Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Why Doctors Don't Fix Teeth

Episode Date: April 26, 2019

We've joked a lot about how Dr. Sydnee doesn't know much about teeth, but this week we're explaining exactly why. It all goes back ... to The Historic Rebuff. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. Hello everybody and welcome to Salbo, it's maryl tour of misguided medicine. Oh me. I'm your co-host Justin McRoy and I'm Sydney McRoy

This is a Celebr requests episode. Well, I don't know that request is technically accurate nobody nobody requested this episode It was in Celeb inspired. Yeah, I guess that's true. Is that... Are dear family friend Hank Green. Well, you tell the story. Hank Green tweeted a little,

a vignette about doctors, essentially the point was doctors don't know anything about teeth. And they don't? The doctors say, I'm gonna take care of you head to toe and then you're like, by my tooth and you're like, oh, whoa, whoa, whoa, whoa, no, don't know anything about teeth. And they don't. The doctors say, I'm going to take care of you head to toe. And then you're like, by my tooth, and you're like, oh, whoa, whoa, whoa, whoa, no, don't know anything about that. And that's true. I will not argue that point.

I have said on the show before, we are not taught anything about. You probably know less than I do about teeth. No, that's not true. It's weird to think about that. I know more about teeth than you. No, that's not true. They don't take knowledge from you about teeth in medical school. They just don't necessarily give you knowledge about teeth. But you could make the assumption safely that your brain has been filled

up with so many other knowledge is about the human body that some of the tooth knowledge has been displaced as a result. Well, your brain has been filled up with so much knowledge about Mario that tooth knowledge has probably been displaced. Sydney, that was sexist. I need to say it. But that was sex. That's sexism folks.

You gotta call it out where you see it. That was sexism. Ouch. That had nothing to do with the fact that you're a video game journalist or at least you weren't a former life. I'm retired. Okay, I hung out Mario's hat. I wouldn't know Mario if he spat in my face these days.

All books for me. You know what I did this morning? I watched A Touch of Evil by Orson Wells. A noir film. A film? Yes. Was it good? It was.

Was it a little bit weird to see Charleston Heston and brown face for the entire movie? Did that soil experience it? Yeah, definitely. Thank you, New York. Yeah, listener. I did. It's our the experience. Not great. You know, Charlie was watching a weird video that had a guide dressed as Luigi in it. And I asked her why, why is that guide dressed as Luigi? And she said, because he's the dad. Because he's the dad. I don't know what that means. Do you know why medical care and dental care are so separate in this country? You have told me the name of the thing,

and I know that, but other than that, I do not know. Now, I mean, the big answer is there are lots of reasons and we'll get into some of the more boring reasons, but the story I want to tell is kind of the mythological origin. I mean, it's really, it really happened. I don't want to say that it is the sole occurrence responsible for this. But the mythological origin is what is known as the historic rebuff, which is a great name for a thing.

It's so good. The historic Rebuff. And I think this episode, this exact happening, is at its core emblematic of the separation between the two. So even if it is not the only reason the two are so separate, I think it is worth exploring. This is a little different. There's a lot more history and a little less medical.

But it is strange if you think about how linked oral health is to rest of body health. Were you best say a real health? No, I was just thinking like oral health is part of the body. Not on oral health. Yes, it's strange. We're trained completely differently.

Everything is coded differently. Insurance is different. They're completely separate. What about like gum disease, stuff like that? Do you guys do that? Not really. No, I'm okay. Now once you start getting into surgeries, like something that might need a surgical intervention, then you're getting into some of the medical specialties, like maxillofacial surgeons, and there are oral surgeons, but these things all get muddled after a while. And when you get into the more serious mouth pathology. Oto-Larencologists will get in there too. So there are definitely some overlaps

when it comes to that sort of thing. But when we're talking about general oral preventive health and dental maintenance and gum health, all of that stuff falls into the, you know, mainly the realm of dentists. It's actually harder to get dental insurance and it's just medical. I think most people know that. And so doctors learn nothing about teeth and dentists only learn about teeth.

