I spoke with Otto about how the dentistry/medicine divide came to be, why it’s stuck around, and what its consequences have been. A lightly edited and condensed transcript of our conversation is below.

Julie Beck: Let’s go back to the origin of how dentistry and medicine became separate in the first place. It’s something we take for granted now, right? But it’s actually really weird. Was there ever a time when dental care was integrated with medical care?

Mary Otto: It stayed generally separate. Taking care of the teeth became kind of a trade. In the barber-surgeon days, dentist skills were among one of the many personal services that barber surgeons provided, like leeching and cupping and tooth extractions. They approached it as a mechanical challenge, to repair and extract teeth. Barber surgery was practiced in the very early part of our country's history. And Paul Revere was a denturist—he was a jeweler and he made dentures too.

But the dental profession really became a profession in 1840 in Baltimore. That was when the first dental college in the world was opened, I found out, and that was thanks to the efforts of a couple of dentists who were kind of self-trained. Their names were Chapin Harris and Horace Hayden. They approached the physicians at the college of medicine at the University of Maryland in Baltimore with the idea of adding dental instruction to the medical course there, because they really believed that dentistry was more than a mechanical challenge, that it deserved status as a profession, and a course of study, and licensing, and peer-reviewed scientific consideration. But the physicians, the story goes, rejected their proposal and said the subject of dentistry was of little consequence.

That event is remembered as the “historic rebuff.” It's still talked about sometimes, not a lot, but it’s seen as a symbolic event and it’s continued to define the relationships between medical and dental education and medical and dental healthcare systems in funny ways. Dentists still drill and fill teeth and physicians still look at the body from the tonsils south. Medical and dental education is still provided separately almost everywhere in this country and our two systems have grown up to provide care separately, too.

Beck: It seems like since the historic rebuff, dentists have really wanted to stay separate. Why is that, do you think?

Otto: People have raised questions about the system over the years, and they’ve called for reforms periodically. Nearly a century ago, in the 1920s, this biological chemist named William Gies was a kind of prophet. He visited every dental school in the country and in Canada for the Carnegie Foundation, for this big report, and he called for dentistry to be considered an essential part of the healthcare system. He said: “Dentistry can no longer be accepted as mere tooth technology.” He wanted oral health and overall health to be integrated into the same system, but organized dentistry fought to keep dental schools separate. [Dentists] emerged as defenders of the professional autonomy and professional independence of the private practice system that we have here. David Satcher, the [former] surgeon general, he kind of said the same thing when he issued this “Oral Health in America” report in 2000. He said we must recognize that oral health and general health are inseparable. And that too, was a kind of challenge. And it seems like things are changing, but very slowly.