Coretopic:Oral Health

Report of the Special Rapporteur on Extreme Poverty and Human Rights on his Mission to the United States of America: Delivered to the United Nations in Geneva, June 2018, Philip Alston, the UN Special Rapporteur on Extreme Poverty and Human Rights offers a scathing assessment of the ways that factors including budget decisions and shortages of medical and dental services contribute to the suffering of millions of poor Americans.

State-Specific Children’s Health Insurance Program Fact Sheets: State-by-state data on Children’s Health Insurance Program enrollment, participation, eligibility, benefits and cost sharing from the National Academy for State Health Policy, an independent academy of state health policymakers.

States Stalled on Dental Sealant Programs: This report from Pew Charitable Trusts includes fact sheets for all 50 states and the District of Columbia on reflect the reach, efficiency, and effectiveness of their sealant programs.

The Role of Dental Hygienists in Providing Access to Oral Health Care: Released in January by the National Governors Association (NGA), this paper offers a summary of various policies governing the role of dental hygienists and examines alternative models and practices from states.

Dental Services: Information on Coverage, Payments, and Fee Variation – A September 2013 report from the Government Accountability Office. See an interview about the report. The study was prepared for Sen. Bernie, I-Vt., who called a Sept 12 hearing in which witnesses testified about the lack of care for children, the high cost of dental services and low Medicaid reimbursement rates. Here is a five-minute highlights video from the hearing and witness testimony and the full video from the hearing.

Dental Crisis in America: The Need to Expand Access – A hearing and a report released in February 2012 by Sen. Bernie Sanders (I-Vt.), chairman of the Subcommittee on Primary Health and Aging, put a spotlight on dental health and the lack of access and care many Americans experience. In a statement prepared for the hearing, Sen. Jay Rockefeller (D-W.Va.) said he is “working on legislation to make affordable dental care for our seniors a reality once and for all.”

"Extent of Dental Disease in Children Has Not Decreased, and Millions Are Estimated to Have Untreated Tooth Decay" (PDF): Nationally representative data from the 1999 through 2004 National Health and Nutrition Examination Survey surveys indicate that about one in three children in Medicaid had untreated tooth decay, and one in nine had untreated decay in three or more teeth. Projected to 2005 enrollment levels, GAO estimates that 6.5 million children aged 2 through 18 in Medicaid had untreated tooth decay. Children in Medicaid remain at higher risk of dental disease compared to children with private health insurance; children in Medicaid were almost twice as likely to have untreated tooth decay. Report highlights

Healthy People 2010, Focus Area on Oral Health – Healthy People 2010 is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats.

Advancing Oral Health in America: A 2011 landmark published by the National Academy of Sciences’ Institute of Medicine.

Millions of Americans Lack Access to Essential Oral Health Care: A 2011 report from the Institute of Medicine and the National Research Council looks at the consequences of inadequate access to oral health care and recommends ways to improve access.

Improving Access to Oral Health Care for Vulnerable and Underserved Populations: This 2011 report, from the Institute of Medicine's Committee on Oral Health Access to Services looks at the scope and consequences of inadequate access to oral health services in the United States and recommends ways to combat the economic, structural, geographic, and cultural factors that prevent access to regular, quality care.

Oral Health in America: A landmark report of the Surgeon General from May 2000

National Call To Action To Promote Oral Health, April 29, 2003 (PDF)

Oral Health and Low-Income Nonelderly Adults: A Review of Coverage and Access
This policy brief provides data and analysis of coverage and access to oral health care for low-income nonelderly adults. Lack of resources to pay for dental services, either through dental insurance or out-of-pocket, is a major barrier to oral health care for many low-income Americans. The problem is particularly acute for low-income adults, who are more likely to be uninsured than low-income children.

“A State of Decay” is a state-by-state report released in October 2013 by the nonprofit Oral Health America. The report found that seniors in many states lack access to public and private dental benefits and dental services. In many states, community water fluoridation and other public health initiatives that support oral health are also in short supply.

Aging

"Oral Health: An Essential Element of Healthy Aging" - The Gerontological Society of America has dedicated an entire issue of its monthly newsletter to an exploration of the importance of oral health for elders.

The Role of Nutrition in Maintaining the Health of the Nation’s Elderly: This book, produced by the Institute of Medicine in 2000 is still very useful and is available to read for free online (or download for free as a PDF).

