Sarrell Dental is a chain of dental clinics that serve children on public assistance almost exclusively.  Sarrell is a non-profit in that no one is an official owner collecting profits, but it is financed entirely be fees for its service; there are no donations.  Sarrell not only provides dental care to poor children for screamingly low reimbursement rates, but does outreach and education for free.

I have a few feelings on this.  First, the care could just be low quality, but that is not interesting, and providing care that is a pareto improvement over nothing (meaning it is doing some good and no harm) is not actually that hard.  Doing harm is not impossible, and humans are ingenious, but it is difficult.  So let’s assume for the sake of argument that they are maintaining an acceptable quality of care.  If that is true they are doing an amazing service: dental health is incredibly important for overall health.  Bad teeth are a class marker than often keeps adults who grew up poor down, regardless of their merits.  Getting poor children teeth cleanings is incredibly important and I am glad someone is finding a way to do it.

Second, I bristle at the comment that “This means that patients don’t always see the same dentist, and that can be a good thing on both sides of the drill. Dentists get a close look at their colleagues’ work and at the treatment plans they’ve suggested for their patients.”  If seeing a different dentist every time was so awesome, middle class people would do it.  They don’t because continuity of care is considered more valuable than a second pair of eyes.  But is that correct?  It seems entirely plausible to me that the ideal of continuity of care- a medic who knows you, who knows your history, who can spot subtle trends and probe for additional information- is absent for most people even if they are technically saying the same person repeatedly.  I saw the same orthopedist twice when I hurt my knee and had to remind him the problem wasn’t nor had ever been buckling under load five times in those 15 minute two visits.  I’m not sure seeing a different orthopedist for the second visit, or swapping in a different orthopedist halfway through a visit, would have reduced the quality of care noticeably.   The same could easily be true of dentists.

Moreover, I’ll bet Sarrell writes its records with an eye towards having each visit with a different dentist.  I find it plausible if not proven that this is better than the 10 minute rushed visit people get with a dentist who doesn’t write anything down because he’ll totally remember it.  This gels with my experience at those acute care clinics, which were much less personal but had systems in place to make sure everything ran smoothly.

Third, it seems great that more kids are getting dental care and education.  But I worry that this will run into the same problem we have with the pharmaceutical and adoption industries: we privatize the cost of a thing we consider a moral good and then are surprised when the system begins aligning with the interests of the people funding it.  This is true even if Sarrell’s current MO is a pareto improvement over nothing, and if no one does anything malicious or even intentional.  I don’t think it’s likely Sarrell will secretly encourage children to chug pixie sticks hourly, but could they maybe reinforce the requirement that cleanings be overseen by a dentist rather than a mid-level dental practitioner?  Seems plausible.

Which doesn’t mean I want to fight Sarrell, or McDentistry in general.  The fact that it’s not the platonic ideal doesn’t mean it’s not the best compromise we can get, and those kids need cleanings now.  But it’s important to remember that nothing is free.

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