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Letters: Dentistry's role

January 21, 2019

I agree with Drs. Craig S. Miller, Nelson L. Rhodus, and John C. Robinson, in their My View editorial "Does Dentistry Have a Role in Health Care?" in the Nov. 19, 2018, issue of ADA News. However, I don't think they went far enough in advocating that dentistry become a specialty of medicine.

I believe strongly that all dentists should have medical degrees, obtained through a program similar to that proposed by Dr. David A. Nash, Ed.D., in 1995 when he was dean at the University of Kentucky School of Dentistry. As I understand it, Dr. Nash had gained the approval of the medical and dental faculty for five-year medical-dental education plan in which students would spend the first three years in medical school (supplemented by the traditional basic sciences pertinent to dentistry) and the last two years in dental school. The medical faculty recognized that the traditional fourth year of medical school was spent in elective clinical rotations and that two years of dental studies would meet the requirements of the fourth year of medical school.  Thus, the students would have been able to meet all the requirements for both an M.D. and a D.D.S. degree in five years, including taking the national board exams in both disciplines.(1) The program was initiated, but because of the resistance of the dental faculty who had lost the narrow vote to approve the project, the medical school eventually withdrew its support and the project failed. (D.A. Nash, personal communication, November 5, 2012)

His proposals would have gone a long way towards a true bridging of the dental-medical divide had they been carried out at the University of Kentucky and at the nation's other medical-dental schools. Dentistry would have become a true specialty of medicine. Medical students would have been exposed to a basic knowledge of dentistry in the same way that basic medical education exposes them briefly to all specialties of medicine. Dentists would have been exposed to basic medical sciences and clinical medical experiences, way beyond that which is currently taught in dental schools. It would have been a true remaking of the dental profession towards integration with medicine.

Oral medicine should be on the front lines in trying to steer the basic education of dentists towards Dr. Nash's model. The survival of the dental profession is at stake.

There are many other reasons that dentistry needs to have closer ties to medicine other than the ones mentioned. Dentists need to increase their competence to handle medical emergencies in their offices, beyond that taught in continuing dental education courses at dental meetings. Most dentists have no skill in starting an IV or in listening to heart sounds. Other basic physical examination skills are sorely lacking, such as cranial nerve testing, screening for dermatological conditions on visible areas of the head and neck, etc. 

Increasing the professional competence of dentists would increase the respect and prestige given to the profession by the medical profession and the general public, which is necessary to insure the long-term sustainability of the dental profession. I worry about what's going to happen to the profession of dentistry over the next few decades.

Will dentists become "tooth jewelers" like Dr. Nash, and others, fear, symbolized in the mind of the public by a dancing molar on a placard held up on the nearest street corner?

Will the medical profession eventually decide that they can train their own technicians to handle basic dental care, and refer to dentists only those patients who need more involved treatment, in the same way they would refer a patient for physical therapy; by writing a prescription order for the dentist to carry out? 

If the dental profession cannot compete with medicine in attracting the highest quality students, the ultimate loser is the patient.

Kenneth H. Bateman, D.D.S.
Fort Worth, Texas