"Look Who’s Practicing Dentistry" was very interesting indeed. I am a single-degree oral and maxillofacial surgeon with significant contemporary training in this field.
I have been quite amused by an ongoing campaign regarding a similar issue. The American Medical Association is attempting to limit oral and maxillofacial surgeons from performing procedures that, in its mind, are beyond the scope of our practice. Yet a psychiatrist is allowed to perform a facelift procedure after a weekend course.
This has actually forced many of my peers with dual degrees to practice with their M.D. rather than their D.M.D. licenses. This has been exacerbated by the fact that many state dental practice acts have not been very kind to most oral and maxillofacial surgeons.
However, the reason I am writing is to offer my opinion regarding the practice of dentistry by medical professionals. We can certainly blame many individuals and groups for this. However, for a minute let’s blame ourselves.
As a dental student who wanted to treat my patients as a "body" and not as a "mouth," I often encountered significant stumbling blocks from my instructors, who attempted to teach me a more mechanical approach to dentistry.
I was taught that my involvement in medical management should be to request a medical clearance, regardless of how benign and manageable the condition was. Later, I realized the reason that I was being told to request all those medical clearances was that most of my instructors lacked general knowledge regarding the patho-physiology of most common diseases.
I was also referred to numerous "medicine for dentistry" texts that in my opinion are no different from the "computers for dummies" series of books. To this day, I do not understand why I could not look up information in Harrison or Cecil, the same way that my friends in medical school did. Is there a reason that we, as dentists, cannot process the same information that physicians do, so we have to read books that are simplified for our needs?
When I was placed in a position to be involved in training dental students during my two years of general practice residency and four years of oral and maxillofacial surgery residency, I was quite disappointed by their lack of interest in overall patient management. The response was often, "If I wanted to know all this, I would have gone to med school."
After completion of my residency, as a faculty member of a university and now in private practice, I am still disappointed by the fact that most of my patients are being treated by other dental specialties as a "tooth." I have made it my mission to educate my patients about dentistry and the science behind it, only to be confronted at times by a confused patient believing that a dentist’s service is as mechanical as the refrigerator repairman’s.
At better times, I see the glow on my patients’ faces, amazed that their dentist is so familiar with their overall health. They never realized how much science there is behind their teeth and how it affects their health. I have received similar reactions from nurses, physicians and other health care workers.
With all the problems with insurance companies, reduction in reimbursement, increases in litigation, and so on, I truly appreciate how difficult it is to maintain focus. However, it takes only a few minutes to have a two-way conversation with patients regarding their treatment plan and its risks, benefits and alternatives.
I read many dental journals. Granted that the majority of the articles are anecdotal and not well-supported by scientific facts, but there are many wonderful well-written and -researched articles. Yet I am amazed by how little we refer to new scientific data during our daily conversations with our patients.
I guess my point is that our profession treats dentistry and oral health as a "hole to fill," "space to replace" and "tooth to whiten." Since we treat it as such, we cannot expect that other health care professionals will treat it differently. They certainly confuse our know-how and scientific background with applying fluoride gel and sealants.
While we are on the subject, I believe that the dental practice acts do not give our hygienists well-deserved latitude, similar to that given to physician assistants and nurse practitioners. I believe this latitude will give the dental profession access to the underprivileged areas as is experienced by other medical ancillaries.
We know that the AMA has established and allowed physicians to perform essentially anything and everything on a patient. One way to address this problem is via a political campaign. However, in my opinion, the best way is to educate the public and other health professionals so they realize how important and invaluable dentists are to the health care team. At the same time, dentists need to educate themselves in how to become valuable health care team members.