Antibiotic/antimicrobial resistance

Information from the Centers for Disease Control and Prevention on the growing problem estimated to cost 23,000 American lives a year.

Atraumatic Restorative Treatment (ART) Approach

A peer-reviewed paper describing the minimally invasive treatment for tooth decay, authored by Jo Frencken and others who have helped pioneer the technique.

Cancer

Trends in Human Papillomavirus-Associated Cancers – United States 1999-2015: 2018 cancer registry data analysis from the U.S. Centers for Disease Control and Prevention

Children/baby teeth

Eleanor Fleming, dental epidemiologist and lead author of an April 2018 National Center for Health Statistics data brief on tooth decay rates among U.S. children, offers thoughts on the findings in this NCHStats blog post.

A Healthy Mouth for Your Baby: Information for parents from the National Institute of Dental and Craniofacial Research

The American Academy of Pediatric Dentistry offers a wealth of information about the oral health of infants and children on its website.

This academic paper outlines how an infant’s first dental visit should be conducted, including a caries risk assessment and educating parents on prevention and high-risk dietary practices.

Bloodborne pathogens

This question and answer sheet prepared by the Centers for Disease Control and Prevention covers basics information about HIV transmission. It includes questions about risk to health care workers and patients.

Guidelines for infection control in dental offices, from the CDC

This link provides some basic information from the CDC about the rare transmission of hepatitis B in a dental setting.

An interesting CDC table offering details of reported health care related outbreaks of hepatitis B and C.

Oral complications of chemotherapy and head/neck radiation

Information for health professionals and patients from the National Cancer Institute related to the management of oral complications following cancer treatment.

Dental sealants

This article presents evidence-based clinical recommendations for using sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs.

This question-and-answer fact sheet on dental sealants was put together by the Centers for Disease Control and Prevention.

This link includes short videos produced by the American Dental Association that explain how sealants are applied.

This link brings you to the synopsis of a widely cited Cochrane review of sealant studies.

An informational survey, “Child and Adolescent Oral Health Issues,” produced by the National Maternal and Child Oral Health Resource Center, includes a look at the value of sealants.

The American Dental Hygienists’ Association is a source of information on scope of practice issues in individual states. The ADHA can answer questions and can help you find a hygienist in your state to speak with. Also check with your state dental association or society. In some states, scope of practice issues (such as whether a child needs to be examined by a dentist before a hygienist applies sealants) can be a source of strong debate between dentists and hygienists.

A January 2013 report, “Falling Short,” from the Pew Center on the States grades states' efforts at getting dental sealants on children's teeth. The report gives 20 states and the District of Columbia grades of D and even F for their efforts.

Dental therapists

What Are Dental Therapists? An updated look at the dental workforce model from the Pew Charitable Trusts.

Indian Health Service Proposes Expanded Use of Dental Health Aide Therapists: An analysis of an initiative to expand the dental workforce in tribal communities from the Pew Charitable Trusts Dental Campaign.

The Sullivan Alliance, a health advocacy organization founded by former U.S. Secretary of Health Louis Sullivan, has compiled this map. It highlights states where efforts are underway to change dental practice acts to allow the use of workforce auxiliaries known as dental therapists.

This February 2014 report from the Pew Charitable Trusts offers a cost-benefit analysis of dental therapists working in two private practices, one in the U.S. and the other in Canada.

Suggested national standards for the training of dental therapists developed by a panel of experts convened by Community Catalyst, a nonprofit advocacy organization and funded by the W.K. Kellogg Foundation. They were released in the fall of 2013 for the use of states and tribal nations considering the implementation of dental therapy programs.

Dental tourism

The Growing Popularity of Dental Tourism: This article, written by a dental hygienist for a professional publication, offers a look at the dental tourism trend. The author includes citations to a number of useful sources.

Dental Trauma Guide

An online resource, developed by the International Association of Dental Traumatology and Copenhagen University Hospital.

Dental Health Professional Shortage Areas

Health Professional Shortage Areas (HPSAs) are designated by Health Resources and Services Administration as having shortages of primary medical care, dental or mental health providers. Use this tool to search a geographic area for HPSAs in dental health.

