Hardly a day goes by when there isn’t some reference in the media to the "looming crisis in primary care." These repeated warnings recount tales of current shortages in the number of primary healthcare providers and predict a future supply of primary caregivers that will be inadequate to meet the healthcare needs of the aging U.S. population.
According to the Institute of Medicine (IOM), primary care is "the provision of integrated, accessible, comprehensive, and continuous healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community."
A primary care provider, according to the IOM, is a clinician who:
- cures or alleviates common illnesses and disabilities;
- serves as an entry point to a system that includes secondary care (by community hospitals) and tertiary care (by medical centers and teaching hospitals); and
- provides ambulatory versus inpatient care.
Like family practitioners, dentists, according to Congress, are primary healthcare providers. But how often does one think of dentists in this role?
Given that all of the activities that broadly define primary care are well within the scope of dentistry, the question we seek to address in this issue of Global Health Nexus is: "What is the dentist’s role in primary care?"
To that end, we began by seeking patients’ perspectives through an informal survey conducted in several private dental practices. We asked patients, "What do you want and expect from your dentist?" Would we find that patients want and expect their dentists to recognize nondental disease states and make appropriate referrals, as well as to diagnose and treat diseases traditionally thought to come under the umbrella of dentistry? Do patients expect dentists to play a role in preventing systemic as well as local diseases by actively recommending healthy lifestyles— all things that are part of primary care and that dentists are well trained and well positioned to do? Or would we get other answers? Below is a sampling of replies.
"I want low fees, reliability and convenient hours." "I expect a clean, friendly environment." "I expect my dentist to be on time for appointments and to be confident in rendering a diagnosis." "I want my dentist to be well informed and able to answer all my questions until I’m completely satisfied that I understand the treatment plan." "I expect my dentist to help me keep my teeth."
When asked if they expect their dentist to be interested in their general health, patients said yes, but then spoke only about such things as bleeding gums, pain and the age at which a baby stops teething. For these people, the dentist’s role does not extend beyond the borders of the lips. Indeed, the thing that is most striking is that not one person mentioned the word "health" as part of dentistry! Their responses, while surely not definitive and not the result of a scientifically conducted survey, nevertheless suggest that dentistry may be in danger of not being considered by the public to be an integral component of the nation’s healthcare system. If true, this would be a serious marginalization of our profession, and one that may be selfinduced.
To discuss the dentist’s role in primary care, we have invited several of our nation’s most prominent thinkers in this area to share their views on the need and the opportunities that exist for practicing dentists to enhance the healthcare services they provide, thereby becoming active players in fulfilling the potential of the primary healthcare paradigm.
Our distinguished contributors include Dr. Michael Glick, Editor of the Journal of the American Dental Association; Dr. Bruce J. Baum, Chief of the Gene Transfer Section, Gene Therapy and Therapeutics Branch, National Institute of Dental and Cranofacial Research (NIDCR); and Dr. Jerold Goldberg, Dean of the Case Western Reserve University School of Dental Medicine, which recently introduced the firstever dual degree, DMDMD program. From the NYU Colleges of Dentistry and of Nursing, we are privileged to present essays by Professor Daniel Malamud on the evolving role of dentists in the emerging field of oralbased diagnostics; and Professors Madeleine Lloyd, Caroline Dorsen and Judith Haber on the oralsystemic connection. We also offer a first look at a new smoking prevention program targeting preteens that NYUCD is about to introduce.
On a personal note, I am absolutely delighted that Dr. Charles Bertolami has accepted the University’s invitation to become Dean of the NYU College of Dentistry, effective September 1, 2007. Charles comes to NYUCD from the University of California at San Francisco School of Dentistry, where he has served as Dean and Professor of Oral and Maxillofacial Surgery since 1995. He is one of the most impressive individuals I have ever encountered and one of the most effective communicators in the world of dental education. Charles has a welldeserved reputation for succeeding at every challenge he takes on, and I know that he will take NYUCD to "the next level." I invite you to read the following article, "Introducing the New Dean," to learn more about what Charles brings to his new position, and to join me in welcoming him warmly to our campus.
It has been my distinct privilege and pleasure to serve as NYUCD’s Interim Dean for the past year. I am proud to have held this position and want to say to everyone I have worked with during the past year—faculty, staff, alumni, and students— I can’t thank you enough for your help and support. I look forward to continuing to work with you and with Dean Bertolami to ensure that NYUCD’s momentum in the world continues to grow and that NYUCD thrives as never before.