Dentists

Every year in the United States, more than 100 million people visit their physician but do not go to their dentist. This medical–dental divide is a problem because oral health care is so important. Oral health affects how we speak, eat and breathe. Painful toothache and other conditions lead to lost work and school days. In elderly people, clinical studies show that maintaining healthy teeth is linked to longevity and higher quality of life1. In the United Kingdom, more than 26,000 children between 5 and 9 years old were admitted to hospital because of tooth decay in 2017–18 — more than twice as many as were hospitalized by acute tonsillitis.

The upshot is that any attempt to connect more people to the health-care system cannot afford to ignore dental services.

And yet that is exactly what has been happening for many years. Most medical practitioners overlook conditions in the mouth that can affect the whole body. Meanwhile, dentists tend to see the mouth as a self-contained compartment and rarely look beyond it. This separation between mouth and body impedes health care. Greater interaction between the two health professions is needed.

During dental check-ups, early signs of general conditions should be recognized and taken seriously in collaboration with physicians. Conversely, medical practitioners should be able to inspect the mouth and refer the patient to the dentist with the understanding that oral health is essential for whole-body health.

Obsolete divide

A few centuries ago, dentistry was considered more of a craft than a health profession. The main form of treatment was to pull teeth out of the mouth.

At the beginning of the twentieth century, as knowledge of the danger of dental infections increased, dental and medical students came closer together. In most universities today, the two groups of students share some basic classes during their training. However, the clinical paths they take as they progress towards graduation and beyond are still mostly separate, which is not conducive to integrated care.

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Part of Nature Outlook: Oral health

Merging dentistry and general medicine is an important goal. After all, oral diseases are ubiquitous. Untreated tooth decay is the most prevalent human disease, and gum disease is the fifth most prevalent condition. What’s more, dentists are well positioned to detect early signs of general diseases, as they often show up first in the mouth. Recurring mouth ulcers, for instance, can indicate vitamin deficiencies and low immune response. Gum disease can be a sign of diabetes or metabolic changes.

To take advantage of the connection between mouth and body, medical students should learn about dental anatomy, including the importance of the oral biofilm and the basics of the most prevalent oral diseases. They should also be able to perform a basic clinical oral examination to detect undiagnosed conditions that affect general health and well-being, such as tooth decay, gum disease and pre-cancerous lesions.

Dental training, meanwhile, needs to include a holistic view of health care. There is strong evidence linking localized gum inflammation in periodontitis with systemic inflammation that negatively affects conditions such as heart disease, diabetes, pregnancy complications and chronic kidney and lung diseases. Studies also suggest that untreated periodontitis can increase the risk of COVID-related lung complications and death24.

Changing habits

A modern dental education already provides knowledge of general anatomy and physiology, as well as oral medicine. But a more active approach is required to translate the theory into clinical practice and ensure that dentists and physicians alike consider the mouth and body as two parts of the same system.

Continuing education can help shift the mindset of health professionals. Interprofessional courses can be a powerful tool for change if used to inform, inspire and motivate practitioners to focus on knowledge exchange and integrated health approaches. Such learning opportunities should be offered by dental and medical associations and organizations.

The main barrier to information sharing is likely to be the perception by many physicians that oral conditions are not important. Presenting solid research data on the effect of oral health on the body would be a good way to persuade physicians to change their attitudes and behaviour.

Educating patients also brings health benefits. Medical and dental professionals should make sure they understand the importance of behaviours that promote or put at risk the health of all body systems and organs — particularly diet, smoking, exercise, alcohol consumption and oral hygiene. Physicians who grasp the importance of oral health can more easily educate their patients to care for their mouths as much as the rest of their bodies. And dentists can persuade their patients to monitor their general health more closely.

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More from Nature Outlooks

To promote integrative whole-body health, dental surgeries will need to change some of their habits. When recording a patient’s medical history, dentists should enquire about health-promoting behaviours, such as when they last visited a physician. They should also screen for common health conditions such as high blood pressure and high blood sugar during routine dental visits. Medical organizations might need to provide dental staff with training on the use of blood-pressure monitors and glucometers, how to interpret the readings, and when to refer patients to physicians. Each year, about 27 million people in the United States have a dental visit but do not see a physician5. Given the large number of people with undiagnosed diabetes and hypertension, and the high health and financial costs of these conditions, dentists could have a crucial role.

Turning dental surgeries into health screening facilities will become even more valuable once saliva starts to fulfil its potential for non-invasive diagnosis. In the coming years, quick chair-side tests will be able to identify biomarkers in saliva that indicate a variety of diseases in the body, including cancer, endocrine disorders and viral infections.

The current wall between doctors and dentists needs to come down. Blending the two disciplines has the potential to promote the early identification and treatment of diseases and conditions, leading to disease prevention, better patient outcomes, more effective management of chronic diseases and reduced costs for health-care systems.

The connections between general and oral conditions are clear. Closer collaboration between the two professions can benefit the patient, decreasing morbidity and mortality, and reducing institutional as well as individual health costs. The archaic division between dentistry and medicine is detrimental to overall health and needs to end.

Source : https://www.nature.com/articles/d41586-021-02919-3

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