by Richard D. Weber, J.D.
MDA Legal Counsel
Published in the March 2003 issue of the Journal
Question: I treatment-planned a denture for a patient. The extractions were performed and an appointment was set for the initial fabricatin of the denture. I later received a phone call from the patient canceling the appointment, stating that he had found a person who would make the dentures at a considerable cost savings. Upon discussing it further with the patient, I have concluded he is seeing a denturist. Is denturism legal in Michigan?
Answer: The Michigan Public Health Code defines dentistry as "the diagnosis, treatment, prescription, or operation for a disease, pain, deformity, deficiency, injury, or a physical condition of the human tooth, teeth, alveolar process, gums or jaws, or their dependent tissues, or an offer, undertaking, attempt to do, or holding oneself out as able to do any of these acts."
Any person who is not licensed to practice dentistry in Michigan who performs any of these acts or services in Michigan violates Michigan law. Therefore, if a person practices denturism and is not licensed as a dentist, and in doing so performs acts or services within the scope of the above definition, that person violates the law.
The Michigan Public Health Code licenses three categories of dental professionals: dentists, dental assistants, and dental hygienists. Assistants and hygienists practice under the supervision or assignment of a dentist. This means that a licensed dentist must designate a patient of record upon whom the services are to be performed and the dentist must describe the procedures to be performed.
Although recognized as a licensed specialty in some states, denturism is not subject to licensure in Michigan; nor is it a recognized specialty under Michigan law.
Dentists have a broad scope of practice. Among other things, dentists advise patients about denture use, take impressions, bites, casts, and designs from patients for the construction or altering of dentures. Dentists also fit and adjust dentures in a patient's mouth. The scope of dentistry includes any activity involving interaction with someone seeking dentures. Denturists who perform such services must possess a license to practice dentistry.
On the other hand, to the extent a denturist's activities fall outside the scope of practice of dentistry, denturists are not required to possess any state license. A recent informal letter from the Michigan Attorney General concluded that "denturists may construct, repair, alter, and reproduce dentures, so long as they do not diagnose, treat, or operate on patients."
The practice of denturism is further limited by the restrictions imposed upon dental laboratories by various sections of the Public Health Code. These statutes prohibit dental labs from possessing prosthetics as substitutes for human teeth or jaws or for the correction or malocclusions or deformities without having a dentist's written work authorization. The sections also prohibit dental labs from advertising or holding themselves out as suppliers of prosthetic dentures or other substitutes for human teeth or jaws or for the correction of malocclusions or deformities.
In the question posed, there is an implication that the denturist is not a licensed dentist, and that he may well be dealing directly with the patient. If so, it appears that the denturist will be diagnosing or treating the patient. It is difficult to see how a denturist could fabricate and fit the denture without treating or diagnosing. If so, the denturist will, in my opinion, be practicing dentistry without a license. And, the practice of dentistry without a license is not only illegal, but also a felony under Michigan law.