Research has demonstrated that physician knowledge of the interactions of oral and systemic health is limited. However, physicians should be able to discuss the importance of oral health in a variety of circumstances: For example, when diabetes is diagnosed oral health should be discussed because it is well known that poor oral health can worsen diabetic state. When prescribing new medications oral health should be discussed because many medications are xerostomic or increase the likelihood of stomatitis and caries. These are just two examples of oral health concerns that are often overlooked in the high pressure environment of medical practice.
Ignaz Philipp Semmelweis was a physician who suspected that the failure of doctors to wash hands was resulting in puerperal fever and high mortality rates. At the time, this mode of reasoning was contrary to mainstream medicine and his important findings were dismissed for several years. Many continued to die, unnecessarily, through puerperal fever. Simply because there are no randomized controlled trials to support causal connections between oral and systemic health should we continue to treat the mouth separately from the rest of the body? Numerous studies identify possible associations between oral and systemic disease and it is little wonder – the mouth is part of the human body! The importance of oral health should not be ignored simply because we haven’t been able to conduct case control trials – would you like to be randomized into the “no dental care” group?
A recent study released by United Concordia health insurance has demonstrated several interesting findings: in patients who received dental preventive care the overall medical cost of managing diabetes, stroke, heart disease and complications from pregnancy were much lower – statistically significantly lower. Additionally, there were far fewer hospital admissions for those who received preventive dental services. However, it is not common practice for medical doctors and dentists to collaborate on patient care. In fact, there are major barriers within the United States (US) healthcare system that inhibit these collaborations. For example, dental care is delivered in silos: Dental offices are rarely co-located with a medical center and it is up to individual providers to create collaborative relationships between the medical and dental professions. In fact, most dentists are in a solo-practice setting which is in conflict with interdisciplinary collaboration.
Previous research has shown that the matter of oral health problems that present to US hospitals is a major issue in the United States. For example, over $1.2 billion in hospital charges are incurred each year by patients hospitalized for an oral health problem in the US. Further, in the year of the study 277 people died in US hospitals after being admitted due to a dental problem. Were the dental problems mismanaged to the extent that people died? Were the dental conditions neglected to the point that they were fatal? Did the dental condition exacerbate a medical condition that caused death? The exact cause of death is not known. What is exceedingly obvious is that the entire medical team (not just dentists) need to be able to manage and diagnose dental problems as well as educate patients about the importance of oral health and have a basic knowledge of how to help the patient access dental services. However, the most important reason to train physicians to evaluate the mouth is yet to be addressed – oral cancer.
Alarmingly, close to 100% of Medicare supported patients who were diagnosed with late stage head and neck cancer had been seen by a medical doctor in the year prior to their diagnosis. It is possible that none of these visits included an oral screening and the opportunity for early diagnosis was foregone. Due to the limited knowledge of oral health by non-dental healthcare professionals patient care is compromised. Firstly, patients that present to emergency rooms, urgent care facilities and hospitals with dental problems are often poorly managed and a dental visit is still necessary afterward. What is necessary is a structured, educational curriculum to prepare medical doctors for a career in patient centered, outcomes driven practice. Any such practice must include the evaluation, diagnosis and management of oral health complaints. Medical curriculum must change for physicians-in-training and continuing medical education must mandate the training of basic oral health management skills. It may not be practical for every patient to have an oral health screening, however, physicians should have the skillset to be able to implement an oral screening on patients they know to be at high risk or oral cancer or oral disease. The health of the nation depends on it.