So why? Well, the origins of dentistry were much more so a trade. And we've kind of alluded to this on the show in numerous past episodes when we talk about barber surgeons Right Barber surgeons crafts crafts craftsman craftsman their trades trades people it is it was much more of it wasn't a Thought it's not artisans. I should I misspec trade people. Yes, they're not they're not crafting anything in your mouth. I mean, these these were people who were mainly removing teeth. They could bleed you. They there was a point where surgeons and barber surgeons

and what we would think of now as dentists and I mean, to some extent doctors, we're at all kind of overlapped. And the surgeon or barber or whatever you wanna call them that you saw, could do any of these, could do like a surgery, or could remove your tooth, whatever, like would do it all. In France in 1210,

guild of barbers was created, and this would kind of start sectioning out. The professions to decide like, well, how about you don't know anything about surgery. So don't do surgeries anymore. Just stick to pull teeth, bloodletting was fine. A barber surgeon was totally okay to leach you or cut you. Also cut your hair.

Why we've got everybody in the room, demon barber of Seville, it would be great if you would stop killing people and turning them into meat pies. Swini Todd, we would appreciate that if you would stop that because you are making us all look bad. And we get it for sure, it's delicious, but please, as long as we're all here.

You could say that was like the third category. They divide it. They divided everybody into the surgeons, the lay barbers or barbers surgeons, the people who like cut your hair and blood you and then swiney taught. They probably didn't have the guts to name them. It was like, if any of us in the room are killing people and tearing them into meat pie, they want to say it. Yeah, right.

Look to your left. Look to your right. Now look behind you. Oh my God, it's sweet sod. It was easy to throw into the category of like lay barber or like I said, barber surgeons. It was easy to throw teeth into that same category as blood letting and I mean, they really were barbers too. Like they really did cut your hair

and shave you in addition to bleeding you or they did cupping sometimes and then pulling your teeth. But it was easy to throw it in there because at the time it was just thought of as a mechanical thing. How do you take care of teeth? Well, if they go bad, you take them out. I mean it was really that simple. It wasn't thought of as a disease process. So it was just, it was a mechanical problem, it had a surgical solution. It didn't require a lot of finesse. You just yanked it out.

At least this was the concept at the time. Right. It wasn't until 1530 that a book about oral health was even published where people even started talking about the concept of like mouth health. More so than just, I don't know, sometimes a tooth. Broughts out. You had to take care of them before, right?

It was the first book devoted entirely to dentistry. It was called the little medicinal book for all kinds of diseases and infirmities of the teeth. It was published in Germany. And it was aimed at surgeons and barbers and people who would actually take care of the mouth. And again, it talked about pulling out teeth, but it also talked about fillings and then just like brushing teeth,

like trying to keep teeth healthy. Although, again, we still at this point don't understand the origins of like tooth decay or gum disease or anything like that. So it'd be hard to say much other than... We had an inquiry. If I'm trying to remember the cavity episode, we had an inkling that sugar was involved, right, or not at this point yet.

Well, no, not at this point. We didn't know. We have looked back and thought that sugar was involved because of the timeline of cavities, but no. We at this point wouldn't have known. And as we talked about, we talked about this a little bit in our episode on teeth, that there was also a time period in history where black teeth were really desirable

because they were a sign that you could afford, like, marker sugar. Like, royalty would have black decaying teeth because they could eat fancy foods. I hung out with, uh, MC back commander from the Alchemist, a while back a few weeks ago, or filmed a thing for their show. And he has been, um, using Sharpie to color in one of his front teeth for years now. And I just hope that it's okay, that it's not a problem. I'll have to ask the dentist when I go back in a couple weeks.

Yeah, is this guy okay? Is that okay? I also want to say that earlier, I conflated the demon Barbara Fleet Street with the Barbara Seville. Yes, you did. I realized it at that moment, but I wanted to give people time to tweet. So now they can be embarrassed. Now they can be ashamed. The demon barbarer of civil.

