Why doesn't the regular hospital do dentistry?

You go to the hospital for all kinds of problems with various body parts. Eyes, ears, nose, throat, broken bones, etc.

Sure, some doctors have their own private offices where they do podiatry or what have you, but you also have doctors at major hospitals doing the same stuff the little independent guys do.

However, you don’t normally find a dentist at the hospital. What gives?

I saw an episode of ER once wherein Dr. Lockhart was treating a case of meth mouth.

A Google search for “hospital dentistry” returned 7.5 million hits. The first page was dentists advertising their services for hospital patients.

Do they actually work for the hospital?

It looks like some of them do. Others use the hospital’s facilities to perform their services. Seems like that is similar to what many doctors do.

Here’s a residency program: http://sitemaker.umich.edu/um.gpr

Here’s a program within a children’s hospital: http://www.childrenshospital.org/clinicalservices/Site1919/mainpageS1919P0.html

Is that what you meant?

I’m not sure. I guess.

All I know is that I look at a place like Kaiser Permanente and I never heard of them having dentists employed on site.

I also looked at other medical groups nearby like UC Davis and Sutter Health and didn’t notice any dentists there either.

Is it common for folks to go to a hospital to see an hospital dentist for routine work? I just never heard of it and assumed they all had private offices.

I never heard of it either, but it makes sense that there would be dentists who go to the hospital to do things to folks who can’t leave the hospital. I have heard of dentists who go to the old folks’ home to tend to patients there.

I guess we never see them at the hospital. They must be ninja dentists !

Hardly a GQ-worthy source, but considering Jack Webb’s insistence on verisimilitude in his programs, it may be worth noting that a recently resyndicated episode of “Emergency” from back in the 1970s had the ER staff responding to what appeared to be a heart attack in an office/treatment room within “Ramparts General Hospital” where a dentist/oral surgeon was doing work on a patient (due to be put) under general anaesthetic. I’m not familiar enough with what the program was founded on to know further where to check on whether this was common procedure at a L.A. hospital in that time period, but it’s worth noting that a program claiming to be a re-enactment of actual events had a dentist operating within a hospital.

Where I went to university (Leeds in the UK) there were separate Dental and Medical Schools, and separate Dental and Medical teaching hospitals. I used to go to the dental hospital to get my teeth fixed by a student, so as to avoid the NHS copay (in those days at least there was a small copay for most dentistry, but not for doctors).

My guess is that the reason for the separation is largely historical. Most medical specialties have branched of in relatively recent times from the original professions of physician or surgeon, although somehow the once separate physician and surgeon professions have become amalgamated into medicine. I do not really know anything about the history of dentistry, but my guess is that tooth extraction was once a job for the old barber-surgeons (usually relatively unskilled and uneducated, unlike physicians), and that, like actual barbering, dentistry branched off from barber-surgery before surgery proper (originally pretty much just limb amputation) became closely allied with the physicians.

Since then it probably just been tradition that has kept dentists separate. Although there is now a lot of overlap now in the science behind it all, the dentists have their own professional organizations and schools, and even hospitals, and don’t want to lose their independence by being assimilated into the much bigger organizations of medicine (where they would probably find themselves pretty low on the totem pole).

What does one do in a dental emergency? If someone gets a tooth knocked out or something, can an ER handle it or do they have to go hunting for a dentist in the middle of the night?

An ER doesn’t handle toothaches, I was employed in two of them, as a reception clerk and PBX operator so I’ve seen this. They just tell you to take four ibuprofen (a prescription dose) and two tylenols and send you home. If the pain is REALLY bad they may give you something stronger or an antibiotic but just enough to get you thru two or three days till you can see a dentists. If the tooth is out, they can put it back in temporarily but that is it. They only do minimal work. Seeing as you can live without your teeth just fine, it’s really not an emergency. (I don’t agree but that’s how it is)

Some hospitals like Oak Forest Hospital (A branch of Cook County (IL) Hospital) will pull a tooth in an emergency but they don’t fix teeth.

I don’t care what anyone says, teeth aren’t included in medical procedures or insurance as they are too expensive to restore and fix. Medicine is about restoring parts of the body that have a use to their previous state. If they included teeth it’d cost insurance a fortune.

I remember up until about 1995 all my medical insurance included root canals. Then they stopped doing this.

Most dentist are Dr. of dentistry not MDs.
I have mesdical insurance and dental insurance. they are two seperate insurance.

