The Role of Dentistry in the Hospital

Paul J. Willis, B.S.*

In October of 1945, Harry Archer, defeat the purpose of establishing
addressing a Temple University Den- dentistry as an integral part of med-
tal Alumni group in Philadelphia, ical care. The dental profession be-
expressed his regrets that the dental lieves that a hospital exists to offer
profession had neglected hospital den- complete medical services to the pub-
tal services for so long.' He said that lic, and only by including dentistry
a 1940 survey revealed that the few as one of its services can the hospital
existing departments were inadequate fulfill its purpose.
and unorganized. This was due to Before a profession can do some-
undefined objectives of hospital den- thing about a problem it must rec-
tal care within the profession. The
purpose of dentists in hospitals ognize that such a problem exists.
seemed to be to relieve the pain of From dentistry's recognition as a
inpatients who were hospitalized for profession in the mid 1700's until
other purposes. the 1900's, many uncoordinated ef-
forts were made to organize dental
Today, less than 20 years later, services.3 In 1896, Austin Sniffen,
the dental profession has defined and joined the staff of a New York men-
accepted certain objectives and goals tal hospital and started the first den-
regarding hospital dental care. Now tal service in this type of hospital.4
the problems facing the profession About 1905, dentistry in state mental
are how to improve its present hos- hospitals had its real beginning; to-
pital clinics, how to establish more day almost all state mental hospitals
of them, and how to raise the pro- have well-organized dental clinics.5
fession's status in the eyes of the
medical profession. Only by recog- History of hospital dental services
nizing dentistry as an integral part The first complete dental service
of medical care will the public, the to be established in a general hospital
patient, and the dental profession was in the Philadelphia General Hos-
benefit. pital in 1901. John Shoemaker, a
There is a difference between a physician and then the President of
dental hospital that offers only dental the Board of Charities and Correction
services and a dental service in a of the City of Philadelphia, discov-
hospital. I am concerned here only ered that the patients in the hospital
with dental services in general hos- needed dental care. The board amp-
pitals and in special hospitals, such pointed an oral surgery staff, headed
as mental and tuberculosis hospitals. by Matthew Cryer, of four dentists
Attempts have been made to establish and two dental interns who were to
dental hospitals but these are expen- treat patients and hold teaching clin-
sive to set up and maintain and ics for dental students in the city.6
Thus the first hospital dental clinic
served two purposes: patient care
*Sophomore Dental Student, University of Illi- and student training-the main ob-
nois College of Dentistry, Chicago, Illinois.

