Missouri Dental Bd. v. Alexander

• Decision Date: 09 March 1982
• Docket Number: No. 63217,63217
• Citation: 628 S.W.2d 646
• Parties: MISSOURI DENTAL BOARD, Respondent, v. James R. ALEXANDER and Denture Clinics of Mid-America, Appellants.
• Court: Missouri Supreme Court

Page 646

628 S.W.2d 646

MISSOURI DENTAL BOARD, Respondent, v. James R. ALEXANDER and Denture Clinics of Mid-America, Appellants.

No. 63217.

Supreme Court of Missouri, En Banc.

March 9, 1982.

Les D. Wight, Independence, for appellants.

John Ashcroft, Atty. Gen., Gregory W. Schroeder, Asst. Atty. Gen., Jefferson City, for respondent.

WELLIVER, Judge.

Respondent Missouri Dental Board petitioned the Circuit Court of Jackson County for an order finding defendants James R. Alexander and Denture Clinics of Mid-America to have been practicing dentistry in violation of § 332.081, RSMo 1978 ¹ and enjoining defendants from continuing this illegal practice. See § 332.121. ² The trial court granted the relief sought and defendants appealed to the Missouri Court of Appeals, Western District, which transferred the cause before opinion to this Court because it involves the validity of Missouri statutes. Mo.Const. art. V, § 3, (as amended 1976). We affirm.

Much of the evidence was undisputed. In narrated form, the trial court found the facts to be as follows. Appellant, James R. Alexander does not hold and never has held a license to practice dentistry in the state of Missouri. See Chapter 332 RSMo. Appellant Alexander owns and operates as a sole proprietorship the business known as Denture Clinics of Mid-America, (hereafter, Denture Clinics), located at 117 West 23rd Street, Independence, Missouri. Appellant has employed at least two other individuals who participate in the operations of this business. Appellant and his employees refer to themselves as "denturists". Since August 1978, appellants have been constructing, repairing, and adjusting prosthetic dentures and prosthetic partial dentures without written uniform laboratory work orders signed by a licensed dentist and without impressions furnished by a licensed dentist. Appellants also have been selling and delivering dentures and partial dentures directly to the public since August 1978. Appellants have advertised the services they perform by placing advertisements in newspapers serving Jackson County, including the Independence Examiner and the Lexington Shopper. On at least two separate occasions, after supplying a patient with dentures, appellant Alexander signed the insurance forms for each patient on the line designated for the signature of the "treating dentist".

Both respondent and appellants called witnesses who described appellants' general operation. When a new customer arrives at the Denture Clinics, Alexander or one of the other employees requests a medical history and examines the customer's mouth by means of visual observation and palpation by hand. The denturist makes a cursory diagnosis of the health and condition of the customer's mouth and then recommends and offers to supply the prosthetic appliances which he deems appropriate. Upon receipt of a partial payment, the denturist takes an impression of the customer's mouth and constructs a denture or partial denture. When the customer returns, the denture is placed in his mouth or is given to the customer to be placed in his mouth after his remaining teeth are extracted by a dentist. A customer is allowed to return for adjustments of dentures without added charge.

While appellants disputed some of the evidence, there was substantial evidence to support the following. Any failure to diagnose the existence of oral lesions or the necessity of oral surgery prior to the insertion of a prosthetic appliance could jeopardize the health and well-being of an endentulous person. It is important to investigate in potential denture wearers the possibility of other problems such as diabetes and to be aware of the medical and dental history of each patient. Only a dentist has the education and training necessary to examine fully and diagnose the full range of oral health problems inherent in a prospective denture wearer. The making of impressions of patients' mouths require a significant amount of training and expertise. An improperly constructed or fitted denture can cause considerable pain to the wearer. Such a denture can also lead to the development of oral lesions and aggravate other oral health problems. A poorly constructed partial denture can cause the premature loss of remaining healthy teeth.

The field of prosthodontics, which includes the constructing and applying of dentures, clearly affects the health and well-being of persons who have lost their natural teeth. The current delivery system ensures that a licensed dentist is involved to some extent in every step leading to the construction of a denture and places full responsibility with the dentist for every completed denture and its eventual effect upon the patient's health.

I

Appellant challenges the sufficiency of the evidence to support the trial court's findings of fact. In stating this first point, appellant fails to conform to the requirements of Rule 84.04(d) in that he neither states precisely the findings of fact to which he objects nor wherein and why he claims them to be erroneous. See Thummel v. King, 570 S.W.2d 679 (Mo. banc 1978). We have reviewed the record, examined the findings, and conclude that the trial court's findings are supported by substantial evidence. See Murphy v. Carron, 536 S.W.2d 30, 32 (Mo. banc 1976); Rule 73.01(c).

