Of course, I’m not saying I don’t believe dentists exist. I’ve experienced enough sensory data to be pretty sure they do.
Nor am I saying that I don’t believe we need dentists. Obviously, dental problems happen and we need specialist tooth doctors to deal with them.
What I don’t believe in is the paradigm which holds dentistry to be of such preeminent importance. The paradigm that says we need quite so many dentists. That says dentists should operate independently of the rest of the medical system. That says they should provide their own first line inspection function. That says we need routine dental check-ups whether or not we have any reason to believe we have a dental problem.
Here’s how a sensible medical system should work. Your GP is the first line. If you have any kind of problem, you go to the GP first. If there’s a problem with a bit of your body that the GP can’t deal with, he or she refers you to a specialist for that part.
And indeed, that’s the system we have – for almost every part of your body: your brain, you heart, your lungs, your genitals.
But not for your teeth.
Instead, we have a separate system where we get routine inspections of our teeth, just in case anything’s wrong with them. That’s a huge investment of resources, both by the medical system and by us, focussed on a part of the body which seems relatively unimportant compared to, say, the heart or lungs.
Some GP surgeries do routine medical check-ups for their patients, checking things like blood pressure and breathing. Many don’t, or only recommend them for particular classes of patients, such as those over a certain age. But we’re all expected to have annual tooth inspections whatever our age. Maybe we should be doing general medical check-ups for everyone, or maybe the current system is fine. But what seems barmy is to be doing more systematic and rigorous check-ups for our teeth than for any of our major organs. This situation – the bizarre, actual one, rather than the ideal – seems to treat teeth as more important than any other body part, and dentists as more important than GPs or any other medical specialists.
The sensible system would include dentists in the same way it includes cardiologists or dermatologists: if you have a tooth problem, you go to your GP, and if it needs a specialist, he refers you to a dentist.
Presumably, the main theoretical argument in favour of the dentocratic paradigm is that our teeth are so problematic, the extra attention is justified. But that still doesn’t explain the blanket coverage.
Humans in the western world have dental problems mainly because our intake of sugar is much greater than our bodies were evolved for. People in the third world with less sugary diets have hardly any tooth decay.
That’s a good argument for western medicine paying more attention to teeth. But our greedy, sedentary western lifestyles have a lot of other health effects which don’t receive the same level of attention. As already noted, we don’t have our cholesterol, blood pressure and body mass index routinely checked. We don’t have our livers scanned every year for signs of alcohol damage. We don’t register with a back specialist from childhood so he can monitor us for problems caused by sitting at an office chair for eight hours a day.
It could also be argued that the frequency of dental problems during the growing process necessitates constant monitoring. But does it?
Let’s suppose that the majority of adolescents experience problems in dental development which require intervention. That’s a big supposition, too: braces may be a common sight on teenagers, but on over half of them? But even if we accept it, it only justifies routine checks during adolescent years. Also, it’s still an example of dentochauvinism. Adolescents and young adults have high rates of STIs and dermatological issues too, and although there are campaigns to increase STI testing among under 25s, that’s a long way off achieving the cultural expectation of routine check-ups enjoyed by our teeth.
A typical visit to the dentist by a 20 year old will involve him or her being told, ‘your wisdom teeth haven’t come through yet. It’s not a problem now, but it might be at some point in the future. We’ll keep an eye on it. The hygienist will see you next. And don’t forget to make another appointment on your way out.’
Imagine how much greater an effect we could have on public health if all of that effort – not just the routine inspections, but the hygienist sessions, the education work by nurses, and so on – was devoted to STI diagnosis and prevention.