摘要：The dental profession is responsible for the prevention, diagnosis, and treatment of diseases and disorders of the oral cavity and related structures. Although the majority of the US population receives excellent oral health care, a significant portion is unable to access regular care. Along with proposals to develop midlevel providers, the scope of practice for dentists needs to be reconceptualized and expanded. A broad number of primary health care activities may be conducted in the dental office, such as screening for hypertension, diabetes mellitus, and dermatopathology; smoking prevention and cessation activities; and obesity interventions. More than 70% of adults saw a dentist in the past year, which represents an unrealized opportunity to improve both oral health and general health. ALL PROFESSIONS, AND ESPE cially the health care professions, are in a constant state of self-assessment aimed at advancing their disciplines in a consistent and measurable fashion. For the health care professions, the goal is to improve patient health, increase efficiency in the health care system, and ultimately enhance society as a whole. This evolution is expressly true for the dental profession. The changes that have occurred in the field over the past 50 years, and particularly in the past 20 years, have been transformative. Fluoridation of the water supply has been identified as one of the top-10 public health initiatives of the 20th century and has resulted in a 30% to 50% reduction in dental caries. 1 As another example, the introduction of osseointegrated dental implants has changed the clinical approach to managing partial and total edentulism (loss of teeth), and offers patients an expanded range of options for replacement. 2 Furthermore, the development of new dental materials has allowed the profession to offer aesthetic options to patients that can transform a smile, an appearance, and in some cases a life. Nevertheless, the dental profession is now faced with many challenges and questions. Chief among these is the equity issue, as those who are poor, disabled, aged, and living in urban or rural areas have difficulty accessing oral health care services. 3 – 6 This challenge has led to proposed changes in the oral health workforce in the United States that has elicited contentious debate within the dental profession. The introduction of midlevel providers is especially controversial. 7 The perception exists that this change is being driven from outside the dental profession with calls to create a new type of dental provider in the United States that is equivalent to the “dental nurse” that has for decades provided services to students in New Zealand. 8 An issue that is equally relevant and related to any discussion of the oral health care workforce is the need for the dental profession to define its future, specifically in the context of health care reform in the United States. As the population ages and chronic illnesses affect a larger percentage of those seeking and requiring dental services, will the profession be prepared to comprehensively treat these patients? This situation is further complicated by the near total exclusion of oral health care services in Medicare and the general absence of dental services for adults in US health care reform. 9