II

Appellant contends that §§ 332.071 ³ and 332.081 as applied to appellants constitute an unauthorized exercise of the state's police power and deny appellants equal protection and due process of law in contravention of the Fourteenth Amendment of the Constitution of the United States and of Article I, §§ 2 and 10 of the Constitution of Missouri.

(W)e must judge the validity of the challenged ... (statute) according to the standard applicable to the exercise of police power, and the test of the validity of an exercise of police power is reasonableness. In general, the test of reasonableness is met in any case in which the object of the police measure is a proper one ... and the means adopted to accomplish that object are appropriate. The exercise of police power is presumed to be constitutionally valid; the presumption of reasonableness is with the state. The exercise of police power will be upheld if any state of facts either known or which could be reasonably assumed afford support for it. The party challenging certain legislation has the burden on the question of its reasonableness.

Caesar's Health Club v. St. Louis County, 565 S.W.2d 783, 786 (Mo.App.1978), cert. denied, 439 U.S. 955, 99 S.Ct. 353, 58 L.Ed.2d 346 (1978) (citations omitted).

The general law in Missouri was stated recently in Flower Valley Shopping Center v. St. Louis County, 528 S.W.2d 749, 753 (Mo. banc 1975), (quoting Bellerive Investment Co. v. Kansas City, 321 Mo. 969, 981, 13 S.W.2d 628, 634 (1929)):

It has been definitely and clearly established and settled, by the decisions of this court and of the federal Supreme Court, that a statute, or a municipal ordinance, which is fairly referable to the police power of the state or municipality, and which discloses upon its face, or which may be shown aliunde, to have been enacted for the protection, and in furtherance, of the peace, comfort, safety, health, morality, and general welfare of the inhabitants of the state or municipality, ... cannot be held invalid as wrongfully depriving the appellants of any right or privilege guaranteed by the Constitution, state or federal....

Accord ABC Liquidators, Inc. v. Kansas City, 322 S.W.2d 876 (Mo.1959).

When local economic regulation is challenged solely as violating the Equal Protection Clause, this Court consistently defers to legislative determinations as to the desirability of particular statutory discriminations. See, e.g., Lehnhausen v. Lake Shore Auto Parts Co., 410 U.S. 356, 93 S.Ct. 1001, 35 L.Ed.2d 351 (1973). Unless a classification trammels fundamental personal rights or is drawn upon inherently suspect distinctions such as race, religion, or alienage, our decisions presume the constitutionality of the statutory discriminations and require only that the classification challenged be rationally related to a legitimate state interest. States are accorded wide latitude in the regulation of their local economies under their police powers, and rational distinctions may be made with substantially less than mathematical exactitude.

New Orleans v. Dukes, 427 U.S. 297, 303, 96 S.Ct. 2513, 2516, 49 L.Ed.2d 276 (1976). The due process clause permits great latitude to a state in the exercise of its authority to regulate its economic life, particularly the conduct of the professions. Friedman v. Rogers, 440 U.S. 1, 18, n.19, 99 S.Ct. 887, 898, 59 L.Ed.2d 100 (1979); Ohralik v. Ohio State Bar Association, 436 U.S. 447, 98 S.Ct. 1912, 56 L.Ed.2d 444 (1978); Williamson v. Lee Optical of Oklahoma, 348 U.S. 483, 488, 75 S.Ct. 461, 464, 99 L.Ed. 563 (1955); see State ex inf. Danforth v. Dale Curteman, Inc., 480 S.W.2d 848, 858 (Mo.1972).

The construction, repairing, and fitting of full and partial dentures affects the health and well-being of persons who have lost their natural teeth. The current system for providing dentures to consumers ensures that a competent, licensed dentist is involved in diagnosing the need for dentures and in preparing the model from which dentures are constructed. The current delivery system also ensures that full responsibility is placed upon a licensed dentist for every completed denture and its eventual effect upon the health of each denture wearer. The statutes in question are intended to protect the health and general welfare of the citizenry and utilize reasonable means to effectuate their purpose. Regulation of the practice of dentistry, particularly the providing of dentures and prostheses, has been held to be proper pursuant to a state's police power in many of our sister states. Arizona State Board of Dental Examiners v. Hyder, 114 Ariz. 544, 562 P.2d 717 (Banc 1977); People ex rel. Dunbar v....