Shave, haircut … tooth pulled? The hidden history of dentistry
TruckBeat has been asking for audience stories and questions about health in East Tennessee.
When possible, we investigate to turn those questions into stories. And sometimes we ask you to vote for questions you think deserve a closer look.
In our most recent voting round, one question emerged as a clear winner: “Dental problems affect your health as much as anything else. Why is routine dental care not considered as important as regular health insurance?”
This listener question points to a longstanding health disparity the U.S. Centers for Disease Control and Prevention acknowledges is “profound in the United States,” particularly for people of color, and for people with lower education or income levels, who face barriers in accessing health services and dental insurance.
For more perspective on why health care and dental care are often not included under the same insurance policies, we spoke with expert Melinda Beeuwkes Buntin, chair of the Department of Health Policy at Vanderbilt University’s School of Medicine and former deputy assistant director for health at the Congressional Budget Office.
But first, some context about who in America has dental insurance coverage.
Dental haves and have-nots.
“Non-Hispanic blacks, Hispanics, and American Indians and Alaska Natives," the CDC says, "generally have the poorest oral health of any racial and ethnic groups in the United States.”
And, according to the National Association of Dental Plans, around 114 million Americans have no dental coverage, and 738,000 people turn to emergency rooms for dental treatment each year.
Even Americans with Medicaid may not have dental coverage.
While state and federal dental programs have expanded dental care for U.S. children over the last decade, dental care remains difficult to access for many adults, even those who are covered by Medicaid. That’s partly because adult dental benefits are optional, not mandatory, under federal law, the Kaiser Family Foundation reports.
The results of this policy look like this:
Insurance isn't the whole story.
Pew Charitable Trusts research shows that, “even when controlling for insurance status, low-income and minority children remain less likely than their more well-off peers to receive preventive dental care.”
From 2011 to 2012, Hispanic and African American children between ages 2 and 8 were twice as likely to have tooth decay than white children.
Preschool Native American children, “experience four times as many cases of untreated tooth decay as white children.”
Children in rural areas are less likely to have insurance that covers dental care, and are more likely than city kids to end up in the emergency room for preventable dental problems.
Pew reports low-income, minority, and rural families face a number of barriers besides access to dental insurance that determine how much preventive dental care children in such households receive, including transportation, cost of care and shortages of providers in many parts of the country.
Oral health vs. overall health.
Why does it matter how much dental care people receive?
There is increasing evidence that poor oral health has been associated with serious health problems, such as heart and lung disease, diabetes and stroke.
“We are starting to have a better appreciation of how dental health contributes to general physical health and how infections that enter through your mouth or enter through the teeth can actually affect lots of other parts of the body and people’s overall health,” says Vanderbilt University’s Buntin.
“So, with the perspective that modern science and medicine have on oral health, you can see that there is an argument to integrate them more than there has been in the past."
Still, Buntin says, integrating dentistry, and dental insurance, into the rest of medicine would be complicated, in part, by the separate networks and fee schedules used by insurance companies, doctors and dentists. “I don’t hear much discussion of [integrating the two] in policy debates,” she says.
How did dentistry become separate from other types of medicine in the first place?
Historians have found evidence that preventive and restorative dentistry, and early oral surgery, in various forms, were practiced widely throughout the ancient world.
"But in parts of the world that influenced our historical traditions, dentistry was not part of medicine. It was sometimes part of surgery, which was considered a lower status profession compared to other parts of medicine," Buntin says.
In Europe, she says, dentistry and medicine evolved as separate traditions long before scientists had an understanding of tooth decay, preventive care and oral health.
“Basically, for a long time, there wasn’t a lot that could be done for people other than pulling their teeth, and so a lot of early dentists were actually barbers,” she says.
Dentistry was performed by barbers?
That's right. Barbers.
“You’d go in and get your trim and your tooth pulled. And in some places, blacksmiths pulled teeth," Buntin says. "It sounds kind of gruesome, but if you’re the person who needs your tooth pulled maybe going to the barber is convenient, especially if that person is already trimming your mustache or something like that.”
European medicine and surgery were also practiced by monks or priests, sometimes with assistance of barbers. That is, says Encyclopædia Britannica, until 1163, when French church authorities ordered, “that henceforth no monks or priests were to practice any surgery, since it was felt that the shedding of blood was incompatible with the holy office of the clergy.”
And that left the barbers, who after adopting the title of "barber-surgeons," as the only group to continue practicing dentistry and tooth-cleaning in Europe for a couple hundred years.
Fun facts about European dentistry:
More from The Encyclopædia Britannica:
The first book in Europe devoted entirely to dentistry was published in Germany in 1530.
In 1728 the Parisian surgeon Pierre Fauchard, considered the father of modern dentistry, established dentistry as its own profession separate from surgery with the publication of the book, The Surgeon Dentist, or Treatise on the Teeth.
The word "dentist" emerged in English after the French "dentiste" in the mid-1700s.
Dentistry jumps the pond.
According to the American Dental Association, an English immigrant named John Baker brought dentistry with him to the American colonies in 1760. And the profession quickly took hold in the New World.
Did you know?
The American Revolutionary and Son of Liberty, Paul Revere, practiced dentistry in Boston.
According to the American Dental Association, Revere also apparently invented dental forensics In 1776.
More fun facts:
Read about the fascinating history of dentistry on the American Dental Association website.