Why Dentistry Is Separate From Medicine
The divide sometimes has devastating consequences.
By Julie Beck
Mar 9 2017
Doctors are doctors, and dentists are dentists, and never the twain shall meet. Whether you have health insurance is one thing, whether you have dental insurance is another. Your doctor doesn’t ask you if you’re flossing, and your dentist doesn’t ask you if you’re exercising. In America, we treat the mouth separately from the rest of the body, a bizarre situation that Mary Otto explores in her new book, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.
Specializing in one part of the body isn’t what’s weird—it would be one thing if dentists were like dermatologists or cardiologists. The weird thing is that oral care is divorced from medicine’s education system, physician networks, medical records, and payment systems, so that a dentist is not just a special kind of doctor, but another profession entirely.
But the body didn’t sign on for this arrangement, and teeth don’t know that they’re supposed to keep their problems confined to the mouth. This separation leads to real consequences: Dental insurance is often even harder to get than health insurance (which is not known for being a cakewalk), and dental problems left untreated worsen, and sometimes kill. Anchoring Otto’s book is the story of Deamonte Driver, a 12-year-old boy from Maryland who died from an untreated tooth infection that spread to his brain. His family did not have dental benefits, and he ended up being rushed to the hospital for emergency brain surgery, which wasn’t enough to save him.
I spoke with Otto about how the dentistry/medicine divide came to be, why it’s stuck around, and what its consequences have been. A lightly edited and condensed transcript of our conversation is below.
Julie Beck: Let’s go back to the origin of how dentistry and medicine became separate in the first place. It’s something we take for granted now, right? But it’s actually really weird. Was there ever a time when dental care was integrated with medical care?
Mary Otto: It stayed generally separate. Taking care of the teeth became kind of a trade. In the barber-surgeon days, dentist skills were among one of the many personal services that barber surgeons provided, like leeching and cupping and tooth extractions. They approached it as a mechanical challenge, to repair and extract teeth. Barber surgery was practiced in the very early part of our country’s history. And Paul Revere was a denturist—he was a jeweler and he made dentures too.
But the dental profession really became a profession in 1840 in Baltimore. That was when the first dental college in the world was opened, I found out, and that was thanks to the efforts of a couple of dentists who were kind of self-trained. Their names were Chapin Harris and Horace Hayden. They approached the physicians at the college of medicine at the University of Maryland in Baltimore with the idea of adding dental instruction to the medical course there, because they really believed that dentistry was more than a mechanical challenge, that it deserved status as a profession, and a course of study, and licensing, and peer-reviewed scientific consideration. But the physicians, the story goes, rejected their proposal and said the subject of dentistry was of little consequence.
That event is remembered as the “historic rebuff.” It’s still talked about sometimes, not a lot, but it’s seen as a symbolic event and it’s continued to define the relationships between medical and dental education and medical and dental healthcare systems in funny ways. Dentists still drill and fill teeth and physicians still look at the body from the tonsils south. Medical and dental education is still provided separately almost everywhere in this country and our two systems have grown up to provide care separately, too.