40 Journal OF THE AMERICAN. DENTAL SOCIETY OF ANESTHESIOLOGY

jectives of hospital dental services The administrative clause recom-
today. mends that the dental department
Although individual efforts had be responsible for its own adminis-
been made, the medical and dental tration and that it organize the de-
professions, as groups, did not thor- partment in accordance with the rules
and standards of the hospital. A
oughly explore the situation until dental administrator should work
1938. In that year the American with the heads of other departments
Hospital Association, with the Amer- in the hospital.
ican and Canadian Dental Associa-
tions, studied the need for hospital The consultative role of the dental
dental services. The group prepared department would be to advise phys-
the Manual on Dental Care and Den- icians on the oral health of their pa-
tal Internships in the Hospital. The tients; the dentists would be avail-
information included was approved able to diagnose oral manifestations
and recognized by the American Hos- in the mouth which might be indic-
pital Association in 1941.7 ative of a systemic disorder. On the
other hand, physicians would be
Meanwhile, the Council on Dental available in the hospital to assist
Education was studying this problem the dentist with problems beyond his
and beginning to make public its realm of knowledge.
approval of more cooperation and
interaction between the medical and The educational function of the
dental professions through the hos- dental department is of prime con-
pital. The American College of Sur- cern. Dental internships provide ad-
geons in 1943 adopted a minimum vanced training for the dentist while
standard for dental departments in familiarizing him with hospital pro-
hospitals.8 Later that year the Amer- cedures. Dental internships could
ican Dental Association formed com- help provide the answer to the public
mittees to study basic minimum need for dentists, especially for the
standards and decide which standards indigent. The medical profession has
they could adopt. Also in 1943, the been doing this for years. The Coun-
American Dental Association esta- cil on Dental Education approves 196
blished the Council on Hospital Den- internships and 131 residencies in
tal Service, which gives accreditation 218 of the nearly 7,000 hospitals in
to hospital dental services.9 The the United States today." New York
Council also works with the Joint and Philadelphia hospitals offer the
Commission on Accreditation of Hos- greatest number of these internships;
pitals to establish, maintain and im- the others are sparsely scattered
prove standards of dental clinics in throughout the country. This is in-
hospitals. adequate considering the number of
graduating dentists per year and the
Functions of hospital dental services number of hospitals with no avail-
The Council on Hospital Dental able dental internships or residencies.
Service recommends four main func- The clinical functions can be ac-
tions for hospital dental services.°10 complished through outpatient and
These are administrative, consulta- inpatient services. Outpatient services
tive, educational and clinical. usually consist of available emergency
February 1965 41
care and clinics for the indigent. One of the main aspects of hos-
Much depends on the type of hospital pital dentistry under consideration
and the community it services. Some is that of hospitalizing patients for
communities would benefit from an involved dental procedures which
emergency outpatient clinic but would presently are performed in private
not frequent the main clinic for rou- offices. This pertains to two types of
tine care. Most hospitals with dental dental patients. The first group are
services provide an outpatient emer- those who are mentally or physically
gency clinic. Because of the lack of disabled but not hospitalized. Includ-
dental interns, however, outpatient ed in this group are the senile and
clinics for routine care are not prev- children who are emotionally unable
alent. This is an area in which the to withstand numerous and tedious
dental profession can make much office visits. Controlled anesthesia
progress. can be administered to these patients
Extent of hospital dental services in a hospital, and most work can be
accomplished at one time. This pro-
There are many alternatives as cedure is advantageous to the pa-
to the extent and type of services tient emotionally and enables the den-
that should be rendered for inpat- tist to work without interference
ients. One should first consider what from the patient.
dental services should be performed
in a hospital rather than in the office. Another consideration is that of
Some dentists administer general administering general anesthetics to
anesthetics in the office for many patients who hesitate to seek dental
dental procedures. Hospitalizing the care because of extreme fear or lack
patient, however, assures better post- of time. Although patients are some-
operative care and the use of hos- times hospitalized for multiple ex-
pital facilities in the case of an emer- tractions or other surgical procedure,
gency during anesthesia. Many pa- hospitalization is not as common for
tients carry insurance which would extensive, routine dental care. For
cover at least part of the expenses. example, a highly neurotic patient
Patients hospitalized for lone per- can have four or five teeth prepared
iods may require complete dental for full crowns at one time if he is
care. This pertains to patients in under controlled general anesthesia.
mental, veterans, and tuberculosis Patients requiring full mouth gin-
hospitals and to those hlospitalized giveetomies can be treated in the
with long-term illnesses. Most federal same manner.
hospitals serving these patients have Recognizino the need for wide-
dental departments. According to a range dental services in hospitals,
survey conducted in 19.58 almost 97 the Council on Hospital Dental Ser-
per cent of all federal hospitals had vice has recommended that the fol-
complete dental services.12 Tn state, lowing services be available: dental
local and privately owned general roentgenology, oral hygiene. oral
hospitals there also are many patients pathology, oral surgery, periodonties,
who require dental treatment and who restorative dentistry, and pedodontics
