Expert: Mark Bornfeld DDS - 4/2/2005

Question
Hello Dr. Bornfeld,

I was recently at my dentist's office because I was having a toothache in my upper right side.  My dentist took an x-ray and looked in my mouth and did some things and came to the conclusion that I should go see my physician because he (my dentist) thought I probably had a sinus infection.  I went to physician to take care of my sinuses and sure enough, the antibiotics worked just fine!

I haven't been back in to either office, but I am wondering why my dentist didn't prescribe me antibiotics for my sinus infection (I mean he prescribes other stuff like valium).  Instead, I had to pay him for my office visit as well as my doctor for that office visit to get the antibiotics -- when my dentist had already figured it out!  I just feel like I wasted my money.  What is your opinion on why my dentist didn't prescribe me the antibiotics?

Answer
Dear Ryan,

The jurisdictional boundaries between the health professions can sometimes seem arbitrary, and the laws that govern them are somewhat arcane, at least from the perspective of the layman. However, there is good reason why your dentist neither diagnosed nor treated your presumed sinusitis. Beyond the fact that the legal scope of a dental license does not permit a dentist to manage non-dental illness-- a dentist's training does not qualify him to do so. You will note, as your narrative no doubt accurately reported, that your dentist did not say that you had a sinus infection, but rather that you "probably had a sinus infection." When phrased this way, you can infer that this was not a diagnosis, but was speculation on his part, and was not sufficient on which to base an appropriate course of action. Think for a moment if your pain was from a sinus tumor, a trigeminal neuralgia, or other non-dental condition; were this the case, any inappropriate treatment by your dentist might have delayed a proper diagnosis-- perhaps even losing enough time to alter the course or outcome of the illness.

Legally speaking, the parameters that define the different health professions are there to protect the public. It is a short jump beyond dentists treating sinusitis to dentists treating skin infections, dentists treating Alzheimer's Disease, dentists prescribing contraceptive medication, and any of a number of other transgressions that can and do happen on a daily basis (a review of professional complaints in New York State makes for some interesting reading; see http://www.op.nysed.gov/rasearch.htm ).

The process of subdivision and specialization which has affected the health professions does spread whole-body healthcare over a great number of types of health care providers, which does create a measure of inconvenience for the patient. However, it has also led to a higher level of expertise in these varied disciplines. On balance, that is a good thing.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY