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The "Care Gap" between the Medical and Dental Fields

From a session during NLC by Jenna Hang, Class of 2021

This year’s National Leadership Conference allowed attendees to explore various topics that covered the wide scope of dentistry. One such topic was examining the relationship of dental and oral care to general health care. Dr. Lisa Simon from Harvard School of Dental Medicine gave an insightful talk on the history of the two, and where the relationship is heading.

Dentistry, though not always as separate from medicine as it is now, was always somewhat of its own trade. Barbers would perform extractions back in the day, and this was an accepted practice — no one went to a physician to seek care for a toothache. But the profession of dentistry did not become its own until Baltimore in 1840, when the first dental school officially opened. History has it that Chapin Harris and Horace Hayden, self-trained dentists, approached the University of Maryland’s college of medicine with the proposal of adding dental instruction to their medical course but was rejected.

But, as Dr. Simon will say, the separation is a historical fluke. Although the story of how dental school was borne may be true, the dire separation present today is more or less a product such as the development of insurance (e.g. Medicare and Medicaid). In fact, in 1965, both the ADA and the AMA were part of the Joint Council to Improve the Health Care of the Aged, and both entities opposed Medicare. By some turn of events, the AMA lost while the ADA won, which meant that the ADA would not participate in Medicare. This has continued to current day, where Medicare (and Medicaid) does not include dental benefits.

As dental students, we are taught the link between oral and systemic health — how diabetes, kidney disease, and cardiovascular disease can be related to oral health. Medical students traditionally do not get the same education, but looking forward, this may change. In Maine, a shortage of dentists has prompted the state to add teeth to doctors’ training. Many attempts across the country are being made to close the “care gap” — in fact, in between August and December 2018, 2700 flu shots were given inside dental offices, and 5152 people were seen by nurses in dental offices as they waited to be seen at the dentist.

The road is looking a little brighter for dental care and medical care to be integrated. There are still many factors to consider, but the more the topic is made known, the quicker we may be able to see change.

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