Center for the Future of the Health Professions Feb. 2022 digest
Posted: February 24, 2022
This month, The Center for the Future of the Health Professions will be posting its second monthly op-ed column for 2022. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce, so they can effectively plan for a sustainable future and make the best use of available resources.
This month features a discussion around a short history and the future of dentistry, oral health, and oral medicine by Leonard B. Goldstein, DDS, PhD. Dr. Goldstein serves as A.T. Still University’s assistant vice president for clinical education development. Dr. Goldstein earned his doctor of dental surgery degree from Case Western Reserve University and his PhD from the City University of Los Angeles. Immediately following dental school, Dr. Goldstein served in the U.S. Army as a captain in the dental corps during the Vietnam conflict.
We look forward to your response to this very interesting information.
The short history and the future of dentistry, oral health, and oral medicine
In the 1926 report by William J. Gies, the dental curriculum typically contained about 4,000 hours that were distributed over four years (1). Now, almost 100 years later, we see a dental education curriculum that is about 4,900 hours, which are still distributed over the same four years (2). In the U.S., there is a reluctance to expand the dental education to a fifth year. Only Delaware and New York have mandated a PGY-1 residency program requirement for licensure.
Oral medicine is a specialty between medicine and dentistry which focuses on oral symptoms, diagnosis, and oral care of medically compromised patients. Oral medicine is a medical specialty that has ended up in dentistry, and is now somewhere between both dentistry and medicine (3,4). From a historical perspective, the oral cavity became the domain of dentistry because of how teeth were looked upon in ancient times. Teeth were considered to be bone, and were not interesting to practicing physicians. Toothaches were primarily remediated by extraction, performed by barbers and blacksmiths. Dental care emerged as a mechanical and surgical branch of healthcare, distinct from the rest of the body. As a result, dental care and dental education in the U.S. evolved separately from medicine, with the establishment of the first independent dental school in Baltimore, in 1840 (5).
Dentistry is a young profession, less than 180 years old. These are some of the historical phases of dentistry:
- The initial (and longest phase) was basically extraction based
- A second phase was introduced with the publication of Pierre Fauchard’s “Le Chirurgien Dentiste” in 1728 which introduced the restoration of defective teeth
- Next was the prevention phase with the advent of fluoridation
- The diagnostic phase was initiated in 1960 with the identification of blood-based proteins in saliva, that began the use of saliva and other oral fluids in diagnosis
- The future is bright for a phase of regenerative oral medicine that requires more medical and molecular knowledge than what is currently in the dental education curricula
There are or will be fewer dental interventions, which in turn will demand more preventive, diagnostic, and regenerative approaches for a more educated population. This shift from disease management to a preventive driven profession may lead to a shift in education and the practice of dentistry to either a surgical, intervention profession, or a medical, diagnostic and preventive profession.
The emerging non-traditional aspect would be more suitable as a medical sub-specialty. Areas such as oral regenerative medicine, oral diagnosis, immunotherapy, and stem cell therapy are some examples that may require expansion of the scope of practice of oral medicine that will require additional medical knowledge. Oral medicine may be better positioned to emerge as a specialty to treat the non-invasive aspects of future oral care (6,7).
Oral medicine is nor recognized as a specialty in dentistry by neither the ADA nor 47 states. A possible solution would be a shift from dentistry to medicine as a post-graduate specialty. Evidently, the future of oral health and how it will evolve is within the domain of the dental education system. However, the future of oral medicine as a specialty is still cloudy, and it will ultimately depend upon various factors, including the possibility of greater integrated and inter-professional practice between the medical and dental professions.
References
- Gies WJ: “Dental Education in the US and Canada: A Report to the Carngie Foundation for the Advancement of Teaching”; 1926; P. 471
- ADA: “Suvey of Dental Education, Volume 4: Curriculum Table 1, Dental School Curricular hours 2010-2011” http://www.ada.org/~/media/ADA/Science%20%20Research/HPI/Files/DSE4_2010-11/Final
- Baum B: “Inadequate Training in the Biological Sciences and Medicine for Dental Students: An Impending Crisis in Dentistry”; JADA; 2007; 138;P. 16-25
- Baum BJ, Scully C: “Training Specialists in Oral Medicine”; Oral Diseases; 2015; 21; P.681-684
- Field MJ: “Evolution of Dental Education”: In Institute of Medicine (US) Committee on the Future of Dental Education; 1995; National Academies Press; Chapter 2; P. 39 http://www.nap.edu/catalog/4925.html
- Rozier GR, White BA, Slade GD: “Trends in Oral Disease in the US Population”; J Dent Ed; 2017; 81(Suppl8):eS97-eS109 https://doi.org/10.21815/jde.017.016
- Scully C, Miller C, Urizar JMA, et.al.: “Oral Medicine (Stomatology) Across the Globe: Birth, Growth, and Future”; Oral Surg Oral Med Oral Path Oral Radiol; 2016; 121: 149-157