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A Disconnect of Epic Proportions
At American Dental Partners, Inc. (ADPI), a provider of business services to dental groups throughout the United States, we are strong advocates for the dental profession and for improving healthcare. In ADPI’s view, dentistry is a medical specialty just like ophthalmology and otolaryngology. Unfortunately, it often appears as though the mouth is disconnected from the body, a dilemma that can be referred to as a “disconnect” of epic proportions.
This disconnect is long-standing, and its precise cause is difficult to determine. However, an important research project conducted between 1921 and 1926 sheds light on how this perception may have originated. This study, conducted by William Gies and popularly known as The Gies Report, set out to answer the question, “what are the reasons for the prevailing indifference in dentistry to scientific, educational, and medical circles?” The report concluded that dentistry was generally regarded as more of a trade than a profession; its science, chiefly that of prosthetic mechanics, exerted little influence beyond the useful applications; and its educational system was chiefly technological. As Gies stated, “the universal opinion is that dentistry, because of its unusual technical requirements, is a mechanical art of restoration and not a branch of medicine.”
Perhaps it was this view of dentistry that started the disconnect between oral health and systemic health. But there are other contributors, such as medical education. While many dental school students take medical school courses early in their dental school education, medical students receive very little, if any, education related to oral healthcare. The generally accepted definition of primary care by the medical profession does not even include oral healthcare—a glaring omission.
Another contributing factor is how medical and dental insurance is provided in the United States. Most medical insurance plans offered in America do not cover dental procedures, and many of the large medical insurance providers, such as Cigna and Aetna, have one subsidiary that provides medical insurance and a separate one for dental insurance. In fact, the largest provider of medical insurance in the United States is the federal government through the Medicare program—and Medicare does not even provide coverage for dental care.
Despite the message of the Surgeon General’s report on Oral Health in America and the overwhelming scientific knowledge that maladies of the oral cavity adversely impact systemic health (such as the link between periodontal disease and diabetes, cardiovascular disease, and the birth of low-weight, pre-term babies), oral health still is often not connected to general health. As a matter of public policy and quality care, this needs to change. In the author’s opinion, the best way to change it is to have the dental community at large acknowledge that the profession of dentistry is indeed connected to medicine.
How can the dental community once and for all establish dentistry as a branch of medicine? One answer was provided long ago by Dr. Charles Mayo, one of the two brothers that founded the Mayo Clinic. In 1913, he declared, “the next great step in medical progress in the line of preventive medicine should be made by the dentists.” Prevention and disease management are the keys to establishing the dental profession as a branch of medicine.
In dentistry, the primary and most common diseases are periodontal disease and caries. Both of these diseases can be prevented and readily managed provided the proper clinical protocols are in place and administered consistently. ADPI affiliated dental groups, if they so choose, can implement the organization’s proprietary Caries Risk Assessment Program designed for the prevention and management of caries, as well as ADPI’s Resonant Hygiene Program, which is geared towards the prevention and management of periodontal disease. Programs such as these should be widely implemented in dental practices across the country.
Educating physicians on the importance of good oral health is another important step. Dental professionals should be educating obstetricians and pediatricians on oral health disease management and encouraging them to refer their patients to a dental practice to ensure that poor oral health does not lead to more traumatic and life-threatening illnesses.
As the ADA states, dentistry is a branch of medicine. It is high time that dentistry be regarded as the noble profession it is and recognized for its contribution to overall health and well-being. It begins with those of us who have a passion for oral healthcare.
About the Author
Gregory A. Serrao
American Dental Partners, Inc.