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Integrating care for the good of the patient

Medical staff iconsA multidisciplinary approach to health care has long been a topic of conversation. Unfortunately, most of us have yet to see it materialize. I spoke with Kenneth Kornman, DDS, PhD, president and chief science officer of Interleukin Genetics, about the importance of medical and dental integration. Interleukin Genetics is developing genetic tests for several systemic diseases using markers for chronic inflammation. Chronic inflammation has been linked with several systemic diseases, which lead to early morbidity and mortality. As a periodontist, Dr. Kornman is especially interested in the link between periodontal disease and systemic disease such as type 2 diabetes. A great way to address chronic systemic disease is to open the lines of communication between the medical and dental care systems.

Right now very few schools offer courses with combined medical and dental students. Dr. Kornman thinks we’re missing an opportunity using early clinical exposure for medical and dental students to make connections. The difficulty of including dental students in all biomedical classes with medical students is in making sure they still have sufficient clinical training. Nevertheless, it would be helpful for students from both programs to examine the same patients. It’s necessary to train physicians to look for oral health warning signs just as dentists are taught to look for clues to systemic diseases. More importantly, it could start the conversation for better interdisciplinary understanding. Another benefit comes from showing the patient that there are significant connections.

Another opportunity for integration arises in advanced training. Currently the medical system has a different format of compensation for advanced procedures performed by specialists. Those procedures often need to be done by professionals with additional training because general practitioners do not have the experience. Dentistry, on the other hand, uses a general practice model. More cases can be effectively managed by general dentists. Specialists have more training and experience, but the procedures performed are not necessarily independent. Some specialty programs have combined courses or place residents in hospital or comprehensive health care clinics. These types of delivery models may be the first step toward multi-specialty practices and care integration.

So how does a multidisciplinary approach to health care benefit the patient? Dr. Kornman explained that people who live with a good quality of life past age 90 and beyond usually don’t have their first experience with a major chronic disease until 20-30 years after people who die or get sick much younger. There are a handful of factors, including chronic low-grade inflammation, that can predict if a person will stay relatively healthy into old age.

Even with current changes in health care delivery, the U.S. health care system still won’t be able to afford treatment for all the chronic disease we have. Our best option is preventing those diseases from developing in the first place. Large-scale clinics such as the Joslin Diabetes Center in Boston combine medical specialties such as ophthalmologists and renal specialists to manage disease complications. But they don’t have dentists or other clinicians to address the complications of periodontal disease or related problems. Other prevention clinics such as the Cooper Clinic in Dallas emphasize prevention, evaluating patients on multiple platforms and include a full dental exam. Given the connection between chronic inflammation and serious systemic diseases, control of chronic inflammation is extremely important. As a significant contributor to chronic inflammation, periodontal disease is a good target reached through regular dental treatment.

Dr. Kornman had some advice for current dental students. We have an opportunity to work with students in other health professions to address chronic diseases. We can also open a dialogue with our faculty regarding what can be done in conjunction with other professionals. Now is a perfect time to start finding colleagues on the medical side to build connections that will pay off later.

The health care delivery system is in the throes of dramatic change. Currently, dental care is fairly independent. However, we’ll probably see more overlap with chronic disease management in the future. Dr. Kornman agrees it’s a very exciting time to be in our position!

~ Rachel Bush, Las Vegas ’18, ASDA Electronic Editor

Rachel Bush

Rachel is a fourth-year dental student at the University of Nevada - Las Vegas. She hails from northern Illinois and has enjoyed the transition to desert life. She is active in her school's volunteer Women's Clinic, which provides free care for abused women. She serves as an electronic editor on ASDA's 2017-18 National Editorial Board (her second year in that role).

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  1. Integrative health care that incorporates things like dental care can certainly be beneficial. It is a great way to make sure that everyone gets the treatments that they need. Not only that, but it also helps practitioners understand how different diseases relate to each other.

  2. Rachel, Thanks for the guide..This is very helpful for you.

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