The general population has a worldview that you go to your primary care physician for your health, and you go to the dentist as a part of your “annual maintenance” not much different from getting an oil change or rotating your tires. Your health insurance is separate from your dental insurance, and your teeth are separate from your body.
This is the world we live in, but can we change it? Should we?
"Doctors are doctors, dentists are dentists and never the twain shall meet”
As far back as we know, dentists have always had their own little corner. Often operating alongside barbers rather than in hospitals; dentists provided a functional service rather than a medical one. In the mid-late 1800’s, dental schools started to pop up and they sought after the approval of institutional medicine, but were told to stay out of their lane. A couple hundred years later… here we are. Your doctor will make you say “ahh” and have very little clue what he/she’s looking for. Your medical chart will likely not reference your dentition and oral health.
In 2018, over 2 million people went to the emergency room for dental related issues. The large majority of hospitals don’t even have dentists on staff. This leaves many with a grueling 8 hour stay only to be told “sorry your face is swollen..here are some antibiotics and go see your dentist in the morning”.
While there are some individuals and organizations that aim to close this gap, there are powerful forces that fight daily to keep these two worlds completely separated. The patient is the one to pay that cost.
Dental “insurance” isn’t actual "insurance. With your medical insurance plan, the company takes a monthly premium and you are insured against unexpected costly treatment (i.e., you get hit by a bus). However, if that bus hits your face, your dental insurance won’t be covering the cost of your dental treatment. Instead, they usually give you coverage for “good behavior (cleanings, x-rays, exams), and then you get an annual allowance between $1,000 to $2,000. You’re on your own after that. This is not insurance, it’s a benefits plan.
This leads to patients seeking dental care in other countries (dental tourism) and general distrust in the dentist that’s telling them they need “X procedure”. From the eyes of the dentist, we are recommending in a similar fashion to a physician (not that this convinces most of you), but the insurance companies have slyly made patients think that their monthly contribution is insuring them, and guess who looks like the villain when the bill comes?
The reality is that your mouth is connected to your body, despite what the logistics of our healthcare system may imply. It’s the gateway to the entire system. There are muscles, soft tissue, hard tissue, a complex microbiome, and an infamous joint. To neglect this is asinine, and many do just that; neglect. The majority of dental treatment is preventable (decay, tooth loss), and most of the remaining dental treatment is elective (veneers, whitening, orthodontics). Unfortunately the treatment for neglect can add up quite quickly. The teeth are biological, chemical, and functionally mediated. There is a lot that goes into properly restoring someone back to health after years of damage. We’ll get into that in future posts though. For now we’re going to keep this higher level.
Taking care of your teeth is actually quite simple, yet so many people don’t know how to do it properly. This is partly due to products created for profit that do more harm than good (abrasive toothpaste that FEELS GOOD). Another element of the abundant misconceptions in dentistry is that many practitioners don’t know how to guide their patients beyond filling a cavity. Preventive care is not exactly a trait that is fostered in the dental office because patient’s roll their eyes at the notion of flossing. Both parties are at fault. Dentist’s are judgy and patients are neglectful, throw them both in a pot and you have a recipe for disaster.
So now that we’ve gone through a bit of historical context of dentistry as a profession and its fragmentation from medicine as a whole, it’s a bit more palatable to understand the origins of misconceptions of dentistry, general distrust, lack of perceived value, and limited access to care. It’s also easier to understand water fluoridation at the state level.
“…wait, so we have all these cavities in our community, but hardly anyone can afford the dentist and insurance coverage is lackluster?”
“Fluoridate that damn water then”
-Not an actual quote
We all have aspirations to have a beautiful, glowing white smile. It’s one of the ultimate signals of health and vitality. No one wants “bad teeth”. However, it has evolved to be a luxury rather than something attainable. People with nice smiles get accused of having manmade veneers the same way muscular men get accused of using steroids. Is it possible to “close the gap”, and make dentistry more accessible? Maybe, but probably not.
I’m not a politician or a CEO of an insurance company, but I can use my voice and my laptop to help educate those who may not have access to affordable ways to improve oral health, and clear up misconceptions that float around pervasive corners of the internet. I’ve written quite a bit about oral health on my twitter account (@bowtiedgatordds), but as I embark on this Substack journey, I figured it was fitting that we start from the beginning.
Until next time,
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Can you do a write up about novamin.
I order novamin toothpaste from Europe and ever since doing so, no cavities.
Yet not available in the US
I don't have teeth (I am an AI robot) but excited to learn more abt this topic