There is no doubt, our country is experiencing a chronic health crisis. We have higher health expenses than any other country and experience mediocre overall health outcomes (i.e., chronic disease prevalence, life expectancy, etc.) compared to other countries. As our health care industry is forced to make a transition toward outcome-based care, I believe that dentistry could have an invaluable role to play in the future setting of primary care.
By now we are all familiar with the many factors influencing our country’s rate of health spending (e.g., fee for service procedures, fragmentation of the health system, increasing medical technology usage, etc.) But what about chronic disease outcomes? In a health care system characterized by reactive, acute-based treatment for decades, it has become clear that chronic disease and proactive treatment has not been a priority. Today, 5% of the population accounts for nearly 50% of total health care spending. About 1 in 4 individuals have a “chronic condition” such as cardiovascular disease, diabetes, asthma or mental disorder. What’s worse, we are expected to face a primary care shortage in coming years. So how can we stop this spiraling cascade of chronic health issues from continuing?
In comes dentistry, which has long been regarded as a separate field rather than part of medical care. And why is that? Considering that we use our mouths every single day of our lives, it makes sense that the condition of our teeth and gums have some indication of our general health. In fact, when properly performed by a dentist, oral health assessments are powerful tools that can reveal more than just the condition of our oral health. They can uncover important information about our lives which can help primary care physicians. An examination of the oral cavity can reveal excess carb/sugar intake, diabetes risk, oral cancer risk, HIV/AIDS status, heart disease risk and many other medical conditions. Using this information, oral health professionals are in a position to proactively manage patient habit and behaviors before they become chronic conditions.
But the questions remains: if oral health exams are helpful in early disease diagnosis, why isn’t this information going to my PCP?
Unfortunately, the answer is complicated. However, the solution has been partly laid out by the Affordable Care Act. The advent of the Patient Centered Medical Home model opens the door for an interdisciplinary approach to patient care using a team of medical professionals. The opportunity to incorporate oral health into medical care has never been so evident.
On one extreme, the integration of dental and medical services makes financial sense for population health as well as for the health care industry. Dental procedures are generally less costly than medical procedures and less strenuous on resources. In dentistry, you have outpatient procedures performed by a dentist, assistant, hygienist and small clerical staff. A typical medical procedure can be accompanied by a short hospital stay and could require an anesthesiologist, surgical doctor, along with various nursing and administrative staff. Still, more effort is needed to bring us from a reactive to a proactive model of care.
Dr. Fred Ferguson DDS, a pediatric dentist in New York, has an idea that uses a proactive approach to solve the problem of patient compliance and interdisciplinary collaboration. According to Dr. Ferguson, “insurance would work if patients were more engaged in their own health, but in order to do so they need access to the correct information.” MySmileGuide is an oral health and education platform he developed that provides personalized data for all age groups and their health providers. His patients (and their families) log into the website and are asked a series of questions about their oral health and habits. Based on the answers, an oral health score is computed with information relevant to the patient’s age. These reports can then be reviewed, shared with physicians and uploaded to patient portals for routine monitoring. Endeavors such as MySmileGuide are becoming increasingly important because they allow dentists to participate in the proactive approach to health outcomes in their community.
Make no mistake, a solution of this order would require the support of dental and medical professionals as well as policymakers and payers. But whether it is through patient referrals or complete co-location of services, the benefits that come from oral health collaboration with primary care are evident. If the health of our patients is of the utmost importance, as it should be, there are plenty of reasons why interdisciplinary involvement at some level should be seriously considered.
Do you have thoughts on better integrating oral health into overall health care? Share your ideas in the comments below!
~Tony Bogdan, predental