should be treated in a dental depart- (which should include an orthodon-
ment in the hospital. tics service).13
412 Journal OF THE AMERICAN DENTAL SOCIETY OF ANESTHESIOLOGY
 Examples of hospital dental services (1) control of fear, (2) better pre-
The Hollywood Presbyterian Hos- operative preparation and postoper-
pital in Los Angeles has a dental ative care, (3) better use of available
clinic that is a section of the Eye, time, and (4) minimal postoperative
Ear, Nose and Throat department. coml)lications."8
It is equipped with two operating And what has happened to the
rooms. Treatments offered include dental clinic of the Philadelphia
routine dental care, in addition to General Hospital? From the 1901
surgery for which the patient can staff of four dentists and two surg-
best be treated under general anes- ery interns, it has grown to a staff
thesia. The dental service also in- of 22. This includes a chief of the
eludes a 24-hour, emergency outpa- entire service, six visiting chiefs
tient clinic, where the main objective two oral surgeons and one each for
is to relieve pain and treat acute oral medicine, prosthodontics, res-
emergencies and then to refer the pa- torative dentistry and dental roent-
tient to a private dentist. The clinic genology. There are four visiting
is in the process of establishing a assistants, one oral surgery resident,
dental diagnostic center and a re- two dental hygienists and eight rotat-
search and education dental clinic.14 ing interns. The clinic offers almost
Our Lady of the Lake Hospital all dental services. It also takes pride
in Baton Rouge, La., has 50 active in having established the first rotat-
members on the dental staff, two of ing dental internships in 1948.'7
whom are oral surgeons and the re- Conclusions
maining general practitioners. They
have a complete operating room with These are only a sample of the
ten anesthesiologists available. The dental services offered in United
treatment administered covers almost States hospitals today. In 1960, the
every phase of dentistrv: treatment Amierican IHospital Association stated
of complicated fractures, extractions that 2,352 hospitals out of the 7,000
of impacted teeth, full-mouth extrac- hospitals in the United States had
tions, gingivectomies, and the prep- dental departments.'8 Few of them,
aration and insertion of multiple unfortunately, are as well staffed or
restorations.15 offer as many types of services as
Dentists at Lackland Air Force those I have described. The less well-
Base in Texas are confronted with staffed hospitals and the ones having
no dental departments are the ones
two major problems. Many of their that the dental profession must con-
patients have never been to a dentist centrate its endeavor to include den-
or have gone only in emergencies tistry as an important phase of over-
which usually resulted in extraction all medical care.
of a painful tooth. Other men are
stationed at the base for such a short Irving Gruber predicted in March,
period that numerous office sittings 1962, at a conference on Hospital
are not possible. These patients are Dentistry in Rochester, N. Y., that
hospitalized, and complete treatment the hospital of tomorrow will include
is given them at one time. The den- all phases of dentistry on an inpatient
tists believe that the advantages are and outpatient basis. He believes that
February 1965 43
the hospital also will include an in- Hospitals. New York State Dental
Journal, 13: 144-146, March 1947.
ternship and residency program that 5. Ibid., p. 144.
will be on a par with that offered to
the physician. He emphasized that he 6. Ivy, Robert H.: Fifty Years of Dental
Service and Internship at the Philadel-
was making these predictions based phia General Hospital. Oral Surgery,
on progress to date rather than on Oral Medicine, & Oral Pathology, 5: 835-
39, April 1952.
prophetic dreams."9
7. Archer, loc. cit., 149-151.
The responsibility to promote the 8. Ibid., p. 150.
concept that a dentist should be a 9. Guaralnick, Walter C.: Hospital Dental
respected member of a hospital staff Services. Harvard Dental Alhnni Bul-
falls on the local dental societies and letin, 20: 56, April 1960.
the individual dentist. Dental groups 10. Council on Hospital Dental Service.
Basic Standards of Hospital Dental
can establish dental departments in Service. The Journal of the American
the hospitals of their communities, Dental Association, 62: 106-109, Jan-
but the dentist must take advantage uary 1961.
of the available service. By so doing, 11. Allison, Morgan L.: Dental Internships
and Residencies. Journal of Oral Surg-
he can instill in his patients the idea ery, Anesthesia & Hospital Dental
that a dentist, like a physician, has Service, 20: 60-61, January 1962.
a private office and is affiliated 12. Survey of Hospital Dental Depart-
with a hospital' to which he can take ments. The Journal of the American
Dental Association, 62: 139, January
his patients when necessary. The 1961.
dental profession has been traveling 13. Council on Hospital Dental Service. loc.
uphill in this endeavor. It is the re- cit., p. 106-109.
sponsibility now of every dentist and 14. Cimring: loc. cit., p. 1-5.
future dentist to continue to pursue 15. Konikoff, Ben S., and McHardy Colin:
this course. Operation of a General Hospital Dental
Staff. Journal of Oral Surgery, Anesthe-
sia Hospital Dental Services, 20: 331,
References July 1962.
1. Archer, Harry W.: The responsibilities 16. Burch, Richard J., and Shuttee, Thomas
of the Hospital Staff Dentist. Penn- S.: Hospitalization of the Dental Pa-
sylvania State Dental Journal, 3; 149- tient Requiring Extensive Treatment.
151, February 1946. Journal of Oral Surgery, Anesthesia &
2. Cimring, Harry: An Unusual Example Hospital Dental Services, 18: 424429,
of Hospital Dentistry. TIC Magazine, September 1960.
12; 1-5, August 1963. 17. Ivy: loc. cit., p. 335-339.
3. Friedrich. Rudolph H.: Dentistry in 18. Survey of Hospital Dental Depart-
Hospitals. Journal of the American Hos- ments, loc. cit., p. 189.
pital Association, May 1, 1957. 19. Gruber, Irving E.: Hospital Dentistry
4. Sniffen, D. Austin: The Value and Pro- Tomorrow. New York State Dental
gress of Dental Departments in Mental Journal, 28: 458-459, December 1962.

4A4 Journal OF THE AMERICAN DENTAL SOCIETY OF ANESTHESIOLOGY