Inequity Along the Medical/Dental Divide

Dental and medical health systems in the United States have evolved as fully separate entities. This division exacerbates health inequity, since patients’ poor oral health affects their general health. The professionally entrenched view that what’s in patients’ mouths is somehow isolated from what’s going on in the rest of their bodies is one all clinicians need to resist, since this view can be a source of harm, particularly among vulnerable patients and communities. Practical and ethical strategies for better aligning medical and dental goals of care are considered in this issue.

Volume 24, Number 1: E1-105 Full Issue PDF
  • From the Editor
    Jan 2022

    Inequity Along the Medical-Dental Divide

    Lisa Simon, MD, DMD
    It’s obvious that our mouths are part of our bodies. Yet in health care today, it’s hard to imagine any other body part so wholly neglected.
    AMA J Ethics. 2022;24(1):E3-5. doi: 10.1001/amajethics.2022.3.
  • Case and Commentary
    Jan 2022

    Should Dentists Treat Despite Medical Contraindications?

    Bernard Friedland, BChD, MSc, JD
    Some patients who need general medical care before a dental intervention can suffer increased risk for poor outcomes if they have compromised access to care.
    AMA J Ethics. 2022;24(1):E6-12. doi: 10.1001/amajethics.2022.6.
  • Case and Commentary
    Jan 2022

    How Should Emergency Department Clinicians Respond to Unmet Dental Needs?

    Alexa Curt and Margaret Samuels-Kalow, MD, MPhil, MSHP
    Division between medical and dental care exacerbates health inequity and forces many with compromised access to seek oral health care in emergency departments.
    AMA J Ethics. 2022;24(1):E13-18. doi: 10.1001/amajethics.2022.13.
  • Case and Commentary
    Jan 2022

    Why Should Primary Care Clinicians Learn to Routinely Examine the Mouth?

    Jesse Feierabend-Peters, MD, PhD and Hugh Silk, MD, MPH
    Despite availability of good national oral health curricula for medical trainees, most physicians are ill-equipped to identify oral cancers or avoid unnecessary referrals.
    AMA J Ethics. 2022;24(1):E19-26. doi: 10.1001/amajethics.2022.19.
  • Medical Education
    Jan 2022

    Education Solutions to the Medical-Dental Divide

    Chad M. Rasmussen, DDS, Kale B. McMillan, MD, DDS, MS, Dane C. McMillan, MD, DDS, MS, Leon A. Assael, DMD, and Kevin Arce, MD, DMD, MACM
    A medical-dental schism from 1840 persists and prevents oral health’s integration with overall health, to many patients’ detriment.
    AMA J Ethics. 2022;24(1):E27-32. doi: 10.1001/amajethics.2022.27.
  • Policy Forum
    Jan 2022

    Health Equity Needs Teeth

    Eleanor Fleming, PhD, DDS, MPH, Julie Frantsve-Hawley, PhD, and Myechia Minter-Jordan, MD, MBA
    Continued separation of dental and oral health from general medical care generates unnecessary prescriptions and pain management that are neither restorative nor responsive to patients’ primary complaints.
    AMA J Ethics. 2022;24(1):E48-56. doi: 10.1001/amajethics.2022.48.
  • Policy Forum
    Jan 2022

    Time for Dental Care to Be Considered Essential in US Health Care Policy

    Marko Vujicic, PhD and Chelsea Fosse, DMD, MPH
    Training, service delivery, and financing are done separately in dentistry and general health care, which has influenced reimbursement structures, access to services, and outcomes.
    AMA J Ethics. 2022;24(1):E57-63. doi: 10.1001/amajethics.2022.57.
  • Policy Forum
    Jan 2022

    What Primary Care Innovation Teaches Us About Oral Health Integration

    Ann Claire Greiner, MCP and Anita Duhl Glicken, MSW
    Five lessons from the patient-centered medical home could help motivate infrastructure investment, care innovation, and payment reforms critical to achieving equity.
    AMA J Ethics. 2022;24(1):E64-72. doi: 10.1001/amajethics.2022.64.
  • History of Medicine
    Jan 2022

    Eight Ways to Mitigate US Rural Health Inequity

    Jo Henderson-Frost, MD, MPH and Mark Deutchman, MD
    In March and April 2020, more than 90% of dental practices were closed entirely or seeing emergency patients only.
    AMA J Ethics. 2022;24(1):E73-79. doi: 10.1001/amajethics.2022.73.
  • History of Medicine
    Jan 2022

    Is Oral Health Essential?

    Elizabeth McGough and Lisa Simon, MD, DMD
    COVID-19 teaches us how to design a unified health care system that transcends historical precedent.
    AMA J Ethics. 2022;24(1):E80-88. doi: 10.1001/amajethics.2022.80.
  • Viewpoint
    Jan 2022

    How Medical-Dental EHR Integration Can Improve Diabetes Care

    Neel Shimpi, BDS, MM, PhD, Elizabeth Buchanan, PhD, and Amit Acharya, BDS, MS, PhD
    Poor oral health has been neglected as a public health threat, despite recognition as “epidemic” in scale by the US Office of the Surgeon General.
    AMA J Ethics. 2022;24(1):E99-105. doi: 10.1001/amajethics.2022.99.
  • podcast1-2201
    Podcast
    Jan 2022

    Ethics Talk: Why Oral Health Care Is the Way It Is

    On this episode of Ethics Talk, Dr Lisa Simon discusses her path from dentistry to medicine, and health journalist Mary Otto guides us through a history of oral health care in the United States.