The value of doctors and nurses has certainly been emphasized during the COVID-19 pandemic. But the value of dentistry? That’s another story.
Dentistry was left on the sidelines, grouped with malls, gyms, movie theaters, and other entertainment and leisure businesses as optional or non-essential. In some states, florists were still able to deliver bouquets, and medical marijuana dispensaries and golf courses made the cut, but dental practices were shuttered.
Upon reopening, it seemed government would right its wrongs. But with the recent World Health Organization recommendation that patients delay routine dental visits until the pandemic is under greater control, it’s become a shocking reality that the critical role that dentistry plays in the healthcare landscape is misunderstood and clearly undervalued.
Thankfully, the ADA quickly and strongly disagreed with the WHO, saying, “millions of patients nationwide have safely visited their dentists during the last few months.” But this is not enough.
In the industry, we know dentistry is a meaningful component of our healthcare system. The US Surgeon General’s 2000 report on Oral Health in America raised awareness about the connection between oral health and general health. And, since that time, a great deal of additional research has underscored the oral-systemic link, proving that poor oral health can lead to a variety of systemic issues, including diabetes, obesity, cardiovascular diseases, and dementia.
According to the ADA, more than 2 million visits to the emergency room each year are dental related. So, to improve overall health and to ensure that our frontline emergency workers can focus on non-dental medical emergencies, it is essential that dental practices remain open to fulfill the critical role they play in the overall healthcare system.
Dentists—Among the Most Essential and Safest Businesses to Visit in the Pandemic
It is not a question of whether dentistry is just now focusing on safety. Dentistry has always been focused on safety. The relevant question is whether dentistry has adapted its safety measures to the new COVID environment. Based on my interactions with dental practices all across the country, the answer is a resounding yes!
A recent study of COVID-19 transmission risks and social benefits from the Massachusetts Institute of Technology determined that dentists were among the “most essential and safest businesses to visit during the pandemic.” Dentistry has always operated as a safety-conscious profession, employing stringent infection control procedures and the use of personal protective equipment (PPE). In July of 2020, both the WHO and the Centers for Disease Control and Prevention (CDC) said there had been no confirmed cases of COVID-19 transmitted in a dental office.
It’s no surprise that dentists have responded quickly in the midst of the COVID-19 crisis, with heightened safety measures, including the use of PPE by administrative staff, daily health screenings for staff and patients, social distancing in common areas, and enhanced processes for cleaning and disinfecting.
In recent months, the ClearChoice network established a multidisciplinary team comprising network prosthodontists, oral surgeons, clinical assistants and operations managers, environmental safety and infection control experts on staff, and an independent compliance consulting expert to further refine our “best in class” protocols.
It is understandable that certain procedures such as tooth-whitening aren’t considered a critical service while COVID-19 is surging. But it is absolutely essential to treat active dental pain and infection, progressing disease such as periodontitis, or issues of function that prevent the patient from consuming a normal, healthy diet. Calling these services elective or nonessential ignores the impact that the progression of these problems could have on a patient’s overall health and drives many patients to overcrowded emergency rooms in the interim.
Gap Needs to Be Bridged Between Dentistry and Medicine
The oral-systemic link has been well-known for years, but there remains a chasm between the treatment of one’s oral health through dentistry and the treatment of one’s general health within the medical profession. Until that chasm is crossed, the oral cavity will continue to be disengaged from the overall anatomy and reduced to a non-essential component thereof, even when the evidence shows it plays a critical role in the health of the integrated whole.
As professionals, we have discussed this among ourselves for years. But we have yet to bridge the gap with stakeholders outside of the dental profession, including patients, regulators, and the broader medical community. Until we do, we will continue to deal with the consequences of a perception that dentistry lives outside the healthcare profession.
Initiatives are underway to cross this chasm. One such example is the Harvard School of Dental Medicine. As a means of inciting change, the school has spearheaded an initiative to integrate oral health and medicine, bringing together academics and leaders in the healthcare community to find ways to connect oral health and primary care.
There are other examples, but progress has been slow. As dental professionals, it is imperative that we collaborate with medical professionals to achieve optimal health for our mutual patients and to change the perception of dentistry from non-essential to essential. We have data and knowledge on our side, and the imperative now before us is to take more control of our collective destiny by taking action.