It's not bad. It's a good conflation. I like it. Spoonerism. I'll allow it. But at this point, dentistry is still very much tied to surgery. We've talked about Pare, a lot on the show, the father of surgery. And he includes a lot of information in the late 1500s about dentistry

in his surgical text. When he's describing very surgical procedures, he also has a lot of information on tooth decay and that kind of stuff. It's the two are still very tied. The profession of dentistry as its own thing probably starts, we can say, in the 1700s with Pierre Flauchard, who we've talked about before, is known as the father of modern dentistry. And he wrote comprehensive books to talk about the surgeon dentist, you know, a separate entity, the surgeon who is a dentist, who is different from other surgeons, because there are a lot of things particular to oral anatomy and function, and the things that we need to do to fix problems in the mouth that are very specialized and are their own trade altogether.

And from there, there were people who started practicing exclusively on teeth because up until then, if you were, I mean, this has been the story of medicine in general, right? At first, a doctor just did everything because you got the title doctor and you just did whatever. And then we realized that there's a lot of stuff to do on the human body. And we should probably have some people who do this part and other people who do this part. And we could argue whether we have become too segmented in this time and history.

But the point is, there's a lot to know. And so it made sense to have some people who were like doing surgery on this part and other people who did surgery on this part. Dentists at this point start practicing exclusively on teeth. The first dentist to practice in America came from England in 1760, John Baker. And then Isaac Greenwood was the first American born dentist in the United States. We've talked about before the first dentist president, first dentist who could be present. I get there you go. That's true. Although this would have been before the

revolutions. Yeah, because that would have been, well, it would have been wild to expect the revolution. Yeah, because that would have been, well, it would have been wild to expect. Exactly. First few presidents do been born. That's true. They were technically born in the whole. You know, we just started this country last week, but the rules are rules. So in 1768, one of our, we've talked about this before, Paul Revere started advertising his services as a dentist.

Do you remember that? Paul Revere was a dentist. He also, as we've covered, he was the first to probably practice forensic dentistry. Oh, solving like biting crimes. If anybody is like bite-centric crimes, he'd be like, I know these teeth. Dig into the lab. Yeah, I want to buy. Take it to the lab. Yeah, I want to buy dog to if by cat. Yeah, what? Yeah. Okay. What?

No, nothing. I don't think so. I'll work on it. Uh, so he, he started making bridges and, you know, dentures and false teeth and those kinds of things. And so he was able to address. When he bust a guy, he'd be like, that news bell, the police are coming. Like the British. I think the emphasis, it's the emphasis.

You need to work on the and then it will. The police are coming. The police are coming. That's it. That's close. Is that better? Is that better? Keep, just keep workshopping it. So he was able to identify one of his friends who had fallen on the battlefield by his bridge

that he knew he had made him. He went, I know this bridge. Oh, Jimmy. Also, Jimmy's, Jimmy's the six street bider. I finally cracked that case at the same time my friend was killed in battle. How could you? Uh, throughout the 1800s dentistry started developing all kinds of stuff unto itself. As more and more people, you know, just practiced dentistry outside of surgery or anything else. More advances

were made. And we, as I already mentioned, we started making better bridges and like porcelain teeth and rubber was invented. And this was a good base for a lot of like false teeth and that kind of thing. There were more dental books published. The reclining dental chair was invented. That was a big, and that was a big advance, that was important. Okay, was that the first reclining chair though? Because I've got somebody got in there like, excuse me, this is awesome. I'm getting, hi, my name is Paul Lezie Boy.

And I want to license this chair technology. I want to buy this. I want to buy this. He's not going to license it. I want to buy, I'll take 100% of your reclining this chair technology. I want to buy this. I want to buy this. He's not going to license it. I want to buy. I'll take 100% of your reclining dental chair business. But this was in the 1800s, so for a few points on the back end, so advisory shares.

$200. $200. $200 and advisory shares. And 100% sharks. So anyway, the dental chair, I don't know if it was first reclining chair, either way. We've talked about the Amalgam Wars. Amalgam was brought over by the crock whores who were not brothers, but are still called the crock whores brothers from France and they were kind of snake oil salesmen themselves and they did a lot of things wrong, but they

weren't completely wrong about Amalgam, but it took a while for a malgum to get over this bad association. Right. But as dentistry was evolving into its own thing, there were some dentists who were beginning to see, you know what, the more we learn about teeth and oral health, the more we need to know about health in general, the more it's linked to the rest of the body and There were certainly dentist practicing at the time who were also doctors and They were able to utilize this information for both, you know that the two complemented each other having both knowledge bases helped them And so there were some who began to think you know what?

