HARVARD MEDICAL SCHOOL PRIMARY CARE REVIEW

A “Mouthless” Medical Education: The Gap Between Medicine and Dentistry in Academia and Practice

January 6th, 2022

Medicine and dentistry in the classroom: the context of Harvard Medical School and Harvard School of Dental Medicine

Since the conception of Harvard School of Dental Medicine (HSDM) in 1867, students at the dental school learned alongside medical colleagues at Harvard Medical School (HMS) during their early years of professional development. The idea of dentistry as a science and a specialty of medicine was pioneered in the U.S. by HSDM through an integrated medical curriculum and the creation of the Dentariae Medicinae Doctoris (DMD) degree in recognition of the oral cavity’s inextricable link to the rest of the body.

Today, in the first year of medical school, HSDM students are not only taught the hard science of medicine but also the art – listening, empathy, teamwork, and human connection. The impact of these soft skills on the experience of patients and the quality of care should not be underestimated. These basic tools and medical knowledge prepare the class of first-year medical and dental students to go off to explore their specialties. While it is certainly true that some will use these skills more than others, they are nonetheless essential to the care of our patients. The way that dental students and their future patients benefit from the integration of medical training makes me wonder about how medical students and their future patients would stand to benefit from the integration of dental education.

As a first-year dental student studying at HMS, I have experienced the sharp divide between medicine and dentistry in class and in clinic. There are expectations that my curiosity should not stray too far from my area of specialty. Likewise, there is an expectation that my medical classmates should focus on the body sans the mouth. I chose to attend HSDM because I believe in their mission of unifying the mouth with the body but did not expect the dismissal of the mouth by doctors of the body.

A lack of adequate oral health education in medicine

As it stands today, physical exam education focused on oral health for the current first-year medical students at HMS is almost exclusively limited to a total of 2 hours on a single Wednesday. To put this in context, each Wednesday, medical and dental students are taught physical exam skills to test different parts of the body for notable findings that may help make or support a diagnosis.

There are normally two sessions, ranging from a total of 5-8 hours, committed to a wide range of body systems (e.g., cardiovascular, neurological, and musculoskeletal) and body regions (e.g., abdomen, eyes, and lungs). In the classroom, cardiology, dermatology, rheumatology, pulmonology, oncology, neurology, psychiatry, ophthalmology, and gastroenterology are seamlessly weaved into the curriculum, constantly reminding us of the intricate connections between all the systems and organs of the human body.

The link between diseases and the oral cavity, however, are often boiled down to vague oral ulcers and “mucosal membrane involvement.” To realize the dream of unifying the mouth with the body requires more than just buy-in from the dental community; it necessarily must involve the medical community – to not only give spaces in the classroom to dental providers but to encourage physicians to understand and embrace the oral health specialty in the practice of medicine. Yet our medical schools remain “mouthless,” as put by Dr. Reidar Sognnaes.

The importance of oral health indicators of disease

Many early telltale signs of disease show up first in the mouth. Small, white spots inside the cheeks, known as Koplik spots, can warn of measles before the characteristic red spotted skin rash appears. Additionally, the manifestation of disease in and/or around the mouth can help create the list of possible diagnoses. For example, dry mouth, fissured tongue, and unexplained increase in dental erosion can point clinicians to suspect to Sjögren’s syndrome, an autoimmune connective tissue disease.

In the hospitals and clinics, there are patients with problems that show up all over their bodies, including their mouths. Physicians with better background knowledge on important signs and symptoms in the oral cavity can detect systemic diseases sooner, narrow down their list of possible diseases, and improve access to oral care, especially in areas with few dental providers. More intentional integration of oral health medicine into the medical curriculum stands to benefit physicians and their patients; it is a high yield endeavor for the health of our patients to bring the dental specialty and medicine together, but that must involve participation from both sides.

Bridging the gap: the need for cross-disciplinary learning and collaboration

Several medical professionals, including primary care physicians, a pediatrician, a nurse practitioner, have guided clinical learning sessions at HSDM after recognizing the important role the oral cavity plays in the health of their patients. Their goal is to help dental students appreciate the relevance of medicine to dentistry through experiences with patients in the dental clinic so that the students are utilize medical knowledge once they become providers.

In a similar way, medical school is an opportune time to introduce a change to the culture of medicine and emphasize the connection between the mouth of the body. Encouraging cooperation of oral physicians and physicians from the start of their journeys as providers can facilitate better communicate of important findings, pertinent underlying conditions, and timing and type of treatment later down the line and thereby improve patient outcomes. By bridging the gap between dentistry and medicine, health care providers can remain true to our commitment to the health of our patients – to the whole health of our patients.

**Feature photo by Anna Shvets from Pexels 

 

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Subin Jeong, BA

Subin Jeong, BA, is a first-year dental student at Harvard School of Dental Medicine in Boston, MA. She earned her BA at Tufts University, where she studied Spanish Culture and Community Health. Her professional interests include access to oral health care, community health, and culturally competent care.

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