I volunteer as an advocate for domestic violence/sexual assault patients in the ER at Columbia Presbyterian. A few months ago, I was called in for a patient whose partner had bitten her face so deeply that the wound went through her cheek to her mouth. The patient was actually transferred from a different, affiliated hospital to Columbia because Columbia had a dental resident on call, who could sew up all of the different layers of oral tissue. (It took about an hour and a half, and my patient was afraid of needles!) Columbia has its own dental school as part of the medical complex (and nursing, public health (my alma mater), OT, PT, etc.), and I assume that’s why they have dental residents on call in the middle of the night.

A related question that’s often occurred to me:

Why isn’t dentistry a sub specialty of medicine?

That is, why aren’t dentists tooth doctors in the same way that opthamologists are eye doctors? If it’s because teeth are non essential, well, not entirely true, but plenty of specialist physicians treat things that aren’t life and death. Is it because teeth are too complicated or too simple for physicians to concern themselves with?

My understanding is that oral surgeons are dentists who also go to med school and are trained in surgery like other surgeons. Is this accurate? What’s the real deal (the ahem, well, you know)?

Why does one person become a dentist, another an endodontist, and another an oral surgeon?

Along these lines, how much dental/teeth related training do physicians get? Do they take a “don’t mess with it, it doesn’t concern me” attitude, or could they work on teeth in case of emergency?

NJ has a combined med and dental school

http://njms.umdnj.edu/

Probably for historical reasons. Dentists were considered somewhat less skilled than doctors and required less training. Dentists were considered tooth pullers and did not require the amount of training a doctor did.

A good example of how it was is in the novel Mcteague, where the title character became a dentist simply by working with another frontier dentist and opens up his own practice in San Francisco. However, when the state sets up a licensing program, McTeague loses his practice. Frank Norris did extensive research, so the situation here was probably accurate. And it looks like the UK didn’t license dentists until 1921.

But dentists are tooth doctors now. They just have a different type of doctoral degree and different requirements than medical doctors.

I think most dentistry in hospitals is of the reconstructive and emergency variety (which are usually covered by health insurance). It’s probably not cost-effective for a hospital to house dental offices.

Interesting.

Kudos on the Frank Norris reference. One of my undergrad fav

Dentist checking in here…

The first 2 years of dental school used to be very similar to the first 2 years of medical school, the current trend is to move away from that and give those “basic” courses from a “dental perspective”

Teeth are actually complicated in their own way, the current way of things of having dental school separate from medical school is best, trust me on this one. You should never really ask a physician a question about teeth, they are definitely not qualified to answer, a dentist, may be able to answer medical questions, though.

Oral surgeons go to dental school (4 years after the 4 years of undergrad college) and then go on to their residency. Most OS residencies are 4 years in length, while some are 6 years (they earn an MD from these). The 2 different types does NOT mean that the 4 years’ guys are less qualified, it just means that their program didn’t include “getting an MD” option, but as far as the actual skill set, they are very much similar. People choose the 6 year route from various: prestige of having that MD, also because they are also interested in working in a hospital as a career as opposed to an outside clinic (the MD makes getting hospital privileges that much easier).

We all become GENERAL dentists first and then we can choose to practice as such or get additional training. Endo- root canals (2 year residency), Oral Surgery (4 or 6 year residency), Orthodontist- braces (3 year residency), Periodontics- gums specialist/implants (3 year residency), Pedodontist- children specialist (2 year residency), etc…

Physicians get VERY little training, a couple of lectures (depending on their medical school). They MAY be able to take a tooth out or pack giant cavities with some temporary material, but I personally never seem one do that. Go to the dentist for your dental needs.

A couple of guesses from a hospital worker:

  1. Med insurance doesn’t cover many dental procedures. Dental insurance usually won’t cover hospital expenses, with the possible exception of some surgical procedures. The dentist can bill but the hospital can’t. There is no financial incentive for a hospital to offer routine dental care. I would think it would be very difficult for a dentist to get regular hospital privileges.

  2. Dentists don’t want to take 24/7/365 call. That’s why they went to dental school.:slight_smile:

  3. Most ERs have the number of an night/weekend dentist that they’d be happy to give to you.

Most dentists now have connections with an ‘emergency dental service’ in the area, which is available 24/7 to treat dental emergencies. My dentist mentions this service, and the number to contact, in the recorded phone message if you call after office hours.

This ‘dental emergency service’ can range from an actual dental office that is open & staffed around the clock, to an informal arrangement between local dentists where they take turns being ‘on call’ and they agree to get up and drive to their office to meet an emergency patient in the middle of the night.

ER’s will treat the medical part of a dental emergency; beyond that they either have a pre-arranged dentist on call for such emergencies, or just refer the patient to the same local dental emergency service. (Note that something like a tooth knocked out is NOT a dental emergency – the tooth’s gone, now they deal with replacing it with dentures, an implanted fake tooth, etc. – and these are not ‘emergencies’.)