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One of the primary goals of the Affordable Care Act – more popularly known as Obamacare - was to expand access to preventive health care services. From screening tests to vaccines and counseling, the ACA is centered on the idea that preventing healthcare problems is far more effective than fixing them.
It’s odd then that realistic provisions for dental care are so noticeably absent in the healthcare exchange marketplace. Granted, dental care has had an awkward relationship with the medical industry for a very long time, but the ACA was supposed to reform the oddities of our health system. And one of the strangest quirks of the U.S. medical industry is certainly the long-standing separation between dentists and the rest of the healthcare community.
Why Dentists and Doctors Got Divorced
To understand why dental care is medicine’s strange little stepchild, we have to go back a few millennia.
People have been trying to figure out what to do about aching teeth for a long time. According to the American Dental Association (ADA) archeologists have spotted grooves on prehistoric human teeth indicative of toothpick use. A grave inscription in Egypt dated to 2600 BC, honors Hesy-Re, an Egyptian scribe, who apparently was also “the greatest of those who deal with teeth, and of physicians.” The ADA refers to Hesy-Re as the first dentist.
And though the ancients may have had a few of the details wrong - dental decay was attributed to the presence of worms burrowing through teeth in an ancient Sumerian text, an idea that persisted until the 1700s - much of their basic understanding of dental science was sensible. Hippocrates and Aristotle’s writings on treating decayed teeth and gum disease, tooth extractions, the life cycle of teeth, and the use of wires to stabilize loose teeth still make sense to the modern mind. Dental care was sophisticated too. The Etruscans, from what is now central Italy, were installing gold crowns and fixed bridgework back in 166-201 AD.
Despite all of the classical world’s skill and scientific exploration about oral health issues, dental historians agree that dentistry got its start as an official profession around 1210 with the establishment of a Guild of Barbers in France. The barbers eventually split into two groups: surgeons who performed operations and barber-surgeons, who were trained to shave beards, extract teeth and bleed ill people. (Bleeding was a cure-all for every disease, as it released demons, restored the body’s natural balance, and reduced inflammation).
In 1728, Pierre Fauchard, “the father of modern dentistry” began pushing dentists to separate themselves from those unsavory surgeons, whose patients – in a time before sanitation was understood and anesthesia existed - considered themselves lucky to survive an operation. Fauchard was using techniques learned from jewelers and watchmakers to create false teeth and implants – painstakingly carving each individual tooth from ivory and creating tiny pivots, pegs and wire fasteners from gold. It’s easy to see why he felt that dentistry should be a separate, elevated practice distinct from the crude medical standards of the time.
Following Fauchard’s example, dentists’ training focused on teaching careful craftsmanship until well into the mid-twentieth century. And so dentistry was considered something of a cosmetic art, rather than a lifesaving medical science. In the 1960s the first research on importance of o
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