Open Wide: Dentistry's Successes


January 21, 1992|By DANIEL S. GREENBERG

WASHINGTON. — Washington -- Politicians should take time out from their agonized writhings over the health system and absorb instruction from a field of patient care that's a spectacular success: dentistry, a health profession so effective in practicing prevention that it has seriously crimped its own business.

While medical schools continue to receive an abundance of applicants, several dental schools have closed in recent years for lack of candidates. Applications have declined because word has got around that dentistry isn't the booming profession that it used to be.

vTC The reason is that prevention, the strategic centerpiece of modern dentistry, really works for a great majority of the 'N population. And when it fails, the dentist's drill provides simple and relatively inexpensive repairs.

As a result of fluoridation, emphasis on frequent brushing, gum care and proper diet, more and more Americans are reaching advanced ages with most if not all their teeth intact -- a great turnaround in the history of health.

A survey conducted several years ago by the National Institute of Dental Research dramatically charted the change. Among those and older, 42 percent were missing all their teeth and only 2 percent had all 28 permanent teeth. But among middle-aged adults, only 4 percent were missing all their teeth, and half had lost at most only one tooth.

The difference is that the older generation grew up in what might now be called the prehistoric days of dental care, when artificial fluoridation was non-existent and the dentist's drill, if available, was a great fright.

It can be argued, of course, that the ills of the teeth are more approachable by preventive methods than the ills of many other parts of the body.

But prevention has always been a poor relation in the culture of American medicine, which prides itself on aggressive treatments surgery, drugs, and other invasive methods. Prevention ranks low in the medical school curriculum, and it has gained a foothold in government-financed research only after persistent badgering and statutory directives from Congress.

It was only recently, for example, that cancer research turned to serious preventive studies, particularly diet and life-style.

But even though the quest for cures has made relatively little progress during 20 years of the ''war on cancer,'' preventive studies still take second place in the allocation of the government's research money for the disease.

Dentistry's triumph has gone curiously unnoted in the scale of American cultural values, which remain indifferent to the great technical advances achieved by this health profession.

Dim-wits routinely strain for dramatic effect by invoking root canal surgery as the ultimate unpleasantness, though in fact that treatment, like most everything else in dentistry today, is painless or nearly so. And ridicule about dentists and dentistry are routine fare on TV sitcoms.

Now enshrined on the 1992 political agenda, the health care ''crisis'' has succeeded the cold war as the dilemma and challenge of the moment.

Some advice for all the presidential candidates running around New Hampshire, as well the White House occupant who wants to stay there: Check out dentistry, the only health profession that's suffering from success.

Daniel S. Greenberg publishes the newsletter Science & Government Report.

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