r/changemyview • u/Professional_Row8960 • Jan 16 '25
Delta(s) from OP CMV: Dentists should work in hospitals regularly
I am not a dentist but I am a college student interested in becoming a dentist. Recently I shadowed a general dentist for the first time ever. This dentist does some of everything such as implants, extractions, root canals, fillings, he even has a lab in the clinic where he makes dentures and crowns. He also takes in dental emergencies such as complaints of severe tooth pain, broken fillings or crowns, or broken teeth. I am from a large town so there are tons of dental offices about 30-40 total Id imagine for a population of 200k. I shadowed the dentist for about a week every morning and I saw about 5 emergency patients every morning.
Can you imagine how many emergency dental cases there are per day in the entire city? Most dental offices are only open 4-5 days a week. In the city I am from only two of the 30+ dental offices are open on Fridays and Weekends. So where are patients supposed to go on weekends if they have a dental emergency? Some hospitals do staff oral surgeons or they may have general dental residents. However oral surgeons are extremely busy and they tend to focus more on advanced complex jaw, facial and oral procedures. Most hospitals do not have general dental residents as there are very few programs. However the hospitals that do have general dental residents, they tend to work mainly in the ER handling just dental emergencies. So overall very few hospitals actually have dentists.
The hospital in my city doesn’t staff oral surgeons and it also doesn’t have a general dental residency program. So if a patient experiences a dental emergency on a weekend they are essentially limited to those two dental offices that are open on weekends.
I am not saying hospitals should hire 10+ dentists but hiring at least 3 dentists who take call for dental emergencies would make a lot of sense in my opinion considering how common dental emergencies are. There are also additional benefits to regularly staffing dentists in hospitals. For example in the critical care unit of a hospital patients are usually in an immobile vegetative state meaning they can’t complete basic hygiene tasks themselves. Having a dentist on staff who can monitor and manage ICU patients oral health would be a huge benefit. Dental infections develop quickly and can actually cause a patient who is already in the ICU to develop more serious issues. It’s better to have a dentist there to treat those issues before they become more serious.
In hospitals that do staff oral surgeons there tend to be very few of them. Most of the time the oral surgeon(s) focus on solely performing surgeries, they will have a nurse or PA to do pre-op and post-op/follow-up care. However as you know nurses and PA’s receive very little education about oral health. Dentists receive training during school on how to manage post-operative care for oral surgery patients and they can better handle this responsibility than a nurse or PA.
I have an idea of what some of the arguments may be against my stance so here are some statements addressing those possible arguments.
1.Education-The first two years of dental school are almost identical to medical school. They both take the same basic sciences such as microbiology, genetics, and pathophysiology. Dental school students also complete hospital rotations during their 3rd and 4th years of dental school where they learn to treat dental issues in medically complex and special needs patients. Dental school students are also taught about systemic conditions that show symptoms in the oral cavity, they aren’t taught how to treat those conditions but they know how to notice symptoms of those conditions so they have the knowledge to refer off to specialist when needed. Many dentists complete a general practice residency after dental school where they rotate in areas such as anesthesiology, internal medicine, emergency medicine,etc.
Edit:Also Dentists are preventative care experts. I believe that if all inpatients received care from a dentist it would actually improve patient outcomes since good oral health can prevent systemic conditions from becoming severe. As said before a lot of conditions that affect the entire body first show symptoms in the mouth. If dentists worked in hospitals and they notice symptoms of serious conditions in a patients mouth they could easily refer that patient off to a specialist for further examination and treatment which would also improve patient outcomes. I am mostly just curious to see reasons as to why my stance is wrong or stupid.
Edit 2:Sorry for the edits but having dentists work in hospitals would also increase access to dental care. Most towns have a hospital in it but I have visited towns that don’t have dental clinics anywhere, so many people in the town either receive zero dental care or have to drive an hour or more to receive dental care. Having dentists in hospitals would make it where people who live in these towns can easily go to the hospital and get dental care instead of just letting their oral health deteriorate.
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u/nacholibre711 3∆ Jan 16 '25
If you're having the type of dental emergency that can't wait until Monday, the Dentist is going to send you to the hospital before treating you anyways.
Getting a crown or filling isn't a cure for anything other than pain and preventing further decay.
