Licensure and regulation are intended to protect
the public safety and assure the provision of quality
dental services. Regulation of the dental workplace
is intended to protect the safety of dental practice
employees and patients.
To a significant extent, licensure and regulation
should reflect and encompass those advances in
technology, education, and workforce that best
serve the public interest. Thus, the most important
assumption about changes in licensure, scope ofFUTURE OFDENTISTRYeducation requirements for relicensure. All recognized
dental specialties have initial certification procedures,
and several have developed recertification processes to
ensure that certified practitioners remain current. In
addition, other organizations, such as the Academy of
General Dentistry, have programs that grant fellowship
and mastership status to general dentists who achieve
milestones in continuing professional education.
Organized dentistry established wellness programs
to protect the public and enhance professional com-
petency by promoting the physical and mental well-
being of dentists.
REGULATION OF THE PRACTICE OF DENTISTRY
Hundreds of regulations affect the practice of
dentistry. Accounting procedures, the protection of
patient records, and the use of specific equipment in
certain clinical procedures are the more apparent
areas where there are efforts to regulate details of
clinical practice (Palmer, 2000a and 2000c; and
Berthold, 2000). Regulation of the dental practice
is so extensive today that new entrepreneurial enti-
ties have emerged offering courses to teach dental
office personnel appropriate compliance techniques
for city, state, and federal regulations. Regulations
governing the dental practice range from local zon-
ing requirements regarding parking lot require-
ments, to requirements for apparel worn in public
places that could be contaminated from the work-
place, to the disposal of wastewater.
Federal and State Regulation
In the United States, government has traditionally
taken a "hands-off" position with respect to the doctor-
patient relationship (Jost, 1997). Health care at one
time was a private matter between the health care pro-
fessional and the patient. As health insurance became
commonplace, the third party payer entered into the
relationship. The resulting complex of responsibilities,
relationships and priorities created a mandate for regu-
lations to protect the interests of patients.
Complex and specialized care, provided in widely
dissimilar environments, and an increasing ability to
solve medical problems with new science and technolo-
gy have provided additional impetus for protective reg-
ulations. The consequent cost is significant; it is esti-
mated that the cost of federal regulation to a family of
four is about $7,600 each year (Wendy Lee Gramm,
Personal Communication, May 15, 2000).
The health care system increasingly has been
affected by regulations such as the Americans with
Disabilities Act, which do not primarily target the
health professions, but which have had profound
implications for health care delivery. Other regula-
tions, such as the Occupational Safety and Health
Administration's (OSHA) Bloodborne Pathogen
rule, which was written largely with the hospital
environment in mind, have had significant cost
implications for dental care. In each case, laws and
the attendant regulations were created to respond to
problems and address perceived needs. And in each
case, these laws and regulations have had unfore-
seen consequences, some of which have worked
counter to original intentions.
In recent years, the political environment has
become less favorable for such sweeping regula-
tions, especially when promulgating them has
dramatic cost implications for the affected sector
and its consumers without identifying offsetting
funding. This trend began in 1995, when Congress
began closely scrutinizing the procedures for
rulemaking and culminated recently when it took the
unprecedented step of repealing the prior administra-
tion's ergonomics standard. That action was a response
to vigorous opposition to the rule.
Certainly, the ergonomics issue typifies the rule-
maker's dilemma: how to impose restrictions on the
marketplace that balance the costs and benefits.
Purported benefits are difficult to estimate accurate-
ly. Nevertheless, estimates are needed. Potential
costs are more easily developed and should be avail-
able for any regulation.Licensure and Regulation of Dental Professionals