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Soon the Brits won’t have anything on us when it comes to smile profiles. And ugly teeth are just the beginning. The root of the problem is a shortage of dentists, which is intensified by a gallop to the money.

Free enterprise and dentistry positively collaborate in various ways – but without a public health (we are in this together) foundation, big holes in the dental care distribution system can open up that hurt real people.

We train fewer dentists because we are letting the “market” decide, which has contributed to the closing of many dental schools. While the market has its efficiencies, it cannot see or feel dental suffering. It only reacts to the money and most often the easiest money. There is no obvious easy money in helping kids and elderly improve their oral and dental health.

This “market” philosophy drops to its knees when children are in pain for weeks and months because dentists have fled for an oasis of plenty. Blaming dentists as money grubbing is a weak scapegoat theory – because few other private marketeers are planting their financial lips where they might get parched.

The reality is that most dental practices are small businesses; while not mom and pop exactly, they work on cash flow like all the others. Plus few of these rural/low-density and low-income areas are getting infusions of private market funds. Why should we expect dentists to sacrifice in these desert locations when most of us have long ago moved from them?

The cost of higher education and dental school is another reason why it is hypocritical of us to expect dentists to work in places where their financial livelihood is limited. To overcome this British-smiles-for-all dilemma is to create incentives to make it worth their while.

While this solution will probably include paying “extra” taxes, let’s consider the alternative: a King George III like dental delivery system. In many ways it looks like this madman might have had a hand in the crazy lopsided system we have.

There are a few people that think paying any taxes are illegal, but I think those people and those who don’t want to make our dental delivery system better are actually Tories in disguise. They want the British to have control over all our smiles.

Okay, many people don't have that kind of money - but those who do could pay more. And where are these no more-taxes and let them eat cake “loyalists” hiding anywhere? Probably in a gated community waiting for the second coming of King Georgie!

These Tory capitalists can vote in politicians that will protect their precious money—but as they do this—many more good people drop even deeper into dental health oblivion.

Yes, even our government (and I mean the George Washington one not the George III one) often drops the ball and sucks up inordinate amounts of money to do things the “magical private sector” can do a lot cheaper. But the amazing private sector is also the one outsourcing your neighbor’s job to some far off country.

This is not to slight foreign countries; we just need to recognize that the private caravan has its lame camels too. Ironically, we are lucky that those countries are sending us many of their best and brightest dentists that often take jobs in those far off (we like to ignore) rural or inner city areas.

We can continue to ignore how our hoarding of wealth (in all its bogus capitalistic meritocracy righteousness) or start bellying up to the bar of better oral health for those less fortunate.

This way of thinking can be seen as bleeding heart – but huge parts of the population with bleeding, diseased gums and no teeth also cost us a lot. No matter what your leaning—bleeding heart or let the masses have bleeding mouths—it will cost you. The only way that (let them pay their own way) strategy stays in place is for you to pay lobbyists to keep politicians from raising your taxes.

Additionally, at some point these people will need health care either for their oral pain or other health effects, which can include heart ailments, strokes and even diabetes—attributed to periodontal (gum) disease. This will come out of your federal, state and county budgets (higher taxes) to cover their emergency room visits. This round about avoidance of our responsibilities is not the United States I think about when I feel the tingle up my spine during the national anthem at a veteran’s day celebration.

Obviously, there are bad and better ways to approach this dentist shortage. Handing over everything to some federal bureaucracy is 20th century thinking. However, the government does help when investing in “basic” research and bridging to the next economic revolution like they did with the Internet (with significant input from Al Gore?)

Tax revenues could be invested in private partnerships with dental organizations and even dental product companies to add the positive aspects of the capitalistic system to the mix. Strategies can be developed to pay for dentist loans to help them serve these low density and low-income areas.

Rather than getting our undies in a bunch about out-sourcing we should take full advantage of globalization to help us spread dental health to more of our citizens. Americans are known for moving onto greener pastures once they get one step up on the American dream. We moved from farms to cities for better work—few will move back when greenbacks are nearly impossible to dig up.

