The Historical Dentist/Physician Professional Relationship

To understand why two healthcare treating professions are not “together” requires a little history. After understanding the historical aspects of this professional separation, it will be just as important to understand the legal malpractice nightmare that is on the horizon.

Dentistry and medicine treat the same body, where one health problem can cross into both professions’ “territory” often without the other’s knowledge. When this occurs, both the patient and the professional lose. So how did this professional communication gap—some would call it a chasm—start?

The Focal Infection Theory

Historically, dental pain—often associated with fetid mouth odors—was related to infections.  There was a theory that mouth diseases were the source of general systemic health problems, called the Focal Infection Theory or the Foci of Infection. This “Foci of Infection” belief was an ancient idea held by many in the medical arena, where teeth were the problem and needed to be extracted. The doctor performing these extractions was the dentist, often associated as a surgeon. We see this in the early dental DDS degrees that stand for Doctor of Dental Surgery. They were often the ones leaning against their red and white striped poles advertising their skills where “bloodletting” was also provided.

In modern times, in an effort to better fall under the medical umbrella, the dental profession has been making efforts in that direction. Newer dental schools now award the DMD degree, the Doctor of Dental Medicine which is synonymous with the earlier DDS degree.  Before there was the degreed MD (medical doctor) physician, the ancient physicians were “alchemists” putting potions together to cure the sick. These slight treatment approach differences between the dentist-surgeon and the physician-alchemist are also a vestige of where the two professions stand today.

In ancient Greece, Hippocrates reported that arthritis could be cured by treating the patient with tooth extractions. In the late 1800s, a dentist and oral microbiologist stated that many general systemic diseases, such as stomach, lung and brain abscesses, were related to many infectious oral diseases.

With tooth extractions often being the early standard of care, the dentist was often the first doctor a sick patient would see. Seeing the dentist was a horrible and painful experience because no anesthetic was used. If the patient was smart, he or she might get drunk, but most likely the dentist’s assistant would simply hold them down.

Then in the early 1800s as dentists continued extracting teeth and physicians were cutting off gangrenous limbs, along with their medicinal potions, a pivotal event occurred. A dentist, after seeing how “laughing gas” (nitrous oxide) was being used at a party novelty, wondered if it could be used to minimize pain during a tooth extraction. Nitrous oxide was marginally successfully, but some dentists were now intrigued if there were other “anesthetic” options.  Chickens were seen as being “knocked out” with ether, waking up later without any apparent residual problems. This observation led to the idea that ether may provide an anesthetic option for dental extractions.

In 1846, a dentist was the first to use ether to extract a patient’s tooth painlessly. A physician observing this surgery was so impressed, he performed a successful neck tumor surgery the next day using ether. Unfortunately for the dentists, who found ether to be a fanciful experiment, did little with this new knowledge. The physicians saw enormous promise for their general surgeries. The physicians’ use of ether—and later other anesthetics—was a medical advancement boom in a way dentistry did not see.

Ongoing Professional Separation

This pivotal anesthetic moment, where dentists “dropped the ball” and the physicians “picked up the ball and ran with it,” was a continuation of the professional separation. It was still the same body and the same patient, but a continual disconnect between the mouth and the body persisted.

The two professions would rarely work together as a team on the same patient. The physicians started hospitals, educating physicians, who then started training specialties where they would work together as a professional team.

At the same time, dentists isolated themselves with their own dental schools, slowly evolving their own dental specialties apart from the medical team effort.  Ironically, it was still the same patient with the mouth connected to the body with few physicians or dentists wanting to acknowledge the connection or work together as a professional team member. This gap in communication occurred either from a lack of knowledge, pride, or both.

With time, the medical profession slowly lost interest in the mouth Foci of Infection theory as a causative factor for any general systemic health problems.  In some ways, even though this early mouth Foci of Infection theory had some credibility, as a primary route for all systemic health problems it had been over-emphasized. Oral infections were not the only cause of systemic medical issue, as Hippocrates had hypothesized with arthritis. This theory did have some credibility, though it needed further investigation should not have simply been thrown out altogether.

It is only recently that oral diseases have started to scientifically take hold again as being a part of the greater somatic body illness complex. Somewhere, someone had an “AHA! moment” that the mouth is still connected to the rest of the body.

What Have We Learned?

What have dentistry and medicine learned from this historical breakup, this gap, this chasm? In most instances, nothing. Many dentists are still on myopic autopilot, treating cavities, extractions, implants crowns, bridges and gum disease.  Many dentists rarely look down the throat thinking “Hey, isn’t that connected to the rest of the body?”

In the meantime, many medical physicians go on treating diabetes and heart disease, delivering babies, giving immunization shots, treating what they think is the “whole body” without giving much thought to the other end of the digestive tract—the mouth. The thought is, “That is for the dentists to worry about. That bad breath…it’s not infection, just bad oral hygiene.”

Huge communication failures have occurred because of the historical breakup of these two professions. The consequences of this breakup is huge, both to the patient and in the near future, to the medical physician in litigious malpractice.

Keep an eye out for the second part of this article “The DDS-MD breakup: Patient Health & Legal Consequences” to see the implications of this disconnect.