Tooth & Caduceus

The Dentist as Physician

Tooth & CaduceusFor most people, dental care is sort of like an afterthought – and the dentist, less a doctor than a technician or mouth mechanic.

When “health care reform” happened, oral health barely registered a thought. Where Obamacare does address oral health, it mainly concerns dental care for children. Even then, it’s not quite the requirement it apparently was intended to be.

“Medicine” is deemed far more important; dentistry, second fiddle.

Every so often, you’ll hear some wonder how the profession might become more esteemed, prestigious. Or you’ll run across papers like this one, insisting that dentists be considered real doctors – in this case, by becoming more scholarly:

Scholarship is clearly the trait that distinguishes a profession from a trade, as evidenced by trends in other health care professions, as well as dentistry.

Because scholarship defines a profession, dentists as doctors and the leaders in oral health should demonstrate the highest scholarship; absence of scholarship risks perception of dentistry as a trade. All dentists can consistently manifest scholarship by integrating basic science, as well as by incorporating the dental evidence-base, into daily practice.

As if the profession lacked for research journals and other platforms for scholarly publishing? Or maybe it’s the particular nature of the research that seems to be lacking?

Actually, there is quite a bit of work to be done when it comes to evidence in support of clinical practice. About 10 years ago, it was estimated that “as little as 8 percent of dental care is justified by peer-reviewed, published, and appropriately analyzed dental research.” While things must have improved some since then, 92% is an awful lot of ground to make up!

Yet the situation isn’t all that much better in the field of medicine, where it’s been estimated that less than 20% of conventional treatment is supported by solid scientific evidence. As an editorial on one study of the medical evidence base put it,

“These data reinforce that absolute certainty in science or medicine is an illusion….”

While addressing these scientific gaps is important work, it might also help to address the more fundamental problem: the divorce of oral from systemic health.

So many of the patients we see have spent years suffering from various chronic illnesses – autoimmune disorders, fibromyalgia, chronic fatigue, environmental illness and more – that conventional physicians have insisted have nothing to do with mercury fillings, root canals, cavitations or other sources of focal infection. We are grateful and honored that they come to us for help in restoring their health – addressing the dental conditions that prove to be interfering with their total wellness.

And we are grateful for the naturopathic and integrative physicians who understand the complex and dynamic relationship between the teeth and the rest of the body.

As Dr. Erwin has noted before,

any real health care reform must begin with broadening our understanding of health itself. For health is much more than the absence of sickness. It is a process – a way of being, if you will.

If we, as a society, made a real commitment to preventive care and the active pursuit of healthy, positive lifestyles, I think we’d go a very long way toward reducing the amount of money we spend on “sick care.”

Biological dental medicine bridges that gap – and demands that the dentist accept his or her role as more than a mere technician but a doctor of the teeth and other oral tissues. As Dr. Erwin has described it,

Sometimes called “holistic,” “whole-body” or “integrative” dentistry, [biological dentistry] combines the best clinical practices of Western dentistry with the wisdom of other traditions, including Traditional Chinese Medicine. Knowing that local causes can have distant effects, the biological dentist always keeps the big picture in mind: the effect of dental conditions and treatment on the body, and vice versa. Thus, issues of biocompatibility loom large. So, too, issues of toxins such as mercury and fluoride: Their effects go far beyond the teeth.

Acknowledging that treating symptoms is not the same as treating – let alone preventing – disease, biological dentistry prefers therapies that support the body’s self-healing abilities. It favors nontoxic, nature-based remedies and a conservative approach to treating the teeth. As one colleague of mine likes to say, “The best dentistry is the least dentistry.”

Image via DED