Educate the Healthcare Community
Historically, physicians and dentists have worked in silos. While there is a plethora of information showing the connection between oral health and general health, many doctors do not get much training about it.
In a 2014 article, Charles Whitney, MD, wrote, “Most medical school graduates don’t know what they don’t know regarding the impact of high-risk oral bacteria entering the bloodstream.” This bacteria can contribute to diabetes, high blood pressure, cardiovascular disease, dementia, pancreatic cancer, rheumatoid arthritis, Alzheimer’s disease, psoriasis, respiratory infections, and more.
Despite the US Surgeon General’s originally publishing a report in 2000 explaining why oral health is essential to general health and well-being, and commissioning another report on oral health in 2020, this lack of knowledge has persisted.
Whitney also lamented about the sluggish progress of a greater dental and healthcare partnership.
“I did not always work closely with dentists and hygienists. It was nothing personal, just that after seven years of medical training, my oral cavity education consisted of exactly one lecture!” he said.
If physicians don’t have much training in the impact of the health of the oral cavity on the rest of the body, how can we expect our patients—or the governments that guide them—to know how truly important their dentist visits are to their overall health? Especially when the WHO puts out erroneous recommendations that patients should delay routine dental visits until the pandemic is more under control.
We must be advocates for collaboration between dentists and physicians and educators about the link between oral and systemic health. This is as true with general dentistry as it is with advanced dentistry.
“As a physician, I am on a personal mission to urge my medical colleagues to work closely with dental professionals. In my lectures and articles, one of my key talking points is, ‘Periodontal disease is a medical condition of the mouth that physicians cannot treat,’” Whitney also said in 2014.
In this time of COVID-19 especially, primary care physicians and other healthcare professionals who treat comorbidities must be aware of how you can help their patients. What should you do? Start the dialog with the physicians in your area.
You can begin to bridge the gap immediately by writing articles for your local hospital newsletter, sending an educational email to local primary care physicians, or holding informative Zoom calls aimed specifically at educating physicians and discussing the link between oral and systemic health and how it applies during this pandemic.
Be Vocal with Dental Societies and the Government
Dental boards are not the voice of dentistry per se. They are regulatory agencies that apply the state’s dental practice rules to licensees. They did not make the decisions that impact us. Instead, those decisions came from governor’s offices and public health agencies.
More appropriately, state and local dental societies are the voice of dentistry. However, they have no regulatory function and failed to protect dentistry in terms of it being labeled non-essential.
We need to proactively reach out to these societies, individually and together, to make clear what the important issues are, what they should be communicating to elected officials and other decision makers, and why dentistry is truly essential for the health of the communities they serve. Get to know these people. Write, call, and meet them in person. And when they misstep, let them know.
Over the past several years, professional dental organizations have seen a decline in membership. This is the right time to reconsider joining and turning them into organizations that work for you.
Talk to Your Patients about the Oral-Systemic Health Connection
Go into any dentist’s office, and you’re likely to find many brochures and posters touting the importance of brushing, flossing, and regular cleanings and checkups. You’re far less likely to see anything about oral health and its relation to overall health. That needs to change.
This message should be prominent in offices and should be a central part of patient communication, both inside and outside the office. When patients are in the chair, instead of small talk, educate them about what oral health conditions can signify. And don’t get lost in the technical detail. Media stories about this issue often carry titles like “Healthy Mouth, Healthy Body.” It’s not as clinical, but it does the job.
Certain organizations offer great reference materials for use in your offices. The American Academy for Oral Systemic Health (AAOSH) offers information and posters. The National Interprofessional Initiative on Oral Health offers the Smiles for Life Oral Health curriculum. In addition, get involved and do your part in the #dentalsafety campaign and help rebuild public confidence in the safety of dental practices.
The more we do to shift patient perceptions of dental care to an integral component of their overall healthcare, the more essential we become.
Take a Stand
Our rallying cry is to act and influence the people who matter so they see our profession the way they should—as essential. It’s up to all of us to carry this torch and educate anyone who has the power to prevent us from ensuring our patients’ oral health is treated appropriately so their overall health, especially now during the pandemic, is not compromised.
Mr. Mosher is an executive with more than 20 years’ experience in the dental and medical technology industries. He is CEO of ClearChoice Management Services, a market leader in providing administrative practice management services to the nationwide network of ClearChoice Dental Implant Centers, providing innovative and quality dental implant care to patients across the United States.
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