Edelstein Responds

As noted by Friedman in his letter, there is extensive experience in other countries from which to assess the impact of dental therapists in those countries. However, the article he critiques is not intended to “fantasize whether dental therapists might be a disruptive innovation in the United States.” Rather, the article seeks to understand the expressed positions of US professional associations—both supporters and opponents of dental therapy. Understanding their positions is important because these organizations play influential roles in determining dental workforce policy in federal and state legislatures.

The article employs disruptive innovation as a recognized framework that has been widely applied to health care services on a range of topics, including workforce. Searching PubMed on the terms “disruptive innovation” and “health care” retrieved 23 peer-reviewed articles published since 2002. The originator of the concept, Clayton Christensen, in a 2007 interview in Health Affairs,¹ explicitly stated that the constructs of disruptive innovation can be applied to health care services as well as to the kinds of products that Friedman lists.

Like my previous writings on dental therapy, the current contribution seeks to provide substantive, objective, evidence-based information that aids both proponents and opponents in assessing their positions. These contributions may make possible better understanding of others’ positions so that meaningful dialogue can ensue and cross-purposes can be addressed.