Health, Fashion, Parenting and Women Related Issues

With impending re-organization of health care, dentists can and should play a more significant role in overall health care. They cannot continue to be isolated from other mainstream health care professionals who are responding to the physical and mental health needs of our community especially in relatively underserved Western Massachusetts

Yes, dentists still need to restore, replace, or straighten teeth, in addition, to increasing awareness of the role of oral inflammatory conditions, such as periodontitis (gum disease) associated with diabetes and other disorders which lead to heart disease and stroke.

Evolving from barber surgeons, those who treated the teeth and surrounding structures have been called dentists for more than 400 years, but as early as 500 BC they were considered physicians of the mouth (Herodotus). In addition to hospital-based training in medicine and surgery, modern dentists study the development and treatment of several hundred diseases, many of which can affect the rest of the body.

Thus, dentists are already de facto oral physicians, who are already providing nutritional and tobacco cessation counseling and are well-prepared to screen and refer to other health care professionals for hypertension, diabetes, osteoporosis, eating and neurological disorders, substance and child/domestic abuse, oral and skin cancer, and mental disorders. Dentists as oral physicians can be available during bioterrorism or disasters for triage and for administering vaccines and other medication.

Recognizing these capabilities and potential of dentists to increase their participation in overall health care, the Massachusetts legislature is considering House Bill #2081, An Act Relative to the Title of Practitioners of Dentistry,” to permit dentists to be designated oral physicians as the appropriate term for what dentists can and should do as true health care professionals. Note that the legislature has already granted podiatrists and chiropractors the right to be podiatric physicians and chiropractic physicians, respectively (Massachusetts General Laws, Chapter 112, Section 8A).

To reduce costs and increase access to dental care, nondentists are being trained in Alaska and Minnesota to provide simple routine dental care under supervision by dentists. Also, medical doctors can now provide preventive and emergency dental care in Maine. These changes should be alerting dentists to the need for a new superordinate classification as oral physicians who will oversee all dental care, including that provided by nondentists, similar to the ophthalmologist with eye care provided by optometrists and opticians.

The proposed oral physician legislation only needs the endorsement of the dental profession, which can then re-organize itself to free up time to do only what it can do, leaving routine tasks to nondentists. Dentists will then be able to expand their responsibilities as oral physicians to provide limited preventive primary care. If monitoring of blood pressure and administering vaccines are now being done in shopping centers and pharmacies, why not take these vital signs, including height and weight, in the dental office? Most people routinely see their dentists more often than their primary care physician.

While some dentists may object to these changes as idealistic, impractical, and confusing to patients, third parties, and regulatory agencies, the real reasons relate to their unwillingness to accept additional patient responsibilities without compensation and/or be subjected to the bureaucracy associated with the costly process of third party payment for health care. The public is already confused by having two dental degrees, DDS and the perceived superiority of the DMD degree. Becoming an oral physician, as either a DDS or DMD, similar to osteopaths who retain their DO as licensed physicians, would reduce such confusion.

The fact that dentists currently enjoy high social and economic status may auger against change. The recent New York Times article, “Boom times for dentists, but not for teeth,” also documented the higher average incomes than primary care physicians, which reinforces the perception that dentistry is more of a business than a health profession.

Becoming an oral physician who can help relieve the present onerous burden on primary care physicians would offset these negative perceptions. Unfortunately, the leadership of the Massachusetts Dental and Medical Societies, who represent their respective professions rather than the public, have testified that they oppose the proposed oral physician designation. Their reasons, however, seem to me and others to be antediluvian, inaccurate, self-serving, and regressive.

If you agree, please help your dentist and your legislators understand the benefits of permitting and in fact encouraging dentists to become oral physicians willing to increase their participation in your overall health care. Massachusetts would be the first state to do so.

Donald B. Giddon, DMD, PhD, is a clinical professor of developmental biology, Harvard University, and a member of the Faculty of Medicine and former Dean, New York University College of Dentistry.berkshireeagle