toward what most practitioners already know: it takes a team to address these issues and not just one individual practitioner. Other important features of paradigm shifts include considering the nomenclature used for the workforce, identifying all potential members of the oral health team, and how to think about a dental, medical, or health care home.

Another challenge to improving access relates to the model of care delivery, including private practice models, institutionally based models, public health models, and models with dentistry at the center. Strong leadership exists for each of these approaches, and those leaders need to work together regarding how the different models fit together in a broader system of health care delivery. Other considerations include focusing on specific populations, the role of the government, and how what happens within the microcosm of dental care and medical care is a reflection of society more broadly in terms of health disparities and other social pressures.

Finally, more evidence and resources are needed such as the development, standardization, and dissemination of curricula in oral health for nondental professionals. Additionally, there is a lack of performance standards across the oral health system. A better scientific evidence base is needed so that new models of care and existing models of care can be held accountable to the same standards.

Shelly Gehshan, M.P.P.

Pew Center on the States

Many people argue that a system of oral health care does not exist. Since the system has failed large portions of society, many people are willing to forego that system and move forward with other solutions outside of traditional dentistry. Dentists are a smart and entrepreneurial group but seem more averse to the use of new types of practitioners (who might be a source of increased revenue and referrals) than the increasing number of dental schools. Organized dentistry, like any other large organization, is not able to change quickly. While many leaders in organized dentistry have great energy and enthusiasm to address access problems, the formal policies remain antiquated. In addition, state practice laws need to be reexamined so that one professional group is not regulating another. More thinking is needed on how to ensure the public is safe with respect to all practitioners. Finally, Gehshan recognized the range of entrepreneurial activity occurring in the dental fields.

Len Finocchio, Dr.P.H.

California HealthCare Foundation

There are many reasons for the irrationality behind how the oral health system evolved. Consideration is needed for how to integrate medical, den-

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