Why isn't dental health considered primary medical care?

Scope of “healthcare” and why dental is separate

• Many argue dentistry and optometry should be fully integrated into general healthcare and insurance, not siloed.
• Others note that in practice, the separation sometimes makes care simpler and more transparent (e.g., LASIK paid in cash with clear prices vs. opaque insured medical billing).
• One explanation offered: path dependence. Early US “health insurance” grew out of hospital-based coverage; dentists and optometrists evolved outside hospitals and kept separate schools, boards, and lobbying.

Insurance models and perverse incentives

• Several commenters distinguish between:
  • Medicine/hospital care problems (clinical, access).
  • Insurance/billing problems (deductibles, co-pays, coding, denials).
• Some advocate national or universal systems to reduce complexity and profit extraction.
• Others are skeptical of state monopolies, preferring catastrophic insurance plus direct-pay for routine care.
• There is debate over whether insurance should cover routine, predictable services (like cleanings) at all.

Effectiveness and evidence for dental care

• A recurring theme is that much routine dentistry is poorly supported by high-quality research.
• Links are shared to reviews suggesting:
  • Only a small fraction of dental procedures are strongly evidence-based.
  • Evidence for benefits of routine professional cleanings is weak or methodologically limited.
• Counterpoints stress that lack of evidence is not proof of ineffectiveness and that ethical or practical constraints limit randomized trials.

Preventive vs cosmetic and overtreatment claims

• Some claim most dental work is cosmetic or unnecessary, with cleanings framed as a revenue source rather than medical necessity.
• Others report clear symptomatic improvements from periodic cleanings, particularly for gum issues.
• There is concern about overtreatment and “upselling,” but also recognition that anecdotes cut both ways.

Health risks and seriousness

• Some initially downplay dental as non-life-threatening; others respond that untreated infections, periodontal disease, and links to cardiovascular and sinus issues make oral health medically significant.
• Cost barriers lead people to rely on ER antibiotics for abscesses while deferring definitive treatment like root canals and implants.

International and system comparisons

• UK, Netherlands, and Brazil are mentioned: dental often semi-detached from main public systems or offered as add-ons, though Brazil is cited as providing public dental care.
• Some note huge price differences internationally (e.g., cheap cleanings in Vietnam) and in/outside NHS, suggesting US prices are not inevitable.