Shortage Designation: Health Professional Shortage Areas & Medically Underserved Areas/Populations

Facts About the Dental Hygiene Workforce in the United States

A four-page summary of licensing, education and scope of practice for dental hygienists from the American Dental Hygienists’ Association.

Diabetes

Get oral health and diabetes resources from the National Institute of Dental and Craniofacial Research, including oral health tips for diabetics and links to government, professional and nonprofit resources.

Disabilities

Practical Oral Care for People with Developmental Disabilities: Designed as a continuing education course for health care providers, this series of readings provides many useful insights into the oral health needs of disabled Americans and lays out strategies for care.

E-cigarettes

Reasons for Electronic Cigarette Use Among Middle and High School Students — Findings from the National Youth Tobacco Survey

Rule to expand regulation of tobacco p roducts: A new rule, proposed April 24, 2014, by the U.S. Food and Drug Administration that would extend the agency’s regulatory authority to cover currently unregulated items said to meet the statutory definition of “tobacco products” including dissolvables, gels, hookah tobacco, electronic cigarettes, cigars, and pipe tobacco.

"This proposed rule is the latest step in our efforts to make the next generation tobacco-free," said HHS Secretary Kathleen Sebelius.

Emergency care

Treating Pain is Not Enough: Why States’ Emergency-Only Dental Benefits Fall Short - A July 2018 issue brief that examines the extremely limited adult Medicaid dental coverage offered by some states produced by the nonprofit Washington, DC-based health advocacy organization Families USA.

A Costly Dental Destination: A look at the rising use of emergency rooms for preventable dental conditions by the Pew Center on the States.

The last line of dental defense: AHCJ board member Maryn McKenna went on HealthRadio to discuss the role emergency physicians are playing as the country's dental safety net, the last resort for patients with dental issues.

Electronic cigarettes

Reasons for Electronic Cigarette Use Among Middle and High School Students — Findings from the National Youth Tobacco Survey

A user-friendly summary of information from the Centers for Disease Control and Prevention Office on Smoking and Health.

Endodontic care

Dental benefits under Medicaid: A useful summary from Medicaid.gov, an official U.S. government website.

Fluoride

Fluoride Myths and Facts: A useful and well-referenced chart from the American Academy of Pediatrics’ Campaign for Dental Health that illustrates the benefits of community water fluoridation.

Water fluoridation: What reporters need to know, a tip sheet from Oral Health core topic leader Mary Otto, provides essential information for covering fluoridation. Her companion blog post on AHCJ's Covering Health focuses on Portland's rejection of fluoridated water.

Silver Diamine Fluoride: A Caries Silver-Fluoride Bullet: A summary and quality-assessed review of research on the use of silver diamine fluoride for the arrest and prevention of tooth decay from the PubMed Health database.

An op-ed from Scientific American, "Why Portland Is Wrong About Water Fluoridation," describes evidence for fluoridation. A similar Covering Health blog post from Mary Otto focuses on the fuzzy science behind the anti-fluoridation movement.

Watch a recording of "Fluoride and your community," an AHCJ webcast on fluoridation controversies nationwide, featuring Shelly Gehshan, (@SGehshan), Director, Children’s Dental Policy, The Pew Charitable Trusts, and Mary Otto, AHCJ Oral Health core topic leader.

Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis
Choi, A., Sun, G., Zhang, Y., Grandjean, P. (2012)
This study examines the relationship between neurotoxicity and fluoride exposure, as well as the dose of fluoride required to result in neurotoxicity.

The Campaign for Dental Health provides resources and information in support of water fluoridation.

"Fluoride in the Water Isn't Going to Hurt You:" This video from Healthcare Triage gives a brief synopsis of fluoridation's benefits.

This research review on fluoride and public misinformation from Journalist's Resource discusses the definitive science behind fluoride dose, risk, and benefit.

The Centers on Disease Control and Prevention site includes a wealth of information on fluoridation.

Covering Health: Fluoridation debate continues across the country

A collection of fluoridation fact sheets from the Centers for Disease Control and Prevention.

Forensic science

Strengthening Forensic Science in the United States: A Path Forward - This is a much-cited and still useful 2009 consensus report from the National Research Council.