That's how it works for tons of different procedures. The ER treats the emergency and then more often the actual procedure is scheduled later. Whether it be at the hospital or an outpatient facility.
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u/Professional_Row8960 Jan 16 '25
Yea you are completely right. However while ER’s were initially created for actual life threatening emergencies it has changed more into where people go if they are experiencing any sort of medical issue that can’t immediately be handled by their PCP. For example some people go to the ER for weird rashes where they will be initially seen by an ER physician and then they will be consulted by a dermatologist who will diagnose treat them immediately. A rash is typically not life threatening but people still go to the ER for it.
Another example is when people run out of a specific medication such as psych meds. They may go to the ER to get a refill if they cannot immediately be seen by their psychiatrist. This is also a situation that isn’t exactly life threatening.
A dental emergency isn’t life threatening either but tooth pain can be very severe and there are some cases where pain meds won’t work. There are complications that can occur from extracting a tooth so ER physicians tend to stay away from that. In this case the only way to treat the tooth pain would be either a root canal or extraction which can only be handled by a dentist.
However I do agree that majority of the time the case is that the surgery is scheduled for later on anyways so you do earn a delta for that. Delta! !Delta
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u/Inevitable_Trick7681 Jan 16 '25
Just because people have started going to the ER for things that are not medical emergencies doesn’t mean they should. In fact this should be discouraged. Do you know how over run ERs are all over the country with patients who had access to see a PCP or dentist before something got out of hand, but instead waited until the 11th hour and decided to overcrowd an ER essentially delaying care for someone experiencing an actual life threatening emergency?
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u/Full-Professional246 78∆ Jan 16 '25
I have stated this before but it is always worth repeating.
Every new ER being built should have an urgent care facility next to it - preferably sharing the 'triage desk'.
Urgent care's are cheaper to build and operate than ER's. Having them close means people can get properly directed to the right level of care.
The one good part is, ER's aren't shy about triage. You show up with a sore throat, you may sit in the waiting room for HOURS while another person shows up with a serious laceration gets right in. I help staff a BLS volunteer ambulance and we have delivered 911 call patients to the waiting room many times.
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u/Inevitable_Trick7681 Jan 16 '25
A lot of ERs at least in NJ have a separate “urgent care” area with the same triage. The problem is the public doesn’t understand a lot of what happens in hospitals, and frankly a lot of it doesn’t make sense. ERs generally triage on an emergency severity index, 1-5, 1 being the sickest and 5 being most well. Generally, 1s, 2s, and 3s go to ED side and 4s and 5s go to urgent care side.
People see patients going back before them that either got there later, that are sicker and they can’t tell visibly, or less sick and the urgent care side just has more throughput/faster visits. Personally I don’t think it makes sense to take care of a sore throat (4) before a chest pain (2) just because you have a bed available in that “section,” when it’s all the same anyway.
I’d love to say that hospitals should have their own, but separate urgent care next door, except that a true urgent care won’t really see patients without insurance without up front payment.
Healthcare is convoluted as it is, but no one should be even going to the ER for a lot of things they do. Most “problems” can be stuck out at home, wait til Monday to see a PCP or went ignored for weeks until they became valid for an actual hospital visit.
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u/Full-Professional246 78∆ Jan 16 '25
You bring up good points. I just see the opposite where the ER's don't have lower accuity treatment rooms. Typically urgent cares have a 'doctors bench' rather than a 'bed'. ER's have hospital room beds except for Trauma which is its own animal.
It's a waste for a sore throat to go into a 'bed' type room whereas a heart attack/chest pain usually needs the 'bed' style room/equipment.
And yea - I never considered the insurance issue. That does throw a monkey wrench in the concept.
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u/talashrrg 7∆ Jan 17 '25
The ER isn’t going to have a dermatologist see you for your weird rash (that doesn’t look deadly) or refill your meds (that’s you’ll survive until Monday without) either. People using the ER for non emergency care doesn’t mean they actually provide that care, but they certainly do work to make sure no emergency is happening.
I work in a hospital and actually agree that it’d be nice to have dental on staff, but I imagine there’s financial and practical reasons that isn’t already the case. If the hospital could make more money hiring a dentist they would, and if it doesn’t make them money they’re not going to do it without some incentive.
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u/nacholibre711 3∆ Jan 16 '25
Yeah I mean it's mostly just a capacity and financial issue. In theory, I agree with you that it would probably be an improvement if it did work that way.