Dentistry really needs to have a rigorous training program that involves Medical education because it's really a medical specialty. Right Specifically, Chapin Harris and Horace Hayden Horace Hayden had been trained by John Greenwood who was the personal dentist to George Washington. He made him his not wooden teeth. They always say they were wooden teeth, but they weren't. They weren't wooden teeth. They were from a tusk, right? Like a hippo. I don't know. I don't know anything about that. But he was also a five player in case you care about that. Oh, he originally was a five player and then he got into dentists. Should I care about it? Isn't going to be important to later?

No, but there you go. Is it the twist later hinge on that fact? Mm-hmm. Just an interesting fact. You learned how to play the five. He has been... Is this check-off's life? Does he want to come back up?

Did you just read that? I was like, what would I say that? No, John Greenwood was a five player. He said, I'm going to make... I'm going to learn how to make fake teeth for George Washington. That's a wild that he's a millennial before his time. Look at that career change.

Midlife goes, forget fifeing. It's time to make teeth. I bet. I bet if you believe in it after life, I like to think that he was watching like, oh, look, they're talking about me. Man, I hope they mentioned the five playing. People forget that, but I really always thought of myself as a five player first. So John Greenwood trained Horace Hayden, who

was given a license in 1810. He was kind of like the grand old man of dentistry. A license to drill. You might say. Sure. You can say that. You can say that. So he was kind of like the important guy in dentistry at the time. Chapin Harris already had a medical degree, but he was very interested in dentistry because his brother was a dentist and he learned dentistry from him and then he also went and studied under Hayden as well because he was known as the guy, the dentist guy in America. And Harris, after all the study, and with his medical background, he started saying, we need to make dentistry a real scientific discipline. It needs to be licensed, it needs to be researched, it needs to be structured and taught, and I'm

going to make it happen. So if you're wondering why dentists go to medical schools and how those two careers became integrated, that's the story of it. Well, they did thank you so much. No, they didn't. They didn't. No. Oh, the rebuff. The rebuff is about to happen. But before we before we were buff, what a tease. Let's retire to the billing department. Let's go. The medicines that ask you let my God for the mouth. So Cindy, you teased me. I think I was fair to say teased this historic rebuff. And now I'm ready to get, get, get, rebuff me.

So Harris and Hayden, but mainly Harris, Harris was the driving force between the, but behind this, at this point. They Harris approached the physicians at the College of Medicine at the University of Maryland in Baltimore. That's where he was working at the time. And he said, hey, I think we need to add like a dental instruction course here. You need to have a whole other program, a dental program within the medical school, and we can get a more rigorous training. Because at the time, you got to remember, while

he had had all of this training in dentistry and had like from a dentist with actual dentists, there were still a lot of dentists practicing in the country who had little to no training, just like doctors, right? Like it's the same as the origins of medical history where for a while, you could just say you were a doctor if you hung out with a doctor long enough, with dentist, it was the same idea. And you also had all the people who were doing the medicine shows at the time where they just went around

and for a few bucks were... For a few years doctors. Yeah, we just rip your teeth out in front of a crowd of people with circus music playing. So he really wanted to add some professionalism. So he went and he said, you know, this deserves a status as its own profession and course of study with licensing and peer reviewed scientific studies and all of this. And the physician said dentistry is of little consequence.

