American Way of Dentistry
The American Way of Dentistry is the dentistry article of this year:
The medical profession has struggled to replicate dentistry’s achievements in disease prevention with its “health maintenance” model. Dentists, by emphasizing preventive measures—like biannual checkups and cleanings, fluoridation of community water supplies, the use of fluoride toothpaste, and encouraging patients to eat less sugar and processed foods—have reduced overall treatment costs as well as pain and suffering to a degree medical doctors can only dream of. They have done so in part through a structure of dental benefits that is far more punitive to those patients who slack off on prevention, or for whom prevention fails, than anything health insurers typically contemplate.
There is so much good information here, I think I’ll be coming back this a lot. One more:
Since the ADA, which protects the interests of practicing dentists, won’t concede that there is a shortage [of dentists], it is likely to oppose any significant relaxation of the credentialing rules. Technological developments have improved dental office productivity—digital radiographs, for example, are available much faster than the old-school X-rays that took minutes to develop. But there are physical limits to how much dentists can do. As Dr. Chester Douglass pointed out, “This is micro-surgery. Try doing micro-surgery where you are concerned [with] one-tenth of a millimeter—you can’t do it for more than 33 or 35 hours per week.
Plus, there’s some discussion of wearing a flipper — a temporary prosthetic device that fits a bit like a retainer. It replaces the teeth you’ve had pulled while you heal from surgery. We made these last semester and, first of all, they are really hard to make. One of the trickiest parts is bending wire around a tooth. You have to adapt this piece of stainless steel wire to the contours of a molar by placing minute bends in the wire. It borders on impossible. I talked to my aunt who is a very accomplished dental lab technician — even she said that, after all her years of work, she still relies on a few expert wire-benders. We do the same at the school of dentistry: it’s truly an arcane skill (and critical) skill.
Secondly, our resident dental lab technician expert was telling us he fabricated a flipper for a dentist who lost his front tooth… and the dentist said he never realized how miserable it was to wear these things. Hopefully such an experience provides a new level of dentist-patient compassion. I think that’s the advantage of a generation of orthodontists who’ve had orthodontic work done on them: they understand that moving teeth hurts like nothing else.
The main thing keeping me from getting braces for a year, having my jaw cut away from my face and shifted back to correct my occlusion, then continuing to wear those braces for another year is not the surgery — it’s the pain of a mouth full of metal cranking on my teeth. Most of my memories from earlier in this life have softened with age and I only really remember the good things… with one exception: braces. All I remember is agony.
So — with regards to dental pain: I think I’ll understand when someone comes into the office and says “I AM IN PAIN.” In fact, when someone experiencing acute dental pain comes in, it’s common to numb them up before they make decisions about what to do with their tooth: otherwise they’ll almost invariably beg for the offending tooth to be pulled as soon as possible.