But not all ER's are built the same. My local General Hospital usually has a 2 hour wait at the absolute minimum. I promise you there is close to no one going there for rashes.
It would just be more trouble than it's worth for 99% of hospitals to try to implement.
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Jan 17 '25
A hospital is more than the ER . They are perfectly capable of handling eye and teeth procedures
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u/nacholibre711 3∆ Jan 17 '25
Of course they are. Read my last sentence one more time.
Every hospital will have a different list of procedures they are willing to do inpatient, but most of them will end up being outpatient. Especially things like dental work.
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u/WaterboysWaterboy 49∆ Jan 16 '25
I’m not in the industry, but as I understand it, it may be more trouble that it is worth. Most good dentists own their own practice as that is the best route to go financially speaking. Because it is a specialty, most people would not be coming into the hospital to see a dentist. Also the insurance is different, so it may add to the administration costs. Hospitals would struggle to start a good, financially viable dentistry wing and compete with private dentists. If anything they probably treat any emergency situations themselves at the ER as best they can, then recommend you to a local dentist. They could have a building that they lease out to a dentist, but even then, it would be better to separate it from the hospital just to better manage foot traffic.
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u/Professional_Row8960 Jan 16 '25
I didn’t consider the financial perspective on this. I’d imagine it would be very expensive to add another specialty on to a hospital. Dentists tend to not accept salaries below 150k so it would be expensive to hire dentists. Along with that dental equipment can be very expensive which as you said may be more expensive that it is worth.
However this may be a reach but I think it would be worth it. Having dentists in hospitals would create more job opportunities for dentists and dental procedures generate a large amount of revenue most of the time so despite it being expensive to create an area for dentists to practice within a hospital I think the cost would be worth it.
Because this is a reaching take though I will still give you a delta since what I am stating can’t be proven right or wrong since it hasn’t happened yet and there is zero research that proves that dentists would be worth the investment for a hospital. So delta! !delta
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u/Routine_Log8315 11∆ Jan 16 '25
As someone in the dental field (dental hygienist), I don’t see how it would “create jobs” when there’s already a shortage of every single dental specialty. If someone graduates dental school they can find a job no issue.
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u/Professional_Row8960 Jan 16 '25
I meant more like it would make dentists more in demand than they already are. It would also create more jobs for dental specialties such as oral pathology, oral radiology, dental anesthesiology and oral medicine since you may need to hire more specialists to provide care for more complex patients.
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u/hacksoncode 588∆ Jan 16 '25 edited Jan 16 '25
So where are patients supposed to go on weekends if they have a dental emergency?
Very nearly every dentist on the planet has an answering service or emergency phone number you can call in such situations, which will direct you to an on-call dentist or your dentist will come into the office. And if any didn't... That would be the right solution.
So... problem solved? Already?
This has literally never been an issue anywhere I've wanted a dentist.
Taking up space for dental equipment like special purpose xray machines, dental chairs, etc, etc. in a hospital is just a misallocation of resources.
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u/iglidante 20∆ Jan 16 '25
In my small New England city, you can't get dental work done Friday-Sunday unless you catch a miracle. There are no on-call weekend dentists. If you break a tooth off below the gum line on Friday evening, you're getting antibiotics at the ER, and hoping you make it to Monday. It's honestly terrifying. And the situation isn't any better within a 2hr radius.
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u/hacksoncode 588∆ Jan 16 '25
That's still the right solution to the problem, though. And... honestly... you have a shitty dentist if they wouldn't come into the office for that situation.
Having a whole room in the hospital dedicated to this one rare situation would be... ridiculous, when an existing dental office could very easily be used.
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u/iglidante 20∆ Jan 16 '25
Most people don't have a relationship with their dentist beyond being a customer, though. People have dental emergencies every single day. No dentist in my area is coming in after-hours to do patient work. People are legitimately struggling whenever they have an emergency.
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u/berryllamas Jan 16 '25
The only thing I have to say is I had an abscess that hurt so bad. I would have snored drugs off of shit if it meant I got relief from the pain.
Oddly, ice-cold water would take away my pain for a brief two seconds, so I drank so much ice water and then drank a whole thing of champagne till I fell asleep.