Oh man. Go away Harris. Oh, are you quoting or is that just your re-actress? They did say the subject of dentistry is of little consequence. How little they know? That is that is one thing. I don't I do not know that they said go away Harris. And also go away. We don't want you to we're trying to have lunch at TGI Fridays. We don't want you to we're trying to have lunch at TGI Fridays. So Harris was not was not

stopped by this rebuff, though it though historic it may be He persevered from 1839 to 1840. He went around and gathered signatures from a ton of different citizens to petition the state of Maryland to start a college of dental surgery at Baltimore. He had the help of Hayden who, like I said, had this reputation as the father of American dentistry at the time. So he was, you know, his, his help was big. There were other, there were other dentists who helped Thomas Bond and William Baxley and, uh, Parmley and all these different people got together. And by 1840, he organized the Baltimore College of Dental Surgery, the first dental school

in the United States. So he succeeded, but it was its own thing. It was its own separate entity, this dental school. It had nothing to do with the medical school. I had to ask the question, why did the doctors say no? Because to just say, dentistry is a little consequence. I mean, like, why? That's such a mean. Why were they so determined not to train dentists?

What was the point? Well, I'm sure there are lots of different answers to this and nothing is ever as simple as one reason. I did find some speculation that it had to do with the inclusion of a specific doctor slash dentist in the in the proposal and that was Henry Willis Baxley. He was among the like I mentioned him. He was among the guys who helped found the dental school. Like I said, he was he was medically trained. He was born in Baltimore and he went to University of Maryland and he got his MD there.

He worked in and around Baltimore at the Penitentiary and at the General Dospensary. He was working at the University of Maryland as a demonstrator of anatomy in 1834. And in 1837, he became the professor of anatomy, like the chief of anatomy there. This might be why there was so much opposition, this specific guy, because at this moment in history

there was this huge struggle at the University of Maryland between the faculty and the board of trustees. The legislature had gotten involved and had taken a lot of power away from the faculty to and the regents to like decide their own thing, whose chief who gets to teach this class, who gets to give these lectures, whatever. The trustees had come in and said like, we don't like what you're doing, we're going to take over, we're going to start appointing people. The faculty didn't like this kind of oversight.

This was not really supposed to be the arrangement. This is not typically stuff that trustees do. So the faculty rebelled and a bunch of them quit. So the trustees appointed their own people. This is very dramatic. It went to court. You're looking at me like this is a big deal. It was a famous part.

It's regents first trustees. It was a huge deal. No, I'm not gonna use like a semi deal. I'm just like, get finished and I'll tell you why I'm laughing. Baxley got caught in the crosshairs of this because he was appointed chief by the trustees. So a lot of the faculty at the University of Maryland did not like him. They didn't trust him. They saw him as a turn coat, you know, as an enemy that he had joined the trustees over the faculty. And so when he was one of the ones who came forward along with Harris and Hayden and everybody else, maybe that's why they were so crappy about it. It's just so wild. We're going to change the course of history because we're mad at

you for like inter for intercollegiate squabbling. There's also some theory that it came from him that he because of all this, he was more reluctant to join. Let's go do our own thing so I can get away from all these guys who hate me. Either way, there's been some speculation that maybe this is why it was so I'm completely, I mean they didn't even consider it. It wasn't like, oh, I don't know, it's going to be expensive. It was just a no. And obviously it created a lot of hard feelings.

So from here, dentistry became its own profession with its own schooling. The American Society of Dental Surgeons was organized. From there, the American Journal of Dental Science was founded, the first dental journal in the world. Because this is part of it. If you're going to have a professional, if you're going to have a profession, I should say, the profession itself, you have to have rigorous training, you have to have licensing, you have to have a society that you have to have licensing, you have to have a society that decides what does it take to be a dentist, what bars must you jump and all that.

And you have to have research. You have to have people who are researching and writing and sharing this information so that everybody kind of gets on the same page, right? So everybody does the same thing. And so that was really what Harris knew and understood and was helping to form, was the profession of dentistry and a big chunk of that was teaching dentists. And from there on, dentists started regulating themselves

and creating their own professional standards, much the same way that physicians did early on. When we talk about like the origins of the American Medical Association and the, you know, the beginnings of the, of AOA, like what is the medical honor society was a way to like bring professionalism to medicine. All of these organizations, they had the same thing with the dental organizations, a way to start structuring. I always thought it was, I found out an interesting point, point, Horace Hayden was really against a dental journal. He didn't want them to

publish a dental journal. Because he thought that if you wanted to learn stuff about dentistry, it was sort of obscene to learn it from what he called a magazine. You had to go to school and learn from dentists from lectures like in the in the great tradition of academics, you couldn't read a quote unquote magazine. And so he wouldn't put anything in it. Do you feel like there's a lot of ignorance on my part here. So please don't, if you're listening, don't read too much into this because I really don't know. But you think there's some element of gatekeeping in this too, like trying to say, we can be dentists and you can't.

