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

This month’s Journal of the American Dental Association published new research findings that the expectation of painful experiences at the hand of a dentist might incite greater trepidation for redheads. They proved to be twice as likely to avoid the dentist as those with dark hair.

“Redheads are sensitive to pain,” said co-author Dr. Daniel Sessler, an Outcomes Research Department chair at The Cleveland Clinic, in Cleveland, Ohio.

“They require more generalized anesthesia, localized anesthesia. The conventional doses fail. They have bad experiences at the dentist and because of the bad experiences, they could avoid dental care.”

Sessler is an anesthesiologist who began observing redheads’ sensitivity to pain after hearing colleagues discussing the subject.

“The persistent rumor in the anesthesia community was that redheads were difficult to anesthetize,” said Sessler. “They didn’t go under, had a lot of pain, and didn’t respond well to anesthesia. Urban legends usually don’t start studies, but it was such an intriguing observation.”

Two studies came from this observation.

In 2004, research revealed that people with red hair need 20 percent more general anesthesia than blonds and brunettes.

In 2005, a study indicated that redheads also experience increased sensitivity to thermal pain and have a greater resistance to local anesthesia.

Researchers believe it’s all about the genes. Variants of the melanocortin-1 receptor gene seem to play a role. This MC1R gene produces melanin, which gives color to skin, hair and eyes.

Blonde, brunette and black-haired people produce melanin, but red-haired people have a certain mutation of this receptor. The mutated receptor produces a different coloring called pheomelanin, which causes freckles, fair skin and ginger hair. These characteristics are found in approximately 5 percent of Caucasians.

Researchers have yet to get a good grasp of the relationship between MC1R and pain sensitivity, but they have found MC1R receptors in the brain and some of them are known to influence pain sensitivity.

Variants of the MC1R gene are not exclusive to red-heads. The dental study involving 144 test subjects found that about 25 percent of the non-redheads also had variants of the MC1R gene. They also experienced a heightened state of anxiety surrounding the dentist and more often avoided the dentist than those without the variant.

There have not been any commercial tests on variations of the MC1R gene.

Once Sessler and his colleagues published the first studies about redheads and pain susceptibility, he received nearly 100 e-mails from redheads around the nation providing anecdotes of awful dentist experiences.

In her 25 years of practicing dentistry, associate professor at the University of Louisville’s School of Dentistry Dr. Christine Binkley also noted the phenomenon.

She claims that her redheaded patients appeared to be “anxious and didn’t get numb. It’s a difficult experience for them,” said Binkley, one of the study’s authors.

However, it did not seem to affect red-heads across the board.

“I have a [redheaded] hygienist that I have to numb up a lot more than normal,” said Dr. Peter Vanstrom, an Atlanta, Georgia, dentist. “She’s very sensitive. I have another redheaded patient who is tough as nails, but his father is extremely difficult to numb.”

Binkley encourages dentists to “pay more attention, evaluate everyone for dental anxiety, and ask them about previous experiences.”

“If you know someone’s anxious, do different things,” she said. “Make sure they’re numb before you start working on them.”

Also, if a patient has bad experiences with pain, they should discuss it with their dentists.

The next phase of research is to determine whether people with red hair and those with variants of the MCR1 gene need higher doses of anesthesia for dental procedures.

According to the authors, unpleasant experiences at the dentist could make patients less likely to have regular dental care, which would in turn worsen any problems they may already have.redorbit