It’s Time to Tear Down the Wall between Dental and Health Care
Historically, dentistry and medicine have been addressed and taught as separate schools of thought. As it turns out, the division of dental and health care isn’t a good thing for public health, making it past time the two should integrate.
When dentistry was born, around 1840, dental care concentrated on pulling teeth and filling cavities. Modern dentistry has progressed significantly beyond that point, offering teeth implantation, the ability to detect and pinpoint oral cancers, using 3D imaging for jaw reshaping, even to be able to treat tooth decay medically, without a drill. Most importantly, scientists have defined a connection between oral health and general well being that shouldn’t be ignored. For instance, periodontal disease, or gum disease, has a connection to the development of high blood pressure, diabetes, and cardiovascular disease. Pregnant women are particularly at risk, with an increased chance of developing pre-eclampsia and delivering low-birth-weight babies.
A More Comprehensive Approach
While dental school produces good clinicians with a firm understanding of dental health, few are equipped to observe and diagnose adjacent symptoms like measuring the risk of heart disease or stroke, or generally identifying early warning signs of physical or mental disease that may impact their overall health, beyond orally.
The Harvard School of Dental Medicine is leading the charge, as the first to affiliate with a medical school and grant a degree of doctor of dental medicine (DMD). They recognized the value of integrating dentistry and medicine to improving overall health and well being for patients, and enhancing their roles in chronic diseases management.
Dental Issues can become Health Issues
Challenges with dental health impact us on many levels, beyond impacting our ability to breathe, eat, and speak properly, poor oral health can also trigger diabetes, cardiovascular issues, and various other chronic conditions. Oral infections can potentially lead to sepsis, a blood infection that can be very serious.
Even with this understanding, dental and medical education are largely separate, just as care is delivered, or covered by insurance, or not. Unfortunately, dental care’s high cost impacts even those with coverage. Many don’t have insurance, Medicare has no dental, and Medicaid lacks much in the way of adult benefits. As a result, the Center for Disease Control (CDC) estimates we lose approximately $6 billion in productivity annually, attributed to oral health issues. Not to mention the increase in emergency room visits for pain management and the contribution to the opioid addiction epidemic.
The Harvard School of Dental Medicine has developed an initiative to integrate the two, oral health and medicine. Aiming to improve the relationship between the two schools of thought and transform how dentistry is taught, practiced, financed, and evaluated to include it with comprehensive health and social services and improve community health.
The Oral Physician Program
The Oral Physician Program was established as a general practice dental residency program integrating oral health, primary care, and family medicine training. They hope to create a combined DMD/MD program, including hospital residency intervals, to train a more rounded physician, focused on both oral and general health.
Others are participating in the erosion of the barrier between the two schools. Kaiser Permanente Northwest has developed an integrated medical-dental practice and the Marshfield Clinic has established a fully integrated medical-dental electronic record keeping system.
Integrated dental health and primary care visits would entail much more. Go in for your routine cleaning and a team of physicians, dentists, nurses, and dental assistants will check your blood pressure, weight, medication status, pending screenings or procedures, AND clean your teeth. Any existing condition or prescribed medications will be taken into account and your health will be managed without multiple referrals to affiliated care givers.
DentaQuest Foundation, the Santa Fe Group, and Oral Health America are working the political aspects of integrating the practices by raising awareness, educating non-dental practitioners, and creating political interest in encouraging oral health. Success has been realized from the education standpoint, however interprofessional practice still has its challenges.
The Dental Profession Must Evolve
In order to successfully integrate the two professions, the dental profession must change. Closer connections between the two may be encouraged by the transition from private practices to small / large group practices and developing mutual diagnostic codes and unifying dental and medical electronic records, but current incentives are minimal.
Payment processing and insurance coverage stipulations hinder the process, however eventual payment bundling and value created based on outcome instead of volume of patients may help. The Surgeon General has brought attention to the issue and has strongly recommended combining the disciplines, closing the access gap and improving overall health. Doing so may improve overall population health and chronic disease care, but the culture must change.
Patient Focus on Dental and Health Care
A fundamentally new approach must be fully developed that places more importance on preventing disease and managing health with a multidisciplinary, patient focused application.