Closing the dental-medical diastema

A 5-year-old girl presented to our pediatric dental clinic. Her family lives three hours away, and had rented a hotel nearby to accommodate and prepare for her restorative dental procedures under general anesthesia. Due to her young age and extensive dental needs, sedation was the only safe and effective option at this point. She had never seen a dentist before. She was terrified, and was in a great deal of pain. She was up to date with medical check-ups and healthy otherwise, but was never referred for preventive or restorative treatment until late into her caries progression.

How do we as providers let patients slip through the cracks of our modern healthcare system?

Oral health is becoming more deeply integrated into the greater healthcare world each and every day. Dental schools increasingly work to enforce the importance of interprofessional communication regarding oral health. This month, I attended the National Oral Health Conference where I met Marcia K. Brand of Shepard University who lead a round table discussed exactly on this.

When oral health is prioritized in the health care world, everyone wins. It is, “the Trifecta.” Community members are the direct beneficiaries here. Members within the area benefit from the convenience of having a dental provider and oral health screening at their primary care office. This usually means that encounters happen earlier than they would otherwise. For example, children are more likely to have a dental home if their primary care physician is trained and executes an oral health screening and referral for consultation when necessary.  Medical practitioners benefit as well. By bridging the gap between medical and dental providers, they improve their patients overall health score by addressing and fulfilling their oral health demands. Lastly, the dental practitioners benefit downstream as they receive more referrals and are able to offer better patient care with earlier encounters.

Of course, there are limitations as well as logistical challenges to this model, and the feasibility of interprofessional healthcare varies greatly from state to state.

Medical professionals often report that lack of time prevents them from being able to perform preventive oral health services. Medical centers struggle with insurance issues due to differences in billing in medical versus dental and the inconvenience of needing to hire a dental professional (hygienist or dental assistant). Some report that they are not confident in their ability to provide oral health screenings. Lastly, many offices report being under-staffed so much so that simply taking on other responsibilities is not practical. This topic continues to be a focus of both the American Dental Association and the American Medical Association.

Smiles for Life is a complimentary online national oral health curriculum which provides resources to educate and inspire healthcare professionals to understand the importance of oral health on one’s general health. The site provides the instruments to screen and refer patients in order to encourage good oral health.

Other useful resources:

OralHealth 2020. Dentaquest Foundation Grantmaking Statement of Purpose

HHS HRSA Oral Health Strategic Framework (2014–2017). U.S. Department of Health and Human Services

Mertz, E. (Dec 2016). Vol. 35, No. 12. Health Affairs: The Dental-Medical Divide

Whitman, E. (Jan 2017). Modern Healthcare: Moving Dental Health into Primary Care

Kodjak, A. (Sept 2016). National Public Radio News. A Good Dentist is Hard to Find

Simon, L. AMA Journal of Ethics. September 2016, Volume 18, Number 9: Overcoming Historical Separation between Oral and General Health Care: Interprofessional Collaboration for Promoting Health Equity

~Dr. Neek LaMantia

Neek (Nicole) LaMantia is a first year pediatric dental resident at the University of California, Los Angeles. She is also working towards her masters in public health. Dr. LaMantia served as the electronic editor for ASDA’s Mouthing Off from 2013-2015.

This content is sponsored and does not necessarily reflect the views of ASDA.