Dentists are also Health Professionals
Sometimes I want to take dentists by their shoulders and shake them roughly: “Wake up!” “Realize that you are also a Health Professional!” “You too can take responsibility for other areas of health that are seemingly unrelated to your specialty!”
For more than 10 years, I have worked closely with dentists (mainly pediatric dentists, but of all kinds as well) and I can’t count the times that I have seen them frustrated for not being able to help their patients in a more comprehensive way. And, although many of them have close ties with their patients, it seems that they always stay on the sidelines by solely attending to problems that appear to be exclusive to the field of dentistry.
An example: Dentists have been talking about cavities for decades. Prevention, adherence to treatment, and education are all frequently mentioned, however, as statistics continue to show us, cavities are still a growing problem. Today, cavities represent the most prevalent chronic disease in the world with more than 2.3 billion adults suffering from it and more than 500 million children. Because cavities are not considered a fatal disease, we pay less attention to it. When we compare mortality statistics of cancer, diabetes, respiratory, and cardiovascular problems, of course that treating cavities is not anyone´s priority.
As someone who is interested in the systemic causation of chronic diseases and who believes it is necessary to stop blaming patients for their bad habits, I realize that dentists–who were trained in the pharmacological paradigm of medical science–, continue to believe that by repeating to their patients the dictum to brush their teeth and eat less sugar, they will finally be able to eradicate cavities.
(Although this is not the topic I want to talk about here, I do want to mention that it is impossible that there are more than 2 billion people with cavities and that the only reason for it is that patients are gluttonous, lazy, and lack self-control. To have these numbers (2.3 billion!), like with obesity and diabetes, the forces at play go beyond individual decisions and have to do with a SYSTEM: The Food and Pharmaceutical Industry, a medical dogma that focuses more on reaction than prevention, as well as cultural and societal habits and practices. For 2.3 billion people to have permanent tooth decay, there must be strong economic forces that do not incentivize the withdrawal of harmful foods and reduce advertising to children, pharmaceutical companies that want to continue selling drugs, as well as doctors who are convinced that their work is limited to giving what seems like good advice without going a step further).
But even assuming that dentists understand the SYSTEMIC causes of cavities and chronic disease, what worries me the most is that the dentist, although he knows that he is a Health Professional himself–because that is what the diploma hanging on the wall and the prefix of “Dr.” on his business card says–he doesn’t see himself as such in the full extent of the word “Health”. The dentist usually feels limited to his area of expertise and although he is very good at it (orthodontics, prosthetics, periodontics, or surgery), every day he faces patients whose problems clearly go beyond a matter of dental bacteria or gingival inflammation.
Although dentists are familiar and support the definition of Health that the WHO gave us dozens of years ago and which Health is defined as the “complete physical, mental and emotional well-being and not just the absence of disease”, dentists have rarely seen themselves as facilitators of that Health for their patients: “Do I get involved in the emotional issues of my patients? Family problems? Nutrition decisions at home? The dynamics of communication? Get involved in personal matters? Educate them? Coach them?” All dentists wish someone else would support their patients in these ways, but they never see themselves as the person who could at least try.
Dentists have the privilege of being around their patients on a relatively recurrent basis, and over the years, they all build close relationships with conversations that go well beyond dental issues. The problem is that these conversations rarely turn out to be more than entertaining and friendly talks when they could also be empowering–if not transformative.
What if the dentist uses his inside information to see himself as a catalyst or as a coach for his patients’ wellness journeys? What would happen if the dentist decided to comment, support, or collaborate on issues that are not exclusively related to oral health?
Dentistry, as well as medicine, are sciences, and as such, they follow the Cartesian paradigm of separating into sub-disciplines all the symptoms that the “machine” of the human body manifests from time to time. When will there be a dentist who criticizes the way dentistry continues to be taught and is no longer useful in the context of rampant chronic diseases? When will there be a dentist who stops waiting for health problems to present themselves to start working with patients? When will there be a dentist who stops waiting for the next technological discovery that will free us from all problems? When will there be a dentist who does not try to reduce tooth decay or gingival problems to a single specific cause but to a cluster of interrelated causes? When will there be a dentist who gives proper place to nutrition, exercise, sleep, stress, cessation of smoking, and emotional management as the pillars of health? And that he, in addition, is not content with prescribing these habits, but really getting into the nitty-gritty world of changing people’s habits? When will there be a health professional who, instead of delegating patients to other specialties, dares to connect the dots by himself and accompany his patient on his journey to balance the physical, mental, and social areas oh health?
It is clear to me that I am being too rhetorical and even pedantic, but this, if you are really following me, show you that I don´t want to blame the dentist exclusively, the same way we can’t blame the patients exclusively. The blame lies within the entire SYSTEM. The SYSTEM in which the dentist was educated and in which he has worked for the last decades. Neither the dentist nor the doctor were taught that in addition to being what they are, they would have to be psychologists, nutritionists, coaches, anthropologists, marketers, and even philosophers. But that is what, in the context of the multi-causal chronic diseases, we would have to do in order to carry the full weight of what it means to be a Healthcare Professional in the 21st century.
When a dentist sees a child every 6 months and realizes that he has changed beyond the expected physiological changes; When a teenager gains or loses a lot of weight; When an adult who always had a clean mouth comes to the office with various problems; When a jovial and cheerful patient returns gloomy and looking down; When a 12-year-old teenager has cigarette stains, or a young girl shows obvious signs of bulimia… Can you keep quiet? Can you continue to think that this is not your problem? Or even worse, think that you are powerless in these situations?
Even more, the dentist rarely sees himself in the mirror to evaluate his own wellness journey and therefore, with the rush of every day, and the large number of acute problems (medical, social, and economic) we all face, his own voyage of self-discovery is never shared with patients so that they see that even dentists are also struggling with their own demons.
Rarely does the dentist turn to see his practice as a space that has to keep preparing to take a more active role in the pandemic of chronic disease that will continue to grow in coming years, even when no other dental office is doing so. Rarely does the dentist dare to seek economic models that pay for health instead of remaining dependent on models that pay for disease.
If cavities are the chronic disease that appears earliest in the life of patients, can we use it as a proxy to anticipate the different ways that we could empower ourselves to solve them? So that we can use these same tools with other chronic diseases later on? Can we think that the skills, knowledge, critical thinking, and awareness that will be needed to address these problems can be cultivated in the dental office by the hand (and the person) of the dentist?
Like all other organs in the human body, the mouth is essential for life to exist. Not only because we eat (and breathe) with it but also because the mouth is the vehicle to communicate with the world. There is no doubt that telemedicine will continue to physically distance patients from healthcare professionals, and perhaps dentistry will be one of the few disciplines where there can be no complete distancing. This means that today, the dentist will be one of the few health professionals who can take advantage of this situation to solve oral problems in person and, at the same time, uses the close bond with his patients to walk together each health journey.
Dentistry is medicine. And medicine is changing its paradigm. Dentists can choose to be part of this transition or can continue to ignore the little voice inside their heads that whisper every day that they could be doing much more for their patients.
Victor Saadia is a consultant, author and creator of the Podcast Back to the Future. He is also the founder of BioCenterCRYO and the Course on Complex, Critical, Multidisciplinary and Systemic Thinking in Health.