Because there's a lot of dentistry things that, like I'm assuming lay people could probably do, or at least more like trade centric people that are like apprentice up. Like I'm assuming there's probably some things they could do. And it makes me wonder if like if there's some element of like, you know, we are going to do this so you can't.

Well, I think that as you, I read a lot of accounts of the founding of these, there were multiple early dental organizations. As I kind of mentioned when we talked about cavities and filling, the Amalgam Wars separated people out into different dental societies pretty early. And then there was one in the West and one, the Amalgam Wars separated people out into different dental societies pretty early, and then there was one in the West and one in the East, and so there are all these kind of warring factions of dentists. The Amalgam Wars is the coolest name for the lamest thing,

the disperity of coolness between those two things is outrageous. But you're right in that there was a concern that you're trying to make this too hard. And then as we move through history, it costs money to just like, and this is the same for medicine. I'm not picking on dentists. You could, everything I'm saying, you could replace with the word doctor and it would be exactly the same. It costs money to go to dental school.

It costs money to pass your exams. It costs money to get a license. It costs money to join these organizations and to stay in good, you know, good faith with the organizations. All of this costs money. And you did have dentists who are practicing at the time who probably were doing legit dentistry. Right. And weren't part of this and didn't go to school because it came along after them. They did allow these people to join the organizations. They're just kind of ushered in like retroactively.

Yeah, exactly. You've been a dentist this whole time. Congratulations, you get this. The dentist was inside you. They actually put people in their dental society without asking them, which was a big scandal. Oh, no. Because then people were like, I wasn't even at that meeting.

I don't want to be in your society, what is it? So as things changed, as there were more and more dental schools, there became this concern again that was kind of the origins of the profession. Wait a second. The more we learn, the more research we do, the more rigorous we are about this profession, the more we know this is medicine. This is all part of medicine, and doctors don't know anything about this, and we're not learning about the rest of the body and we need to know each other's

stuff to do this You know the best possible way and there was some that were concerned that dentistry is moving too far in the direction of fixing Problems after they occur and not preventing them on the front end which again same concern we always have in medicine Are we too procedure focused are Are we too like treat the problem with medicine focused as opposed to preventive health? How can we stop it? So in the 1920s, there was a biological chemist named William Geiss who took the problem much the same way that medical education had what was called the flexner report, which was the Carnegie Foundation sponsored this huge report.

It was like a book-sized report about medical education in the US at this point in history. It was right, right before this. And it was the basis of what we do in medical education now came from all the critiques in this flexing report. Well, similarly, he set out to do the same thing for dentistry. And the guys report was published, the dental education in the United States and Canada in 19. It's called the guy's report, not the guy's report. G-I-E-S.

Right. It's a guy's report anyway. So he went to every dental school in the US and Canada and he published this report in 1926 and he called for it to be Integrated. He said dentistry can no longer be accepted as mere tooth technology. He wanted to any he it's great if you read his conclusions because he says like doctors regard teeth as these strange stone structures in the mouth that I mean it's it's I mean he's right though. He's right like doctors don't know anything about teeth and dentists aren't learning about the rest of health.

And so we need to integrate them, we need to put this all together. And he argued for this, but there was tons of pushback, honestly, from dentists themselves. They didn't wanna lose their autonomy. They didn't want medical organizations and the licensing boards of medical schools

and all these different things. They didn't want them coming in and overseeing their practice because they knew what they were doing. they were learning the stuff, doctors don't know anything about teeth, which they're right. So they didn't want all this oversight. So there was a lot of pushback from dentists themselves who wanted to keep their autonomy. So nothing really changed. There was all this concern, but, and I think dental school, I shouldn't say nothing changed.

