Why Does Health Care Ignore Your Mouth?

dentistry separate from medicine

Story at-a-glance -

  • Dentistry remains distinctly separated from the field of medicine, even though it’s widely known that your oral health is intrinsically connected to your overall health
  • Many people lack access to affordable dental care and instead end up in emergency rooms due to dental problems
  • The American Dental Association (ADA) spends millions of dollars to influence U.S. legislation in their favor, particularly to prevent competition

By Dr. Mercola

Every year, more than 1 million people end up in hospital emergency rooms (ERs) due to dental problems that could have been treated in a dentist’s office. The cost of these visits is more than $1 billion a year.

These startling statistics were reported by The Atlantic in an interview with Mary Otto, author of the book “Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.”1

It’s widely known that your oral health is intrinsically connected to your overall health, but despite this dentistry remains distinctly separated from the medical field.

The ‘Historic Rebuff’ That Separated Your Mouth From the Rest of Your Body’s Health

According to Otto, tooth issues were once viewed as primarily mechanical issues, with barbers (who at one time acted as both surgeons and dentists) taking care of tooth extractions along with haircuts. It wasn’t until 1840 that the first dental college was opened by two self-trained dentists in Baltimore.

They approached the University of Maryland’s college of medicine in Baltimore with the idea of adding dental courses to the medical curriculum but were rejected by the physicians in what came to be known as the “historic rebuff.” Otto told The Atlantic:2

“It’s seen as a symbolic event and it’s continued to define the relationships between medical and dental education and medical and dental health care systems in funny ways.

Dentists still drill and fill teeth and physicians still look at the body from the tonsils south. Medical and dental education is still provided separately almost everywhere in this country and our two systems have grown up to provide care separately, too.”

The result of this separation can be traumatic. In the case of the ER visits, patients are often given antibiotics and pain medication, and then told to see their dentists.

However, many patients have no dentist and no dental coverage for treatment. According to Otto, about one-third of Americans face barriers to getting routine dental care and restorative procedures to stay healthy.3

Rural and Low-Income Areas Often Lack Access to Dental Care

The heavy demand for expensive cosmetic procedures in some regions draws many dentists to wealthy areas. Meanwhile, millions of people in rural and low-income areas have no access to dentists.

Otto described the story of Tammi Byrd, a dental hygienist in South Carolina who fought for children to be able to have their teeth cleaned by dental hygienists without having to see a dentist first.

“The dental association just fought back, they got an emergency regulation passed to stop her from doing her work and finally the Federal Trade Commission came in and took her case and won it for her,” Otto told The Atlantic, “in the interest of getting economical preventive care to all these children who lacked it.”4

Meanwhile, low-income and middle-income people, Native Americans living on reservations, and our soldiers and sailors — even the pregnant ones — are unfairly subjected to dangerous and outdated dental procedures like mercury fillings, based on bogus claims that they’re more cost-effective and efficient than newer, safer filling options.

Not only do dental plans commonly not cover mercury-free fillings in certain teeth, but state Medicaid programs commonly prohibit the use of mercury-free fillings for molar teeth (the back teeth) — forcing low-income individuals to choose between mercury fillings and no dental care at all — or allow a choice but don't let consumers know it.

The Politics of Dentistry

The American Dental Association (ADA) spends millions of dollars to influence U.S. legislation in their favor. In 2008, the ADA's Political Action Committee (ADPAC) even outspent the American Medical Association to become the largest single health care political action committee.5

From 2009 to 2012, the ADA spent $39 million on lobbying efforts, largely, as The Wall Street Journal put it, to protect their turf and prevent competition.6 In many other countries, there are mid-level dental providers, who receive training beyond dental hygienists and are able to provide basic “drill and fill” procedures, like basic fillings.

This allows people in rural areas without access to dentists, as well as people with lower incomes who cannot afford them, to receive basic dental care. In the U.S., however, the ADA has fought to prevent access to this type of care, arguing that only dentists can provide dental care.

Anti-Trust Laws Invoked to Stop Anti-Competitive Behavior by the American Dental Association

In North Carolina, non-dentist providers began offering teeth-whitening services in spas and salons, at prices typically lower than found in dentists’ offices. Dentists complained to the North Carolina dental board, which is composed mostly of dentists, and which then issued cease-and-desist orders to the teeth-whitening businesses.

The board also sent letters to malls telling them not to lease space to the non-dentists and even threatened that the services could be subject to criminal prosecution.7

However, the U.S. Supreme Court ultimately ruled that the dental board was acting under anti-competitive and unfair principles. According to Consumers for Dental Choice:8

“Invoking antitrust laws, the United States Supreme Court has ordered the North Carolina dental board to stop using its power to advance the economic interests of its dentist members.

In a case prosecuted by the pro-consumer Federal Trade Commission, the Supreme Court blew the whistle on the dental board's cozy use of its power to eliminate competition.

The North Carolina dental board members, who are mostly dentists, were using their power to wipe out businesses that were competing with them for tooth whitening services.

The Supreme Court ruled, 6 to 3, that dental board members are not regulators in the public interest, but actors with a special interest in padding their own pockets and the pockets of dentists like themselves.

… Who are these dental board members? The great majority are pre-screened by the American Dental Association’s state chapters, who hand a list of dental board candidates to pliant governors.

In some states, the governor must pick from this list. With state dental associations and dental boards holding virtually identical interests, these boards are not protecting consumers.”

ADA Double Standards

Ironically, while clearly not supportive of competition in the field of dentistry, the ADA advocated that the U.S. Senate should “re-examine the antitrust exemption enjoyed by health insurance companies” that “permits them to ignore the competitive rules that apply to every other U.S. business."9

Steven Krauss, a pediatric dentist in New York, pointed out in 2016 the ADA’s double standard when it comes to competition, as they said they strongly supported the Competitive Health Insurance Reform Act, which would allow the FTC to enforce federal antitrust laws against health insurance companies. He continued:10

“When considering its own profession, however, the ADA takes the opposite position.

In a 2013 amicus brief filed in North Carolina State Board of Dental Examiners v. Federal Trade Commission, the ADA took the approach that the FTC should not intrude in healthcare regulatory matters traditionally the responsibility of the states.

According to the brief, ‘the public is best served when state regulatory boards ... are free to make decisions .... without fear of second-guessing under the federal antitrust laws.’

I guess when the ADA supports any and all means to make healthcare affordable, it means any and all means except obstructing the special status accorded to dentists.”

Why You Should View Your Oral Health as Part of Your Overall Health

Your mouth is not separate from your body, and your oral health should not be viewed as separate either. People who fail to brush their teeth twice a day may be putting themselves at risk of heart disease,11 as advanced gum disease can raise your risk of a fatal heart attack up to 10 times.

There’s also a 700 percent higher incidence of type 2 diabetes among those with gum disease, courtesy of the inflammatory effects of unbalanced microflora in your mouth. Thousands of studies have linked oral disease to systemic disease. Inflammation is well known as a disease-causing force, and gum disease and other oral diseases produce chronic low-grade inflammation in your body.

When the bacteria that cause tooth decay and gum disease enter into your circulatory system, it causes your liver to release C-reactive proteins, which have inflammatory effects in your entire circulatory system. Other health effects associated with poor oral health include an increased risk of:12

  • Bad breath (halitosis)
  • Dementia: Failing to brush twice a day increases your risk of dementia by as much as 65 percent compared to brushing three times a day
  • Pneumonia: Good oral hygiene has been shown to lower your risk of pneumonia by about 40 percent. Other research has shown that people with periodontitis have a 300 percent greater chance of contracting pneumonia
  • Erectile dysfunction (ED): ED is more than twice as common among those with periodontitis than those without ED
  • Kidney disease and more

What You Eat Matters to Your Teeth

Proof that your teeth are intricately linked to your overall health lies in the fact that your diet has a profound effect on your oral health. Make sure you consume a diet rich in fresh, whole foods, fermented vegetables and grass fed meats, which will ensure you're getting plenty of the minerals that are so important for strong teeth.

Minimizing sugar is also important. Your risk of cavities increases the more sugar you eat. One study found that, in order to minimize your risk of cavities, sugar should make up no more than 3 percent of your total energy intake (with 5 percent noted as a “pragmatic” or more realistic goal).13 Overall, some of the true primary causes of tooth decay cited in the literature include dietary factors:

  • Consistent use of refined sugar, sugary soft drinks and processed foods in general
  • Children going to bed with a bottle of sweetened drink in their mouth, or sucking at will from such a bottle during the day
  • Mineral deficiencies, like magnesium, which can weaken bones and teeth14
  • Vitamin K2 is crucial for bone mineralization and unless you have a regular source of healthy non-pasteurized fermented foods in your diet, there is a good chance you will be deficient in this important nutrient.

In addition, make sure you are getting plenty of animal-based omega-3 fats such as those in krill oil, as research suggests even moderate amounts of omega-3 fats may help ward off gum disease.

For Good Health, Take Care of Your Teeth

When it comes to oral hygiene and preventing cavities, please remember, drinking fluoridated water and brushing your teeth with fluoridated toothpaste is not the answer.

Rather, it's about your diet and proper dental care: brushing and flossing. By avoiding sugars and processed foods, you prevent the proliferation of the bacteria that cause decay in the first place. Following up with proper brushing and flossing and getting regular cleanings with a mercury-free biological dentist will ensure that your teeth and gums stay healthy naturally.

Your toothbrush and natural fluoride-free toothpaste are important, but don’t be misled by thinking they’re the only options for sound dental health. Many natural substances, like the foods you eat, also have the power to drastically improve the health of your teeth and gums, and thereby the health of the rest of your body, too. Ultimately, dentistry and medical care should be viewed holistically as one in the same — essential for keeping you well.

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