Question:
I would like to ask the dentists in this group whether you think that
physicians should treat dental problems.
As a family practice physician, I sometimes get calls from patients
saying that they have a toothache, but can't get an appointment with
their dentist any time soon, and will I give them a pain medicine.
Sometimes they say they have an abscess, and want an antibiotic.
Amazingly, often they tell me the dentist told them to call me and ask
me for the medicine.
I don't think I'm qualified to treat dental problems.
What I wonder is, why don't dentists see emergency patients, the same
way we physicians do? It seems to me that, if a patient is in pain,
the logical thing to do is see the patient in the office the same day.
If the plan is to pull the tooth when the infection dies down, can't a
dentist prescribe an antibiotic? Or do dentists not have that
authority?
Answer:
The key here is "their dentist." A dentist is obligated to render
emergency care to his patients of record, or to refer them to another
dentist where such care can be obtained.
It's not that simple when the patient is NOT a patient of record of the
dentist. Human nature being what it is, many people unwisely
procrastinate in taking care of their regular dental maintenance needs.
It is not unusual for a few people to go years without visiting a
dentist for the normal six-month exams and maintenance visits. Then
when their self-inflicted dental pain occurs, they have no dentist.
Although a dentist should help people in need, he has no obligation to
get out of bed at 2 A.M. six nights a week to attend to the predictable
consequences of procrastination by people who aren't even his own
patients.
Most dentists can tell you that their patients rarely have emergencies
in the first place -- because most dentists require their patients to
have the sort of dental treatment that prevents emergencies from
occurring. The number of unpreventable emergencies is relatively small,
and the average dentist is prepared to handle such cases in their own
patients.
How do they know they have an abscess? Who made the diagnosis? If a
dentist made the diagnosis, then he would be rendering appropriate
treatment or prescribing medications until treatment could be
performed.
It's not unusual for narcotic addicts to call doctors and tell them
they "need" a prescription for an antibiotic -- and by the way, some
Vicodin too, please -- because "their dentist" could not see them. This
is a VERY common scam on the part of narcotic addicts. They just keep
calling doctors until somebody gives them the controlled substances
they want.
If the dental emergency is legitimate, the patient's own dentist of
record should be attending the case. Patients calling doctors for
medications sounds a little fishy.
Dentists do indeed have the authority to prescribe whatever medication
is determined to be necessary for the treatment of a dental problem --
for patients of record.
I agree with you. Legitimate cases should be seen by a dentist. But
remember that some "patients" are just fishing for narcotics and are
using the "dental excuse" to persuade you to feed their habits.
Most dental emergencies are due to neglect. I used to make special
considerations for anyone who called with an emergency, then I started asking
people who needed to be seen "now" when the problem started. Many would say, oh,
it started last week but I couldn't get here until now. I'm sorry, but that
isn't an emergency. I will not put my life on hold for someone who can't alter
their schedule to take care of themselves. Experience has taught me to
distinguish between real emergencies and procrastination that has become
uncomfortable.
Its always about blaming the patient. You know what the problem
is? Unlike most people who work dentists don't have bosses so they
have no one accountable to except the state boards and FDA which
is stacked with dentists and get away with all kinds of crap like
telling patients with emergincies it is their fault, that it it's the
publics resopnsiblity to be informed on the toxcity of dental material
and that most decay is the result of poor oral hygene (again
interesitigly the patients fault, though this dosen't apply to me
personally).
Should doctors treat dental infections. Absolutely. Many dentists
are clueless about anything but routine types of infection and
even believe that any infection or decay which doesn't easily show up
on a routine x-ray doesn't exist. Most oral surgeons are no better.
Their concern is more about drug addicts than relieving
pain. Again another way of putting the squeeze on the patient.
Look it thier fault--> they could be a junkie and didn't brush
their teeth!
Dentists are in the dark ages in all most all areas regarding
medical implications of dentistry regarding materials/infections but
still excpect doctors to not impede on "their turf".
Based on what I've seen, I think that all doctors should receive
mandatory training on dental issues to take over for the rife
incomptence and neglect which has occured in the dental community
for decades. They've been given the chance to use their authority
on dental medical issues for good and just couldn't handle it.
