Role of Oral Health Growing In Overall Healthcare Picture

Laurie Hodge, DMD

The role dental health plays in a patient's overall health traditionally has been overlooked by many in the healthcare field, but this situation has begun to change with the success of collaborations between primary care physicians and dentists, according to noted authorities attending the recent National Oral Health Conference in Memphis.

Integration of oral health into the healthcare system and a lack of access to proper dental care, especially among the uninsured, were the two issues that received the most attention during the organization's 20th annual event that included five days of workshops and discussions.

Some 860, dental students, health officials, researchers, educators, legislators and dental directors from across the globe gathered in Memphis to consider how to improve the oral health and general well-being of the public.

"The biggest buzz now in dentistry is the integration of oral health into the healthcare system," according to Jason Roush, DDS, state dental director for the West Virginia National Oral Health Program and president of the Association of State and Territorial Dental Directors, a non-profit, professional association for state dental directors, which helped organize the conference with the American Association of Public Health Dentistry.

"It's a relatively new concept" he said. "Instead of just treating a singular problem with a patient's teeth, our goal is to improve overall health outcomes by collaborating. We see the same patients, so it's time to improve the patient's overall health."

With national research now showing a link between a patient's oral health and overall health, health professionals are seeing an opportunity for collaboration between primary care physicians and dentists in the treatment of patients.

For example, there is evidenced-based data that diabetes is associated with the prevalence of periodontal disease, a gum infection that damages gums. According to the American Dental Association (ADA), The ADA reported 22 percent of patients diagnosed with diabetes have periodontal disease.

Despite the data that oral health can affect a patient's overall health, Laurie Hodge, DMD, dental director for Church Health, the faith-based non-profit organization which provides comprehensive healthcare - including dental care - to uninsured or underinsured in Shelby County, said there's an explicable reason for the difficulty to bring the two together. It's a challenge at both a local and national level for physicians and dentists to work together because of separate insurance systems, incompatible electronic health records and a lack of education.

"The systems aren't integrated and none of them talk to each other," Dr. Hodge said. "You have to rely on the patient for information and medical history, and we don't always get all the information from the patient. Also, the dental profession and the primary care system traditionally have been separate. Patients go to an optometrist for an eye issue, a dentist for their teeth and a primary care provider for everything else."

Dr. Roush agreed.

"We need to change the system to improve health outcomes," Dr. Roush said. "The change must take place on a national, state and local level."

Orpheus Triplett, DDS

Dr. Hodge and Orpheus Triplett, DDS, director of community relations and outreach in the department of pediatric dentistry and community oral health at the University of Tennessee Health Science Center (UTHSC), said they see the success of healthcare collaboration locally at federally qualified health centers, such as Christ Community Health Center, and non-profit health clinics, like Church Health.

Last year, Christ Community Health Center served more than 56,500 patients and averaged about 180,000 patient visits, according to the health center's website. Church Health performed 39,000 procedures and received almost 14,000 patient visits from March of last year to this past March, according to Dr. Hodge.

Church Health incorporates comprehensive healthcare for its patients by offering all three health services - medical, dental and behavior health - under one roof. The facility, also offers nutrition, exercise and wellness education programs.

Dr. Hodge said the arrangement works well between the dental and medical clinics at Church Health because patients may come into the primary care clinic with pain that's actually dental-related.

"The medical staff can walk a patient right over to us to be treated," Dr. Hodge said. "The arrangement eliminates a patient from going to the emergency room for tooth pain. There, they receive either pain medication or an antibiotic and the problem isn't fixed. We try to be smart with the resources we have and decrease the visits to the emergency room for a dental issue."

According to the ADA, dental pain is a common reason patients end up in the emergency room. It accounted for 2.1 million visits in 2010. Dr. Hodge indicated its dental staff could catch bigger health issues onsite while treating a patient's teeth.

"A patient could come in for a dental procedure and may have high blood pressure, but isn't on any medication," Dr. Hodge said. "He or she may have undiagnosed hypertension. We can walk them to the medical clinic. The patients' medical records are in one location, so we can see what treatment they're receiving and know right away what their issues are."

In an effort to integrate healthcare education on a student level, Dr. Triplett, who attended the conference, said UTHSC established an Oral Systemic Health for the Twenty-First Century initiative recently which looks at data on how poor oral health relates to overall systemic health to see how the university can incorporate systemic health education across different colleges.

"The first step is to improve relationships between the medical and dental communities," Dr. Roush said. "We are seeing some evidence of this in dental schools with cross curriculum and development across departments nationally."

Another issue in dentistry, which impacts both dentists and uninsured patients in Tennessee, is the lack of access to care, not just in a rural setting, but also in an urban setting where the poverty level may be high.

"We have an outlier in Tennessee," Dr. Hodge said. "Tennessee is one of two states that does not offer dental benefits for adults through Medicaid. It's become challenging to meet patient's needs. Not everyone has dental insurance and they can't afford it out-of-pocket. We'll see this happen with the baby boomer generation as well. They won't have access to dental care through traditional Medicare."

According to Dr. Triplett, there are a limited number of dentists in Shelby County who accept TennCare because of low reimbursement. Under TennCare, children are eligible to receive dental care, but due to socio-economic situations, parents may not be able transport their children to the dentist, Dr. Triplett explained.

Dr. Triplett said some solutions for urban areas, which were discussed at the National Oral Health Conference, are teledentistry and the use mobile dental units.

"The university is trying to obtain a grant for a mobile dental unit, so we can go into a community and treat patients where they live," he said. "Also, we want to establish a relationship with the Shelby County Schools. Being able to treat children at school can benefit their oral health and education."

Additionally, UTHSC is involved in the ADA's "Give Kids a Smile" program, which provides free oral health services to underserved children. The university partners with Freedom Preparatory Academy and offers free dental services to middle school children at the school during February each year.

Dr. Triplett said he's working with the Tennessee Alliance for Oral Health through the Tennessee Primary Care Association for Tennessee to provide dental care for all pregnant women in Tennessee. He said the state legislature passed the initiative, but hasn't funded it.

"Many pregnant women aren't aware of vertical transference," Dr. Triplett said. "They don't know that bacteria from cavities can be passed on to their babies. We want them to be treated for dental disease, so they don't pass that bacteria to their babies."

Smile!

In addition to tracking a patient's level of pain in the dental clinic, Church Health also tries to gage patients' overall satisfaction with their smile by means of a "Smile Confidence Scale." Before treatment, patients are asked to indicate on a scale of zero to 10 how confident they are with their smile. After treatment, patients are asked to rate their smile on the same confidence scale. "Some patients may walk around with broken teeth and feel isolated when they come in," said Laurie Hodge, DMD, dental director for Church Health. "It may seem like a small thing, but a confident smile can improve a patient's interaction with others and their overall mental health. We want patients leaving here with a seven or higher on the scale."