The American Dental Association

It also helped that by the early 20th century dentistry was dominated by middle- class white men. As a result, dentists and doctors brought equal social status to any legal battles during the early period of professionalization. In addition, the American Dental Association was founded just a few years after the AMA, so dentists had a group to fight on their behalf by the time the AMA began actively challenging the legal status of other competing health care occupations. Partly as a result, almost all dentists were—and still are—trained at schools of den- tistry that are independent of medical school.

A Profession Apart By the mid-20th century, dentistry, like medicine, was an accepted and respected profession. The fact that, by this point, dentists needed four years of college and four years of postgraduate education before they could practice certainly helped their status. (Dentists would also need two or three years of internship training to enter the subspecialties that emerged later in the century.) In addition, dentists’ status was augmented by their growing expertise. In earlier eras, dentists could only extract broken, infected, or eroded teeth. By the mid 20th century, however, dentists could fill cavities, make crowns for teeth, prevent cavities through cleaning and fluoride treatments, craft bridges, surgically implant replacement teeth, and straighten teeth. All these developments not only increased the scope of dental practice but also added to dentists’ prestige (and incomes).

In one important way, though, the fates of dentists and doctors diverged. In 1965, Medicare and Medicaid were founded to provide affordable health care to the poor, the disabled, and the elderly. Dental care was not included in either program, as it was considered less necessary than medical care and costs were low enough that many individuals could afford to purchase it on their own. In addition, the American Dental Association opposed adding dental coverage to Medicare, although they supported adding it to Medicaid to provide poor children with preventive care. Currently, Medicare rarely covers dental care, Medicaid covers it only for children, and most dentists refuse to treat Medicare and Medicaid patients anyway. Consequently, most Americans either pay for dental care out of pocket or go without.