3. McCann D. Cameras capture unlicensed dentist. ADA News, July 15, 1991.
  4. Williamson RT. College active in denturism fight. ACP Messinger 2(25):4, 1995.
  5. Abrams SH. Denturists: do they really provide more affordable care in Ontario? Journal of the Canadian Dental Association 63:771-774, 1997.
  6. Greer M. Peck AM. A study of denturitry directed by the 1998 General Assembly. Frankfort, KY: Legislative Research Commission, January 2000.
  7. Jacob JA. Survey measures free, discounted dental care provided by dentists. ADA News 27(4):22, 1996.

This article was revised on February 14, 2007.

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