Immigrants, my ancestors included, would take on any job as long as they could move to this country. In-sourcing of foreign-born dentists could be utilized to serve in these areas.

Immigrants are also known for being able to develop profitable businesses in even the most difficult situations. They need to and are not expecting (with a "I deserve it because I am an American" attitude) to roll out of dental school with a high buck lifestyle. The foreign-born dentists won’t work for nothing, but they will go where jobs are--not just dismiss it out of hand because where it is located. While most U.S. born dentists are hard working—few of us (dentists or not) ever have the same yearning (and the aggressiveness it engenders) our immigrant ancestors did.

We are often fearful of these “new” people because they do have a work ethic that undermines any “we were born here” coasting attitude we might have. They charge less or work longer they we do--but this disruptive influx of aggressiveness often pushes us to offer a better product in the end.

Imagine what our cars would look like if Japan never threatened us with their quality engineering. Dentistry is no different. We often find we can do things cheaper AND better if someone forces us to find those routes. Another example is what the cost of computers would be without outsourcing the manufacturing. Global migration of dental health workers has some potential but we should not just “steal” dentists from other countries. Giving foreign-born dentists a five-year “grubstake” in this country and then having them return to their home country might be worth it to both countries.

Possibly we just need to invest in our own dental schools (many have closed over the years) and provide different incentives to get more dentists. To cover these gaps we need about 5,000 more dentists per year – but it is not just a number – if they do not want to move into these struggling areas -- raising the numbers will just dilute the financial value of the profession. And we cannot discount the financial aspect. Altruism is one reason people pursue dentistry – but altruism alone does not produce the resources necessary to get dental health care to everyone.

These are rudimentary ideas but it has always made me wince when I hear that as Americans we are so creative and advanced and then see things like dental care being denied our citizens. Of course, some of it is “their fault” – but this (blame-it-on-the-suffering) reasoning leaves me cold and is without the teeth of long-term and comprehensive logic.

This lack-of-dentists dilemma is about failed systems not failed people. I am not advocating free dentistry. A government like ours should be able to make things better than they are – not spoon-feed its citizens – but develop bridge-the-gaps investments where easy capitalistic profits are not free flowing. Free enterprise is often tied to gold mine concepts and then when profits are not 50%, the capitalists leave. While a Darwinian ghost towns effect is the only possible outcomes for some areas, we as good people and brave Americans have an obligation to help in the transition.

Evolutionary Theory might anger some Christians, but as one myself – my gripe is not the theory itself --- it is with how we too often (as a supposed Judeo-Christian society) treat those who seem to be in the throws of Darwin’s theory. If Christians really think dental care should be distributed in this haphazard way, maybe we should try a Muslim-Buddhist society for a while.

Solving the better-dental-care-for-all dilemma is not going to be easy. However, I think it is worth a try. I would hate to find out 230 years after we beat the Brits to give this land democracy we were now going to find ourselves Paul Revering it again, British smiles are coming, British smiles are coming".

Another Dental Diatribe by RAC

NOTE: All reenactments of historical conflicts between our brothers in Great Britain are purely to elicit humor. However, we do ask that you make room for the Tories when they finally decide to leave. Once again, this is in jest - they have it so good – it is unlikely they will go anytime soon even if taxes go up a few percent.

Background Links found in this dental commentary Here dental hygienists bring up some of the statistics in the dentist and dental healthy imbalance. www.adha.org There are many states including Texas and Nevada very if any dentists serve huge tracts of the rural landscape. Here is an example of how dentists have crowded into one oasis-county in Kansas while leaving ten counties in the same state without one dentist. www.poynter.org New York Times shows how ugly the dentist shortage in Great Britain has gotten. www.nytimes.com

Dental school closing review/retrospective: Washington University School of Dental Medicine, Missouri wustl.edu/dental/history Fairleigh Dickinson University: Dental School Closes nytimes.com Here in Maine we see an example of the have and have-nots of dental health: Dentist Shortage pressherald.mainetoday.com Global Migration of Dental health care workers and other health professionals might be hurting the source countries. sagepub.com Thanks for your contribution or dental question.