Proactive Collaboration Between Dentists and Physicians Is Key to Improving Care

As more research shows links between oral and systemic health, dentists and physicians are collaborating to improve care.

Awareness

Reputable medical and dental journals feature numerous studies peering into the awareness among dentists of the link between oral and systemic health. After peeling through many of them, there is no doubt that the knowledge is there.

One study in 2019 exploring dentists’ awareness about the link between oral and systemic health addresses common knowledge topics like the “associations between oral disease including periodontal disease and chronic systemic diseases such as diabetes, coronary artery disease, adverse pregnancy outcomes, and rheumatoid arthritis (RA).”¹

Although these topics are becoming common knowledge among medical and dental providers, there is still a need for medical professionals to step in with focused effort to continue updating their knowledge and educate patients about these oral-systemic tie-ins, regularly.

Patient Education

Creating this awareness for patients will no doubt open the door to greater motivation when it comes to home healthcare and seeking professional oral healthcare. Patients are severely limited in their ability to act without knowing that their periodontal health has systemic implications. In fact, it may still surprise some patients to learn that periodontal disease is a great example of an oral manifestation of systemic disease.

With the limiting belief that the mouth is separate from the body, patients are unaware of the impact that their oral health has on their overall quality of life, nor do they know just how “at risk” they might be for things like heart disease and diabetes related to poor oral health.

One of the ways in which medical professionals are collaborating to improve care is by doing the research so that information relayed to patients is evidence-based and consistent, but we have yet to fully integrate patient education into the plan.

Research

Through research, medical professionals have learned that many cross-referenced oral and systemic ailments are related through inflammation. Studies suggest that periodontal disease elicits regulatory molecules via the inflammatory cascade.

As the cascade progresses, these pro-inflammatory mediators as well as oral bacteria and lipopolysaccharides infiltrate other parts of the body, perpetuating the body’s inflammatory response (chronic inflammation) to disease and infection.

One study looked at the relationships between tooth loss, systemic inflammation, and periodontal pathogens in patients with cardiovascular disease and confirmed that periodontal disease could cause or worsen cardiovascular disease. The study suggests that Porphyromonas gingivalis, a known gram-negative, subgingival, and virulent periodontal bacteria “accelerated abdominal aortic aneurysm and arteriosclerosis in mice.”²

The Journal of Family Medicine & Primary Care offers a systematic review of the literature highlighting the fact that periodontal pathogens that protect the body against periodontal disease have been found in both crevicular fluid and in synovial joint fluid in the case of patients with RA, suggesting the role of periodontal bacteria in the etiology of RA.³

One of the most discussed bidirectional relationships is between diabetes and periodontal disease. “The two-way relationship between diabetes and periodontitis has established that diabetes increases the risk for periodontitis, and periodontal inflammation negatively affects glycemic control.”⁴ The good news is that stabilization of periodontal disease results in greater glycemic control on this two-way street.

Being Proactive

As medical professionals continue to dive into conducting research and versing themselves on these common oral and systemic health relationships, the next step is integrating holistic healthcare and the approach to patient education into graduate programs as well as educating patients in the dental office.

At Delta Dental of Arizona, for example, we have awarded grants to specifically tackle the integration of dental and medical care across the state. Among the programs we’ve supported through our Foundation:  

• The El Rio Community Health Center Pediatric Dental Integration Program provides direct screening, varnish treatments, and oral health education by embedding dental hygiene teams in five El Rio locations throughout southern Arizona. Additionally, the dental health outreach team engages in collaborative, community outreach events (some on hold or modified due to COVID-19) to connect with families who may not have a dental health home.
• The North Country Healthcare Medical-Dental Integration Program imbeds basic screening, fluoride applications, and dental education into existing pediatric and obstetric appointments across northern Arizona. The program also provides referral to dental care, as appropriate, with intent to provide dental homes for those who do not have an established relationship.
• The United Community Health Center (UCHC) Dental Program for Kids integrates oral health services and education into 500 low-income children’s medical well visits at UCHC pediatric clinics per year. The program aims to engage low-income and underserved pediatric patients in southern Arizona who receive medical care with dental services and educate patients about the importance of oral health.
• The Tohono O’Odham Nation Health Care Medical-Dental Collaboration Program, which is a medical-dental collaboration with the Tohono O’Odham Tribal Community, integrates a registered dental hygienist (RDH) into all acute and well pediatric medical visits providing dental education, screenings, fluoride applications, caries identification, and silver diamine fluoride (SDF) treatment in the medical clinic.
• The University of Arizona OHPEN (Oral Health Prevention and Education) Wide Program is a full-spectrum family medicine mobile clinic that provides free critical services to vulnerable populations in Tucson and Pima County. As a part of its care to low-income communities, the mobile unit provides dental screenings, fluoride varnish treatments, and oral health education to children and pregnant women.
• The Barrow Cleft and Cranial Facial Center Post-Surgery Education Program distributes jaw surgery kits and hosts a required oral health education workshop prior to surgery. Patients, parents, and all who will be part of the patient’s care are invited to the workshop to understand and prepare for what is to come following surgery. They also learn how each item in the kit needs to be used properly to care for the oral cavity for the critical two weeks following surgery to have a successful outcome.

As a final example, earlier this year Delta Dental of Arizona partnered with Neighborhood Outreach Access to Health (NOAH) and HonorHealth Foundation on Delta Dental of Arizona Dental Connect to support uninsured patients who visit an HonorHealth emergency room for dental issue across Greater-Phoenix.

It is my and Delta Dental of Arizona’s belief that we need to work together and continue innovating programs like these to improve both the smiles and lives of patients. We are all in this together, and there is much more to be done.

References

1. Nazir MA, Izhar F, Akhtar K, Almas K (n.d.). Dentists’ awareness about the link between oral and systemic health. Journal of Family & Community Medicine. doi:https://dx.doi.org/10.4103%2Fjfcm.JFCM_55_19
2. Aoyama N, Suzuki J, Kobayashi N, Hanatani T, Ashigaki N, Yoshida A, et al (2017). Associations among tooth LOSS, systemic inflammation and antibody TITERS To Periodontal pathogens in Japanese patients with cardiovascular disease. Journal of Periodontal Research, 53(1), 117-122. doi:10.1111/jre.12494
3. Arana P, Salazar D, Amaya S, Medina M, Moreno-Correa S, Moreno F, et al (2018). Periodontal microorganisms in synovial fluid of patients with rheumatoid Arthritis. systematic review of the literature – 2017. Revista Colombiana De Reumatología (English Edition), 25(4), 271-286. doi:10.1016/j.rcreue.2018.06.002
4. Lakshmanan R, Mahtani A, Jacob C (2020). Prevalence of diabetes among patients and the assessment of the awareness of the bidirectional relation between diabetes and periodontal disease. Journal of Family Medicine and Primary Care, 9(6), 2774. doi:10.4103/jfmpc.jfmpc_63_2
   

Dr. Schneider is the dental director at Delta Dental of Arizona. She has more than 19 years of experience in dental administration, dental education, and clinical dentistry.

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