A blog formerly known as Bookishness / By Charles Matthews

"Dazzled by so many and such marvelous inventions, the people of Macondo ... became indignant over the living images that the prosperous merchant Bruno Crespi projected in the theater with the lion-head ticket windows, for a character who had died and was buried in one film and for whose misfortune tears had been shed would reappear alive and transformed into an Arab in the next one. The audience, who had paid two cents apiece to share the difficulties of the actors, would not tolerate that outlandish fraud and they broke up the seats. The mayor, at the urging of Bruno Crespi, explained in a proclamation that the cinema was a machine of illusions that did not merit the emotional outbursts of the audience. With that discouraging explanation many ... decided not to return to the movies, considering that they already had too many troubles of their own to weep over the acted-out misfortunes of imaginary beings."
--Gabriel García Márquez, One Hundred Years of Solitude

Sunday, December 14, 2008

Nothing But the Tooth

Why don't hospitals and clinics have dentists on staff? Why is dentistry different from other specialties that deal with the human body? Why don't dentists get the training that M.D.s get? Why do medical plans not cover dentistry? (Especially Medicare. You'd think nobody needed help paying for dentistry more than its recipients.)

All these questions occurred to me as I was lying on a bed in the hallway at the Stanford E.R., waiting for the diagnosis of what had made me go partially blind. (Literally in the hallway. Stanford's E.R. is so crowded that it has put beds in the hall, especially for patients who don't need modesty curtains. They're even labeled: Hall 1, Hall 2, etc.) My neighboring patients included a woman with no family, no job (hence, no insurance), and a variety of serious and unpleasant illnesses; a diabetic man who had neglected the injury to his foot he received on the job and was now threatened with amputation because it had turned gangrenous; and a grizzled biker type who was there because he wanted a pain-killer for -- he said -- a really bad toothache. The young resident who saw him winced at the state of the man's teeth.

"How long has it been since you saw a dentist?"
"I dunno. A while I guess."
"You need to see one."
(with utter lack of conviction) "OK."

He got the meds and left.

We're constantly told how important dental health is. How infected teeth can spread infection to the rest of the body. In my case, in which the source of an infection was crucial, I was repeatedly quizzed about my teeth. (I am pleased to report that there was a chorus of admiration when a team of doctors and med students examined my "dentition" one day. I must tell my fine young dentist, Dr. W., to whom I once commented, "I have fillings older than you." He has since replaced them. Expensively.)

So why isn't dentistry an integral part of the medical picture? I guess if I Googled enough I'd get an answer, something to do with the histories of the separate professions, rivalries and jealousies and economic advantages. But in a time of reform, when everything is being examined with a view to making it new, when "holistic" is a byword, shouldn't this odd, arbitrary division between dentistry and medicine be re-examined?
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