A patient with a vitamin deficiency “should be referred to the physician who …does have the training and the facilities for a general physical examination of the patient which the dentist can’t claim to be trained for or have the equipment to do it.”
Milan Logan, a biochemist, and lead vitamin expert of the ADA CDT reflecting on his unpopular opinion that the treatment of nutritional deficiencies fell into the medical scope of practice .
Unlike the ADA, the AMA did not announce that vitamin D was ineffective for dental caries prevention. Instead, in 1958 the endorsement of vitamin D dental caries prophylaxis disappeared from the AMA New and Nonofficial Drugs, a yearly publication . The evidence had not changed; what changed was that dentistry was separating from medicine . The dental profession largely won a scope-of-practice conflict with the medical profession; physicians largely stopped learning about dental diseases in medical school, the medical profession stopped endorsing toothbrush advertisements in their medical journals. Research into the medical management of dental diseases, including the role of nutritional deficiencies in dental disease prevention, became abandoned by the medical profession because of this separation.
The ADA reversal on vitamin D dental caries prophylaxis may have been the most challenging step in terms of dentistry separating from medicine—vitamin D was the crown jewel of the medical management of dental diseases, studied for over 25 years, and the only medical management approach of dental caries which was endorsed by the dental profession. The ADA reversal on vitamin D, as was shown here, was controversial but nonetheless became the conventional wisdom. Dismissing the role of other nutritional deficiencies in the etiology of dental diseases was less challenging.
A vitamin C deficiency offers an informative example of how another nutritional deficiency with dental symptoms became ignored. The AMA Council on Foods and Nutrition listed gingival bleeding as a potential sign of a subacute vitamin C deficiency in 1946 . The National Academy of Medicine described an increased gingival bleeding tendency as one of the most sensitive markers for a vitamin C deficiency in 2000 . Clinical trials focusing on bleeding tendency confirmed these conclusions . Nevertheless, the conventional wisdom is to largely ignore a vitamin C deficiency in the etiology of gingival bleeding. Instead, a non-controlled small case-series on experimental gingivitis, a study cited in dental journals over 2,100 times, became the bedrock citation to justify treating gingival bleeding with oral hygiene, an approach which assuredly fails at correcting a vitamin C deficiency [97,98,99].
Research into the role of other nutritional deficiencies, which was often conducted by physicians, such as calcium, phosphate, vitamin B6, and vitamin K became abandoned in a similar fashion [3,100,101]
The National Academy of Sciences concluded in 1989 that the “paucity of more recent evidence” suggested that vitamin D did not play a major role in dental caries prevention . The “paucity of more recent evidence” may have occurred because research questions and funding had become re-framed to questions which fell into the dental scope of practice, not the medical scope of practice. As reported by Brownell and Warner, “A great deal of influence rests in the hands of parties who control the framing of a health issue.” . The dental profession going forward largely framed research questions in such a way as to exclude the medical management of dental diseases.
Key point: The medical and dental profession separated leading to an abandonment of the medical management of dental diseases.