Hispanic dental health

The Hispanic Dental Association is a national, non-profit organization comprised of oral health professionals and students dedicated to promoting and improving the oral health of the Hispanic community and providing advocacy for Hispanic oral health professionals across the United States.
Contact information:
Hispanic Dental Association
1111 14^th Street NW, Suite 1100
Washington, D.C. 20005

This peer-reviewed article, provided by the Hispanic Dental Association and published by the Journal of the American Dental Association dates back to 2005 but provides valuable background and useful insights into the factors that continue to contribute to dental disparities among Hispanics in the United States.

Under President Obama, the U.S. Department of Health and Human Services has developed an Action Plan to Reduce Racial and Ethnic Health Disparities, outlining goals and actions HHS is expected to take aimed at reducing health disparities, including oral health disparities among racial and ethnic minorities. The plan builds on other federal initiatives, including the Affordable Care Act and Healthy People 2020.

The National Council of State Legislatures maintains a list of state offices of minority health and offers a link to contact information for directors along with a detailed description of state actions that created these offices.

“The Human Oral Microbiome”

“The Human Oral Microbiome” This seminal 2010 paper, published in The Journal of Bacteriology offers an introduction to the effort to study the human oral microbiome and formulate a genetic catalogue of the hundreds of bacterial species that comprise it.

Trends in Human Papillomavirus-Associated Cancer

2018 cancer registry data analysis from the U.S. Centers for Disease Control and Prevention – United States 1999-2015

Lead

How to test for lead in your home water supply: A useful collection of resources for consumers, created by CNN Health as part of a package on the problem of unsafe water supplies in Flint, Mich., and beyond.

Medicaid and Children’s Health Insurance Program

Increased Use of Dental Services by Children Covered by Medicaid: 2000-2010: This report finds a continuous increase in the use of dental services by children enrolled in Medicaid from fiscal years 2000 to 2010. It includes a state-by-state status chart. It appeared in the fall, 2013 issue Medicare and Medicaid Research Review which is produced by the Centers for Medicare and Medicaid Services.

U.S. Department of Health and Human Services offers state-by-state information on programs, providers and coverage

The Medicaid-CHIP State Dental Association site has background on programs and benefits. Under its resources section, this site also includes links to state-by-state tables on the delivery of dental services to Medicaid beneficiaries, reports on state innovations and access to care

Children and Oral Health: Assessing Needs, Coverage and Access
This policy brief highlights the prevalence of dental problems among children and examines gaps in oral health coverage and access to dental care, as well as disparities by income and race/ethnicity. It also looks at out-of-pocket costs for dental care, explains the role of Medicaid and CHIP in dental care, coverage and access for children and describes the expansion of oral health coverage for children under the Affordable Care Act.

This July 2013 report published in the Medicare and Medicaid Research Review, a peer-reviewed online journal, includes state-by-state data reflecting percentages of Medicaid children getting care.

Medicare

Oral Health and Medicare Beneficiaries: Coverage, Out-of-Pocket Spending, and Unmet Need
This brief describes the oral health of Medicare beneficiaries, examines sources of dental coverage for the Medicare population, and examines the utilization of dental services, out-of-pocket spending on dental care and access problems. This analysis uses data from the National Health and Nutrition Examination Survey (NHANES), the Medicare Current Beneficiary Survey Cost and Use file (MCBS), the National Health Interview Survey (NHIS) and the Kaiser Family Foundation Survey of Health Care Among Nonelderly People with Disabilities and Seniors on Medicare, 2008.

Mercury

The Minamata Convention on Mercury: Ratification and Implementation Manual
A document compiled by environmental leaders following the 2013 approval of the Minamata Convention on Mercury, an international accord seeking to reduce mercury pollution.

Mouth microbes

The helpful and the harmful: A reader-friendly look from the National Institutes of Health.

Nutrition

The Healthy and Hunger Free Kids Act: A White House fact sheet

Oral Care for People with Developmental Disabilities

An Introduction to Practical Oral Care for People with Developmental Disabilities: A series of publications produced by the National Institutes of Dental and Craniofacial Research.

Oral Health Atlas

Compiled by the World Dental Federation, or FDI, the atlas contains best estimates on the number of dentists, dental schools, and disease burden in countries worldwide.

Oral health background and briefings

The importance of oral health in comprehensive health care: In a viewpoint article, published online May 3, 2018, in the Journal of the American Medical Association, researchers from the National Institute of Dental and Craniofacial Research encourage nondentists to perform concise oral exams when they care for patients.

Insure Kids Now, a website created by the Centers for Medicare and Medicaid, offers resources, including “Think Teeth!” materials aimed at promoting better health outcomes.

The Kaiser Family Foundation offers a useful “issue module” on dental care.

Filling the Gaps: Dental Care, Coverage and Access – This June 2012 public forum at the Kaiser Family Foundation's Washington, D.C., offices examined the gaps and disparities in dental coverage and care in the United States today; the health, social, and other consequences of these systemic deficiencies; and promising strategies for ensuring access to oral health care for all Americans. The Foundation also released four new and updated resources that present data and analyze issues related to oral health care, coverage and access in the U.S.

The Right Care at the Right Time: Are Retail Clinics Meeting a Need? The Alliance for Health Reform and WellPoint Inc. discussed the role of urgent care centers and retail clinics emerging within the health care system. Panelists explored such topics as alternative care settings, reducing emergency room use for primary care, who monitors the quality of care being given at these centers, and more.

Visit to the Bronx provides insight into school-based health programs, from the 2008 Urban Health Journalism Workshop.

CDC's National Oral Health Surveillance System's oral health indicators

The American Dental Association launched a nationwide campaign “Action for Dental Health: Dentists Making a Difference.” In this video clip, the ADA, which represents 157,000 dentists, acknowledges the nation’s “dental health crisis” and outlines the organization’s ideas for addressing it.

American Public Health Association Oral Health Section

Healthy People 2020 Oral Health goals

Oral Health Resources from the Centers for Disease Control and Prevention

World Health Organization oral health resources and information

CDC report provides updated statistics on population prevalence of periodontal disease in U.S. adults: This August 2012 report, entitled “Prevalence of Periodontitis in Adults in the United States: 2009 and 2010,” concludes that 47.2 percent of U.S. adults have some form of periodontal disease. Previous population estimates of the disease may have underestimated its true population prevalence.

Healthy People 2010: Oral Health Findings and Goals: The federal Healthy People Initiative got its start in 1979 with the U.S. Surgeon General’s Report on Health Promotion and Disease Prevention. Since then, every decade, a Healthy People report provides a look at the health status of Americans – including their oral health – and sets goals for improvement in the coming decade. Above is a link to the oral health chapter of the most recent report.

Oral health databases

The Salivaomics Knowledge Base. An open-source data portal used to share salivary diagnostic data across research groups.

Global Oral Health Database

Oral health country/area profile programe: WHO Collaborating Centre, Malmö University, Sweden

Periodontal country profiles: The Niigata University Graduate School of Medical and Dental Sciences in Japan maintains the periodontal component of the WHO oral health data bank. Updated periodontal information is now available

Oral health and insurance

An Analysis of Dental Spending Among Adults with Private Dental Benefits
A study by the American Dental Association’s Health Policy Institute examines dental care utilization and spending patterns among a large sample of adults with private dental benefits.

HealthPocket.com InfoStat: The Best and Worst Dental Insurers for Out-of-Pocket Costs.

Oral health and Learning

A brochure, produced by the National Maternal and Child Oral Health Resource Center, takes a look at the impact of poor oral health status on school performance among children.

Oral Health Worldwide

A new look at the global impact of oral diseases, issued by the Geneva, Switzerland-based FDI World Dental Federation.

Information for policy

Oral health priority action area: information systems: The burden of oral disease and needs of populations are in transition and oral health systems and scientific knowledge are changing rapidly. In order to meet these challenges effectively public health care administrators and decision-makers need the tools, capacity and information to assess and monitor health needs, choose intervention strategies, design policy options appropriate to their own circumstances, and to improve the performance of the oral health system.

Reducing Early Childhood Tooth Decay: Strategies for State Medicaid and CHIP Dental Program Managers: A May 2015 issue brief from the Centers for Medicare and Medicaid developed to guide state health officials in the prevention of ECC.

Oral health professional organizations

The American Dental Association which represents over 150,000 dentists site offers information on the profession and on a wide range of oral health topics, workforce issues, professional standards.

The American Dental Hygienists’ Association, represents the nearly exclusively female dental hygiene profession. Sometimes at odds with the ADA on areas such as scope of practice (what hygienists and other dental auxiliaries are allowed to do) offers resources on dental workforce issues, prevention, training.

