By Jack Cumming
When the American Dental Association endorsed Crest toothpaste in 1960, it changed dentistry forever. The breakthrough was the cavity-preventive inclusion of stannous fluoride in toothpaste formulations, and Crest was the first brand to adopt it. With that endorsement, dentistry moved from treatment toward prevention.
Why?
The question, then, is why dentistry has adopted preventive prophylaxis while general medicine has not. As an example, the American Medical Association has only tentatively adopted the idea of telehealth. Moreover, why is it that the AMA, or the American Hospital Association for that matter, have been unable to give us a single universal, cradle-to-grave electronic health record (EHR)?
The AMA position on telehealth is nuanced. It identifies four “pitfalls,” namely [Source]:
- Erosion of the patient-doctor relationship
- Threats to patient privacy
- Forcing one-size-fits-all implementations
- Temptation to assume that new technology must be effective
Giving these “pitfalls” a little thought reveals the AMA’s advocacy for physicians’ economic interests, even as new modalities may threaten both the number of physicians needed and the office-visit model of patient interaction.
Why Not?
The breakthrough for dental efficacy was the accidental discovery that low levels of fluoride can reduce cavities. This led to the first controlled community water fluoridation experiment in Grand Rapids, Michigan, in 1945, which showed a dramatic drop in cavities, leading to the widespread adoption of water fluoridation and the use of fluoride in toothpaste.
For a time, it appeared that the dental profession, i.e., the education and practice of licensed dentists, would be adversely impacted. Within the context of 1945, that may have happened, though the adverse effect may have been offset by more widespread dental consultations among the general population. In 1945, many people didn’t go to the dentist. Now more people do. Toothbrushing has also become common.
In other words, improving dentistry’s efficacy may have led to its wider acceptance for the greater benefit of humankind. The same might be true of general medicine as it evolves. Most people have recurring six-month dental checkups, while nothing as systematic as that exists for general medicine.
A Changed Mindset
Moreover, dentistry has evolved in other ways. In 1945, dental hygiene, the removal of accumulating plaque, was generally done by dentists. Since then, dentists have delegated that to hygienists with a consequent improvement in cost-benefit outcomes. Physicians still remain the primary point of contact in the medical system, and that seems unlikely to change materially anytime soon.
We should quickly note that neither physicians nor dentists have developed a consumer-friendly payment model. Still, dental fee-for-service structures are more straightforward and less manipulative than the hospital chargemaster system or the inscrutable physician payment system. If we, as a nation, had more deliberative governance, those challenges might be readily rectified.
Proactive > Reactive
The takeaway is that dentistry has become proactive, perhaps as a consequence of the fluoridation breakthrough, while medicine remains reactive, with visits a forum for patient complaints and physician reactions. In dentistry, the talk is of home care, and if that lags, dentists bring you in more often to get you back on the prevention track. In general medicine, prevention is of lower priority than treatment.
Here is an opportunity for senior living. Already, for a small subset of the general population, PACE (Program of All-Inclusive Care for the Elderly) programs are aligned more like dentistry. They seek to maintain the health of older people and keep them on the lowest-cost track. Instead of the narrow perspective of physician specializations, PACE takes the larger, holistic approach to optimize well-being.
The Opportunity
There’s no need to mention what you already know, that the economic impact can be enormous. The opportunity is there for a breakthrough that could improve health outcomes while reducing costs. The United States has, by a wide margin, the highest cost of healthcare of any advanced nation, but without the wellness advances to match that outlay.
Some have tried to pursue that and failed. Remember Atul Gawande’s leadership of a joint project by Amazon, Berkshire Hathaway, and JPMorgan Chase, named Haven, to do just that. Haven, like other efforts, floundered on the political rocks of ill-considered barriers.
The residential senior housing model, though, has attributes that could allow it to become the breakthrough, much as the 1945 Grand Rapids, MI, pilot showed the value of prevention for dentistry. Why not take the senior living industry from an archaic warehousing concept toward a bright beacon of leadership for the American nation?