That part didn't change. Dental schools took this to heart and changed a lot in terms of their instruction and the way that they address preventive care and oral health and that kind of stuff. But as far as the integration of dentistry and medicine, that didn't change. So around this, shortly after this was published, the other issue that came into focus was dental insurance. So we had had health insurance since the 1850s, right? We still didn't have any insurance to cover dentistry. So yeah, it didn't exist.

So it actually started in California, the international Longshoreman's and Warehouseman's Union and the Pacific Maritime Association When asked what might improve their work life said, you know what would help if just like we have health insurance if we could have dental insurance This was in 1954 and the idea spread really quickly to start offering dental benefits as well as To attract people to your place of employment So this was the origin of dental insurance, and it's also why it's completely separate. Because it was just a totally different time and history, and it was added as a whole other thing. And then because we see the two things as separate, there have been calls for reform to integrate

the two better since then in 2000. The surgeon general or issued this huge report oral health in America and said like we need to integrate these better. But again, nobody, the problem is at this point all the professional organizations don't want this. And the result of this is there are over a million visits to emergency rooms each year in the US about dental issues. And the problem with that, if you've ever been to an ER for a dental issue, you'll know

this. There's not much we can do for you in an ER. Dentists are almost never in ERs. There's never been one in our ER, certainly. I'm sure there are places where that happens, but not around here. And when someone comes in with a dental issue, the best I can do is if I think there's infection,

I can give you an antibiotic. If you're in pain, I can give you some medicine for the pain. I can refer you, but I can't, even when we admit people for oral problems that we think the oral surgeon needs to come see them or the mac for us it's a maxlo facial surgeon who will come see them.

Actually, no, I should say he's an oral surgeon and a dentist too. He went to all the schooling at our hospital. But sometimes it's just a follow up like it'll just be reviewed and said, well, I just come see me in the office. It's hard to get into a dentist if you don't have dental insurance. Just like it is with a doctor. Again, I'm not picking on dentists. These are all the same for doctors.

But doctors don't know anything about teeth. So you come to the ER, we can't help you. We tell you to go see a dentist. If you can't afford it, then you're in a terrible position. It's hard to find dentists who will work on sliding scales just like it is with doctors. Sometimes, you can find like federally qualified health centers that will work in association with dentists and they'll help you out But it's a huge challenge medical and dental records are separate. I have no idea what you have if you're my patient I have no idea what happens with your teeth. I don't know unless you tell me I don't have access to any records

I don't have access to any coding or billing information that would help us like do research to connect the rest of your body health with your oral health because the codes are different. It makes research almost impossible. So like trying to figure out the origins of tooth decay and gum disease and why is this patient so much worse off than this one and how can we help them out better and prevent this. That research is very hard to do just from a practical standpoint because of the difference in coding. Moreover, we tend to see oral health is tied to like a morality thing, right? You have bad teeth.

You don't take care of your teeth. As opposed to like, well, no, you have more tooth decay than another patient. Let's figure out why and help you prevent that. Not like it's a moral failing. When we, and teeth are tied to, to our socioeconomic status, right? That's why we call the front teeth, the social six. How important it is to have those top front teeth look

perfect. That's why we have all kinds of ways of straightening and whitening and venerying all that kind of thing, because teeth are very much tied to your status in this country. And there's a lot of money in fixing teeth and making them look pretty. And so a lot of dentists need to do those procedures. And again, this is the same as doctors, procedures pay more than preventive health care and preventive

oral health care. So I'd say the same problems exist for both professions. There's also not enough, Dennis, especially rural areas. There are places where there's just no access. Even if you have dental insurance, there's no dentist. I guess, you know, it's hard, Sid. I've been like, sitting here and trying to think about like, I know a decent amount more than your average joke about medical training, just because I went through it kind of second hand with you.

And I've been trying to think of like, how like, what that integration would even look like? Like, I don't even know what that would look like, because you wouldn't want to treat it like a specialty where you do four years of med school and then do your residency for three years in teeth. Like, that seems like a lot of wasted, you wouldn't want the full slate of medical education

for every dentist, right? Like, especially if we have a problem in the pipeline that's gonna slow down getting dentist making more expensive, you know, to do. And I know dentist can like practice right out of dental school or at least do a year of residency. They're not doing the same.

