I thoroughly enjoyed the recent point/counterpoint article in April JADA, "Should Dentists Become ‘Oral Physicians’?", by Drs. Donald Giddon and Leon Assael. Dr. Giddon stated that "dentists should become ‘oral physicians,’ " and Dr. Assael stated that "dentistry must remain dentistry." Both of these authors presented excellent arguments with regard to the important issue of the proper means of integrating medicine into the clinical practice of dentistry. However, in my humble opinion, there may well be a third point of view.
As an oral medicine clinician, I treat many patients with oral conditions unrelated or tangentially related to teeth. The vast majority of my fees are compensated by the patients’ medical insurance carriers. Such a clinical dental practice often alerts me to the present failings of the current medical and dental care of patients with nondental oral conditions.
For example, many of my glossodynia/burning mouth syndrome, or BMS, patients are dismissed by dental colleagues as patients with purely psychological issues, because there are no clinical signs (which is part of the definition of the condition).1 Recently, one of these patients who concomitantly has the condition of geographic tongue (bilateral) along with her BMS condition (there is no rule that says that only one condition may occur at a time) scheduled appointments with two different physicians.
Both of these physicians diagnosed her condition as due to a herpes infection of the dorsal tongue, which was causing her painful oral burning, and prescribed similar anti-viral regimens. I also believe that the vast majority of my dental students can easily diagnose the clinical appearance of geographic tongue. I also believe that the vast majority of my dental students understand that it would be exceedingly rare for a patient to have a herpes infection (bilateral and therefore not likely to be varicella zoster) of the dorsal tongue. These incredible misdiagnoses by two physicians illustrate that being a physician may not be an asset with regard to the diagnosis and treatment of oral conditions.
However, the vast majority of dentists are not comfortable with the diagnosis and treatment of such oral conditions as BMS. These examples certainly back up both of these authors.
I am in complete agreement with each author’s argument. Dr. Giddon beautifully documented that dentists don’t have enough time or interest to dedicate themselves to the medical issues of dentistry. Dr. Assael beautifully documented that physicians appear to have even less interest in the medical aspects of the oral cavity.
So, therefore, we have two points of view, neither of which appears to lead dentistry in a direction that will correct the issue of improving the dental and oral care of patients with oral conditions unrelated, or merely tangentially related, to teeth, or related to the care of medically complex dental patients.
Another possible model is to formulate a diagnostic and therapeutic branch of dentistry.2 Since its inception, dentistry has been a surgical/procedural profession. Medicine also began as a surgical/procedural profession, but in the last century adopted nonsurgical medical specialties to complement its surgical medical patient care areas. Such a model builds on dentistry’s understanding of oral tissues, diseases and conditions and would complement surgical and manipulative dental care. I congratulate the authors on providing a terrific, provocative discussion, and serious food for thought.
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