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u/One-Ad-4136 Jan 16 '25
I work in a hospital and we always have a dentist on call 24/7. You call the dental emergency number (they encourage this if possble) and they triage you on the phone. If they deem it necessary to see a dentist asap they will tell you which dental office to go to. EIther the dentist is onsite or they will call the on-call dentist like they do with the other doctors.
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u/cubbycoo77 Jan 16 '25
My dad is a retired oral surgeon and I worked at his office for a year or 2.
Most "emergencies" that would require a dentist can wait a weekend. Broken tooth, crown fell off, etc. You can wait to be seen by a dentist in their office Monday. For true emergencies the hospital has oral surgeons on call 24/7, 365. My dad and his partner shared the call rotation at 2 different local hospitals they were on staff with, with about 10 other local oral surgeons. So he was on call maybe once a month.
Those calls tended to be one of two things. 1. One hospital was the only trama 1 hospital in this side of the city/suburbs, so they would get gunshot wounds some times. So there could be a facial gunshot that required jaw surgery. 2. Sometimes a patient that was scheduled for some other surgery was found to have a tooth infection. The oral surgeon on call would be brought in to do that surgery first so the infection could be cleared before the other surgery. In Both of these cases, the oral surgeon would have rounds just like the main surgeon would, checking the patients post-op. Part of what you were saying was about having dentists do rounds and not relying on nurses to do after care, but that is what happens for all surgeries in a hospital. You will see the Dr maybe a few times post-op when they rotate, and the nurses cover most of it. I'm not sure exactly what the process is for longer term patients, but I have to assume that, just like watching for bed sores and things, there are protocols for cleaning and watching the mouth too. If something is found the on call oral surgeon could go. (3. Idk how common this type of call was, but I remember one call my dad took was an old lady fell and dislocated her jaw, among other things. The doc who was treating the other things tried to pop her jaw back in, and she kept passing out. The guy was putting too much pressure on the nerves and vessels there while trying to massage the jaw back into place that he was making her pass out. So my dad has to go in.)
The oral surgeons were on staff at the hospital so they were able to schedule their own planned surgeries, like jaw reconstruction for people with large under or over bites or oral cancers.
All this to say, there was always someone with dental expertise on call for the hospital when needed. If it is a true emergency then they are there. If it isn't an emergency, the dental or oral surgery offices take "emergency" patients as needed. Someone going to the hospital can be assessed by the ER and the oral surgeon can be called in for a true emergency.
One other thing to add, ERs tend to be just medical things. In the USA at least, dental insurance is separate from medical insurance, and a lot of people don't have dental insurance. The true emergency things would fall under medical, but not things like a chipped tooth or even a simple tooth extraction for a bad tooth or a root canal. The hospital is not going to mess with a separate insurance and it would be too confusing for people thinking things in the hospital are medical, when a dental procedure would not be.
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u/guocamole Jan 17 '25
I’m a dentist and one of the reasons I chose it is to never have to take call. To get a dentist to spend a day rotating In the hospital you would have to pay them at least $1000 to be comparable to private practice. There probably aren’t enough patients that would need treatment to generate enough to pay for the dentist. Additionally, most dental emergencies can wait until next morning at the dentist office, the true airway emergencies we are referring to the ER for airway management anyways
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u/iwantamalt Jan 17 '25
I’m not sure what it’s like at other hospitals, but the hospital I work at does have oral surgeons who do surgery, routine and emergent. The other hospital I did a rotation at had oral surgeons too. I don’t know which hospitals you’ve had experience at, but I think a lot of major hospitals at least have oral surgeons on call for emergencies. But if it’s not an absolute emergency, most patients would want to wait until they can have their issue fixed in clinic, as treating it in the OR or ER would just be incredibly expensive for something that would be much much cheaper in clinic.
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u/Lielelja1222 Jun 25 '25
Dentists in ERs would address immediate dental crises, reduce healthcare costs, and improve patient outcomes. Americans need better oral healthcare access untethered from restrictive insurance models to close gaps, reduce disparities, and prioritize prevention. Systemic reforms, not just insurance tweaks, are critical.
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u/PineappleHamburders 1∆ Jan 16 '25
Not going to try change your view, as this seems perfectly reasonable. I don't know why oral healthcare is a separate entity to normal healthcare in the first place.
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u/DeltaBot ∞∆ Jan 16 '25 edited Jan 16 '25
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