Link the residency that um well, they're not doing residencies per se right. I've seen that proposed. I've seen a resident a dental residency proposed. There are some schools where they're doing like joint undergrad dental school degrees. So you don't have to go for full undergrad and then to dental school, they're like combining it, which is not a bad idea, honestly, to like streamline and target the dental education more towards the stuff you need to know. But then you think about like administration wise, right?

Like if you put dentists into the hospital system, right? They're gonna roll up to people that don't know anything about teeth. I mean, at this point right now, like if we flipped a switch tomorrow, right? Like how they even want like they would have to be, they would still be siloed off. We need to because they don't share the training. You know, I mean, I think some easy things would be, and I don't know if this

isn't an undergraduate capacity, like if you want to, or maybe that we just need to have classes in medical school about oral health. And maybe if the dentistry schools could be tied with the medical schools in the universities more, that would help too, where you could have joint classes on oral health as part of whole body health. And to see the connections, because I think we all need to, I think dentists and doctors don't get enough of each other's stuff.

On both sides. You almost need to do the first two years together. And then everybody go to your own. Yeah, I think there would be a way to integrate like whole body health and oral health into a single class that we all should take to understand the connections because people die of originally dental problems. Now, obviously, they become much more than

dental problems before they become serious enough to be fatal, but the people die as a result of things that started out as dental issues. So it should be the purview of physicians. But at the same time, we can't fix those problems. So it is the purview of dentists too. There's a lot of overlap and we both need that education. But the thing about it, and I think it's the same thing I see in medicine, dentists push back against a lot of these changes the same way that doctors push back against changes in the healthcare system because generally the people who are making the changes aren't doctors

and they're not dentists and they don't really know much about it. I think if we, because we need huge changes, I'm advocating, I have many times on this show, I advocate for universal healthcare for a single-payer healthcare system. The same should apply to dentistry. It should all be under one umbrella. You should not have to go broke, paying to get your tooth fixed or to get your blood pressure fixed. I always advocate for that, but I think you have to have doctors and dentists part of this conversation. And that's why it gets so segmented is because you start trying to interfere with professional autonomy and telling us how to do the things we do each day, but the system still sucks to work in. So all of a sudden, I have all these new papers to fill out and check marks to make and you're checking,

like, am I getting everybody all of their numbers where they need to be, but you're not giving me the support that I need to do it because the system still sucks. And dentists are afraid of the same thing that doctors are. The more oversight, the more organizations, the more the legislatures get involved, the more we have to do and the patients' lives aren't getting better and our lives are getting worse.

Patients' lives are getting worse too. Everybody's lives are getting worse. We need to overhaul the whole system, but yeah, part of it has to be, I as a doctor should know something about oral health. And dentists need to know what happens next. More about, I think we need to talk more about the origins of tooth decay and gum disease and how we can prevent it other than brushing, because that's all we know, right?

Breshing and flossing, go to your dentist. Let's talk more about the origins of that and then also about how those things conflict or how those things interact with the rest of the body. We all need to learn more because then we could serve our patients better. Dr. J. Jandannis. There's a great book.

Mary Otto teeth the story of beauty inequality in the struggle for oral health in America. I got a lot of information from that. I would, if you want to know more about this, I would recommend that book. Folks, thank you so much for listening to our program. We are on iTunes and every other podcasting service. If you want to give us a review or a subscription there, we're sure appreciate it. We have got some merchandise at macabreoymerch.com.

That's MCELR-O-Y. You can buy a book on Amazon. It's called the Solbund's book appropriately. Enough, thanks to taxpayers for the user's own medicines as the intro and outro of our program. And thanks to you at home for listening. We really appreciate you. And if you're a dentist and you want to come teach me about teeth, I will not rebuff you. I will un-rebov you and welcome the information. But don't tweet it or folks. She's got a lot of tweets to read already. You

can email us. You can email us and tell me about T because I'm still. You're gonna say that now and you're gonna regret it. Ooh, here in a week like these. Lippin' Dennis. Stop emailing. That's gonna do it for us this week. So until next time, my name is Justin McRoy. I'm Sydney McRoy.

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