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m em bers of the health care professions. The fact th a t such an investigation is necessary points up the need for the state dental licensing organizations, as well as th e ADA, to develop testing program s in the field of professional ethics as p art of th eir licensing exam inations in order to protect the public. In addition, the ADA should encourage dental schools to develop screening program s to be used during th eir admissions procedures to help the schools select only ethical individuals. The other question th a t m ust be raised is: Is a state dental licensure exam ination the proper environm ent in which to te st the clinical skills of dentists? The other major health professions, such as medicine and nursing, do not include clinical exam ination in th eir licensing procedures. It can even be said th a t for dentistry to do so projects the image th a t it is a trad e ra th e r th an a tru e profession. It should be the responsibility of the dental schools to determ ine and certify th a t th eir graduates are technically proficient, and it should fall to the school accreditation authorities to ascertain w hether this vital responsibility is being m et by the individual institutions. A n d res M. L inz, D.D.S. N ew York F E E -F O R -S E R V IC E

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The M ay 1992 issue included an article entitled “A glimpse into the 21st C entury.” In it was a question, “Will fee-for-service continue to be the norm in dental care? Or will capitation program s take over?”

It was interesting to note th a t the responses from both Drs. Dugoni and Laskin m entioned the profession and the public with no m ention of the employer—the purchaser of the dental plans. I have found th a t this omission occurs with regularity when organized dentistry discusses dental plans. This is puzzling because, of the three, the decision on which plan is purchased is th a t of the employer. And the major factor in an employer’s decision on benefits is the availability of funds. The opinions of organized dentistry and the public are secondary. In the U nited S tates, fee-forservice will rem ain the major dental delivery system unless som ething drastic occurs. However, organized dentistry should realize th a t capitation dentistry is an alternative delivery system th a t is here to stay. As in fee-for-service, there are good plans and bad plans, good providers and bad providers. W ith this in mind, organized dentistry should take the bull by the horns and see to it th a t the regulatory guidelines th a t govern capitation program s are proper for the protection of the public and th a t they are being enforced. It will be a m istake to disregard capitation plans and hope they will ju st disappear. R ich ard K. M atsuishi, D.D.S. G lendale, Ariz. HOW

MUCH

IS E N O U G H

We m ust realize th a t today all professions have to look into a m irror, including dentistry. I decided to take a practice

m anagem ent course last week. This course was given in our local district. The focus of the course on needs vs. w ants was tow ard th ree health delivery services in our profession— bonded veneers, bleaching teeth and in-office white inlay delivery services. The speaker spent m uch tim e discussing the incomes gained through these services. The speaker spoke of a $100,000 increase of income w here your office personnel could do m ost of the work and you were not needed a t the chair to bleach teeth. He spoke in grand term s of these different entities and how they could increase income. I tried to contain any ques­ tions. However, after about two hours, I raised my hand and I said, “I’m 58 years old, and as I look around this room, nobody will agree w ith me, but 10 years ago, a well-known dentist in the U nited States came to our area and spoke of gold inlay/onlay preparations. Let me share th a t this has given me such joy to have this m arginal integrity in this bit to restore teeth. It has changed my soul and our profession. “Let me also ask th e speaker if he considers a white inlay/onlay preparation to be anyw here near the excellence in fit in bio-mechanical a d a p ta ­ bility as a foreign body th a t the gold inlay/onlay restoration has done. Let me fu rth e r question th e use of the veneer, so-called cosmetic dentistry. It is my professional opinion th a t they are food traps. W hen you don’t reduce tooth stru ctu re and you leave a m ass of any m aterial beyond w hat n atu re gave us for 250,000 years, I believe they are ju st periodontal food trap s and

cause more harm th a n good.” My m ain concern is th a t excessive work is not done. People commonly complain of the excessive law suits done by crass lawyers who will give a sum m ons and com plaint for anyone who walks into the office and has an argum ent w ith anyone else. I believe all practicing dentists should spend an hour alone every so often thinking of the golden rule, thinking th a t th eir profession gives great power, great license, and realizing we m ay be only w orth the income in the present-day world of an engineer. Lastly, we can also rem em ber th e A rthur M iller play, “D eath of a

Salesm an,” w here Biff says, “Dad, I’m only w orth $3 an hour, you th in k you’re w orth $10 an hour and you’re kidding yourself.” T h om as F. C orcoran, D.D.S. S y ra cu se, NY

C O R R E C T IO N

In the A ugust specialty article on th ird m olars and incisor crowding by Dr. Thom as Southard, Figures 2A and 2B were transposed. The Jo u rn al regrets the error.

JADA, Vol. 123, September 1992

11

How much is enough.

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