Why Medical Care and Dental Care are Separate

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If you’re fortunate, you have health insurance and dental insurance provided either through your employer or through your parents or guardians. If you’re an adult on Medicaid, you may not have any dental coverage at all.

But why are dental insurance and health insurance—and the professions of doctors and dentists—separate, when our teeth are so important to our general health?

The separation between dentistry and the rest of medicine starts from the fact that dental procedures were often performed by barbers. They would pull painful teeth and lance abscesses once they were done giving their clients a haircut or beard trim.

The dental profession didn’t really become a profession until 1840, when the first dental college in the world opened at the University of Maryland in Baltimore. Prior to that, Chapin Harris and Horace Hayden tried to get dental courses to be taught in medical schools, but the doctors believed that dentistry was more of a “mechanical challenge” than a medical issue and rejected their proposal.

Because of the “historic rebuff,” as it is known, medicine and dentistry became separate professions, and remain that way to this day, despite many efforts to make dentistry an essential part of the healthcare system and provide insurance for dental and medical procedures under public insurance programs.

Oddly enough, these days it’s dentists who want to stay separate from doctors. Part of it is about the marketplace, and part of it is about the fact that medical records and dental records have separate diagnostic codes and it would be difficult to get dental records integrated into medical ones. It’s also the reason why health insurance and dental insurance are separate entities.

It’s this divide that brings more than a million people each year to emergency rooms with dental pain. The doctors there can’t do anything but provide antibiotics and pain relief and encourage people to see their dentist to have the problem treated—and for that, it costs the system more than $1 billion a year.

This separation between dentistry and medicine is especially frustrating because dental problems can affect everything about us: our ability to meet our basic nutritional needs, our ability to maintain our overall health, and even our ability to get a job (missing teeth can be a real handicap when searching for employment).

The state of our teeth is also an easily visible status symbol. Wealthy people tend to have nice, straight, white “Hollywood smiles,” while the poorer among us may have crooked teeth, extensive tooth decay, or other dental problems. “Perfect teeth are a very clear way of signaling your wealth,” wrote Julie Beck in The Atlantic, “More clear than if everyone had access to good care and had decent teeth.”

What do you think? Should dental care and medical care be separate? Why or why not? Please share your thoughts in the comments.

Living Healthy: Knowing Your Key Indicators

I often ponder the thought that each of us is unique, both in body and mind. Yet we continually make mass generalizations of what is “right” or “wrong” for our health, without any respect to individuals. Of course, there are things that are generally good for most people, and I can understand why we fall into the habit of applying those truths to everyone. But I think the single most important key to living a healthy life is knowing your unique situation.

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"Health is a relationship between you and your body."

For example, my workout buddy and I run together several times a week and attend exercise classes one to two times per week. She also lifts weights and does core strength training at home. She stretches every morning, as well as before and after our runs and classes. I would like to say I am as vigilant as her, but I’m not—which is part of the reason she is more fit than I am.

But though she has a stronger core and body in general, she is constantly hurting herself. Not the pushed-too-hard kind of hurting. The “I sat down and now my back is tweaked out” kind. She is a thousand times more careful than I am, yet she is always getting injured.

Another friend has cut most carbs, grains, and sugars out of her diet because when she eats them more than occasionally, she finds that she puts on extra weight. I have been on a low-carb, low-grain, and low-sugar for the better part of a year and it doesn’t affect my weight at all.

One of my roommates can’t eat or drink anything with aspartame in it because it gives him bad migraines. I also get migraines, but aspartame doesn’t have that affect on me—but alcohol does, if I drink more than one. He can drink several and not end up with a headache.

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"Self knowledge is no guarantee of happiness.
But it is on the side of happiness
and can supply the courage to fight for it."

I think as we grow, we learn more about ourselves, and sometimes that includes learning about our health. But too many people rely on the doctor when they are feeling down and out rather than proactively managing their health. I read about an interesting program the other day that is coming out of Henry Kravis’ company, Kohlberg Kravis Roberts. It works with employees to help them recognize and understand their own key health indicators and better manage their health.

Now, I’m lucky enough to have health insurance, but there is certainly no program like this that helps me understand my health. What’s my normal blood pressure? No idea—they never tell me so I assume it’s normal. It’s things like that which I should know but don’t.

What do you think? Is it our doctors’ jobs to essentially fix us when we’re sick, or should they be working to help us understand our own health? Do you know of any other programs out there like KKR’s that work with employees to do this? I’m interested to find out what people know and want to know about their own health.