The COVID-19 crisis is the latest sign—in flashing neon lights, this time—that bridging the divide between dental and medical communities is long overdue. After all, it’s unarguable that good health starts in the mouth, and one can only wonder how many lives around the world could have been saved if oral health was treated as a medical situation rather than merely about cavities and crooked teeth.
The mouth is the gateway for pathogens such as bacteria, viruses or other kinds of microorganisms, which can cause diseases like COVID-19, to find their way into the body.
“Oral health is integral to general health. You cannot be healthy without oral health. Oral health and general health should not be interpreted as separate entities,” said Surgeon General David Satcher, MD, PhD, in 2000. Yet two decades have gone by, and in many ways, we are no better off.
COVID-19 is the latest reminder that dentists too often get treated like second-class citizens in the medical industry. In March, the ADA initially recommended that dentists suspend elective dental procedures for three weeks to save personal protective equipment (PPE) for our medical colleagues and ensure the safety of our patients and staff, which was completely understandable. But that timeline was ultimately extended to six to eight weeks, while our patients’ oral health and overall health continued to deteriorate.
Financial relief loans like the Small Business Administration’s Paycheck Protection Program completely ignored the need of dentists whose businesses have been closed and could not use the money for some expenses since it had to be used primarily for payroll.
And even now, after two months and being among the highest-risk professions for exposure, dental offices continue to lack access to adequate PPE and are not allowed to use COVID-19 rapid testing to screen patients. They’re told that those tests are only allowed for physicians. Yet dentists need to command more respect by taking a stand because improving public health depends on it.
We need to start a unifying movement in healthcare. In a typical year, there are 1,500 medical conferences, and oral health should be on the agenda for nearly all of them. Therefore, dentists should contact conference organizers and tell them to put oral health on the speaking track. And then we need to get booked and speak on panels alongside pediatricians, gastroenterologists, cardiologists, and others.
It’s important to understand how we arrived at this disconnect in the healthcare industry. Hence, let’s break down why dentists and other doctors have been kept apart and then explore why the world would benefit from their togetherness.
The Maryland Model
The story of our profession getting left out of medical schools goes back to the 1830s. During that decade, American dentistry pioneer Dr. Chapin Harris and fellow Maryland practitioner Dr. Horace H. Hayden were met with resistance while wisely trying to integrate dentistry into the University of Baltimore Medical School. After UBMS repeatedly turned them away, they cofounded the Baltimore College of Dental Surgery, which was the first institution of its kind worldwide and was lifted up as the standalone template for other schools to follow.
Other countries gradually adopted the Maryland model, which siloed dentistry from medicine and since has, in an effect that probably neither Harris nor Hayden would’ve predicted, wreaked havoc on global public health. This disjointed system too often impedes accurate diagnoses because doctors and dentists are predisposed to not coordinate with each other about oral symptoms and what they mean to bodily ailments. And COVID-19 is the latest reminder of that fact. In a health crisis, everyone in the dental and medical communities need to work as a team. Making us all part of the front lines will save lives.
Today, when medical doctors look into your mouth and recognize a problem, they typically assume the dentist will handle it and do not later inquire to learn if a patient got the right kind of care. In other words, the medical and dental doctors do not work in tandem for the sake of a patient’s health, even though various diseases are caused by oral bacteria getting into the bloodstream.
Once again, this healthcare structure—where practice areas fail to speak or inform one another of symptoms—fails the patients, even though it’s accepted as medical scripture that numerous, potentially fatal diseases start with oral bacteria entering the bloodstream.
And when it comes to dentists, how often do we miss out on the chance of identifying diseases? There are opportunities during dental procedures to pinpoint symptoms that regularly appear in the mouth. Some examples are thrush, which can be indicative of depressed immune function, bad breath from stomach ulcers, and cancerous sores. This lack of coordination between the two branches of healthcare has too many negative repercussions.
The Bridge to Better Public Health
Indeed, we are past due in remedying this situation. To reiterate, we as dentists need to jump into the discussion by getting oral health in the center of the healthcare debate. But we also need to talk with our peers in the internal health physician ranks to rightfully gain our status as their medical brethren and sistren.
I recently joined the Board of Counselors at the University of California-Los Angeles School of Dentistry, and I have already had success in reaching across the aisle, so to speak, to our physician colleagues about the importance of uniting together in the best interest of public health. They get it, understand how the dots connect, and can play a part in this movement.
COVID-19 is a horrible pandemic, but it must inspire dentists and physicians to join forces and bridge this divide. The current disconnect, which was established nearly two centuries ago, needs to become obsolete worldwide for the sake of public health.
The good news is that the dental community has the power to help such change take place. We just need to speak up, educate the public, get on the stage, and engage in one-to-one dialogues with our medical peers, representing ourselves as equals who are ready to significantly improve our patients’ overall health.
Dr. Hoss is the founder of the Super Dentists as well as an author and philanthropist. He has decades of experience working in the dental space and has treated more than 10,000 patients. He is on the Board of Counselors at the UCLA School of Dentistry and has served on the faculty at Howard Healthcare Academy and the University of Southern California’s postgraduate orthodontic program. He is a member of the American Association of Orthodontists, ADA, California Dental Association, and San Diego Dental Society. With this extensive background, he has developed a reputation for innovation and making oral health care accessible, welcoming, educational, and entertaining for families.