The Association of State and Territorial Dental Directors represents the directors and staff of state public health agency programs for oral health. Emphasizes resources and information on public health dentistry rather than private practice dentistry.

National Institute of Dental and Craniofacial Research

State dental associations

Other organizations

International Dental Volunteer Organizations: An online guide, produced by the American Dental Association.

The National Spit Tobacco Resource Program, sponsored by the nonprofit Oral Health America, offers tobacco cessation information to the press and the public.

National Association of Dental Laboratories: The trade group representing dental labs. Site offers information about dental laboratories, standards and technician training.

Oral Health America: A nonprofit organization whose stated mission is "to change lives by connecting communities with resources to increase access to care, education, and advocacy for all Americans, especially those most vulnerable." It gives people access to care through funding, technical assistance, donated dental products, and by facilitating public-private partnerships, as well as providing education and advocacy to encourage policies that create oral health equity.

Healthfinder.gov: This site, run by the Department of Health and Human Services, has a page on dental and oral health.

Perinatal and pediatric care

Information on children's oral health from the National Institute of Dental and Craniofacial Research: Learn more about the tooth decay process in children, tooth sealants, and how to keep a baby's mouth healthy. Resources also available in Spanish.

Final recommendation statement on dental caries in children from birth through age five: This document summarizes the U.S. Preventive Services Task Force recommendations on early childhood tooth decay prevention. The USPSTF offers guidance on the effectiveness of specific clinical preventive services for a range of health conditions.

Pregnancy

Oral health during pregnancy: A September 2018 Issue Brief from the Children’s Dental Health Project

Improving the Oral Health of Pregnant Women and Young Children August 2012 Policy Brief: From the National Maternal and Child Oral Health Policy Center, this report, designed for policymakers, but useful for journalists, outlines the connections between the oral health of mothers and children and explores the implications of wider access to services.

Oral HealthCare During Pregnancy: A National Consensus Statement: The 2012 summary of the conclusions of an expert workgroup meeting sponsored by the Health Resources and Services Administration. Provides guidance for health professionals but also helpful for reporters.

Prescribing opioids

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016: Published in the Journal of the American Medical Association and available free, the report includes a dozen evidence-based recommendations aimed at improving communications between health care providers and patients related to the risks and benefits of opiod therapy for chronic pain.

Rural oral health

A Rural Oral Health Toolkit from the Rural Assistance Center, a rural health information portal established by the U.S. Department of Health and Human Services’ Rural Initiative, serves as a source of story ideas and background for journalists covering rural places.

Senior oral health

The nonprofit Center for Oral Health produced Guidelines for Providing Dental Services in Skilled Nursing Facilities to guide nursing homes in setting up dental care mobile and portable dental services for residents.

The Impact of Edentulism on Oral and General Health: From the International Journal of Dentistry, this link provides a review of literature related to the causes and effects of edentulism.

The report concluded that adult Medicaid benefits in 21 states offered no dental benefits or emergency coverage only; that dental health provider shortage areas are prevalent in 31 states and that 13 states more than half of residents live in communities lacking water fluoridation.

Overall, Americans are keeping their natural teeth later into life. But the report, citing federal data found “strikingly high” rates of edentulism in eight states including West Virginia, where 33.8 percent of adults were edentulous.

A State of Decay ranked states with numeric scores based on a formula that weighted factors that contribute to the oral health of elders. Minnesota got the highest grade: 92.9 percent. Mississippi came in last with a grade of 29.3. Follow the link to see how your state scored.

Temporomandibular Disorders (TMD)

Temporomandibular Disorders (TMD): From Research Discoveries to Clinical Treatment,
A consensus study from the National Academies of Sciences, Engineering and Medicine.

Transcript of N.C. Board Of Dental Examiners v. FTC arguments before the U.S. Supreme Court

During an intense hour of oral arguments, the nine justices of the U.S. Supreme Court delved into whether the state board overstepped federal anti-trust laws in sending out threatening “cease and desist” letters to operators of teeth whitening salons in mall kiosks and salons. At issue: Was the board, which is dominated by practicing dentists, unfairly obstructing competition from lower-priced providers? Or was the body fulfilling its obligation to protect the public health by acting as an arm of the state to shut down illegal practitioners of dentistry?