A little over a year ago, my dental school switched patient record systems to Epic in an attempt to teach interdisciplinary care for our patients at the dental school. Epic has not historically been used for dentistry, so there was quite a bit of trial-and-error for everyone involved. But, looking back and looking ahead, I do think this was a step in the right direction. Though health insurance may not reflect it, the mind, mouth and body are connected in endless ways. Integrating medical and dental records validates the phenomena we see in our patients — one always affects the other.
The mouth is the window to the body. There are so many systemic illnesses, conditions and general bodily changes that manifest in the mouth and vice versa. For example, according to the Journal of the American Dental Association, people with diabetes (type was not specified) often have periodontal disease, too, and people with periodontal disease can have trouble controlling their blood sugar. Based on my (pretty limited so far) clinical experience, patients can be unaware of this connection and are shocked to know that their diabetes has anything to do with tooth loss. Another common condition is bulimia. Individuals with bulimia often have a specific erosion pattern on the lingual portions of their teeth that dentists can often notice during routine exams. An even more relevant example is stress-related oral trauma. The oral effects of the COVID-19 pandemic and the rise in racial injustices are being widely discussed. Within this last year, there have (anecdotally) been more tooth fractures and failed dental treatment than usual due to the stress that so many people are facing. Additional examples of systemic conditions that could result in oral manifestations, according to the Mayo Clinic, include cancer, Alzheimer’s disease, HIV/AIDS, pneumonia, pregnancy, nutritional deficiencies, unhealthy diet patterns, underlying GI issues and depression, to name a few.
In addition to the conditions listed above, our mouth can even affect the way we look and breathe. Dr. Steven Lin, author of “The Dental Diet,” writes, “Teeth are an excellent indicator of health — they tell us about the foundation of our skull, brain and airway.” He even goes on to say that people who have “striking smiles” usually also have prominent cheekbones and jawbones to support those straight teeth, in addition to “high standing skulls…and upright skeletal posture.” (I don’t know about y’all, but I will be on the lookout for these patterns in every person I meet from now on.) He also mentioned that those prominent cheekbones and jawbones are accompanied by good airways, which leads us to the etiology of sleep apnea and other airway-related conditions. Dr. Lin also says that “dental disease is a painstakingly obvious message that something is very wrong in the body as a whole.” He goes on to say, “Over the past decade, our application of bacterial gene sequencing technology has found that the bacterial imbalances that begin in our mouth during tooth decay echo throughout our entire digestive system and body.” By continuing to familiarize ourselves with oral patterns of mental and systemic conditions, oral health care professionals can be a key piece of the puzzle to helping diagnose patients and referring them to the proper channels for treatment.
As oral health care providers, our patients are encouraged to see us every six months and even more often if they are diagnosed with periodontal disease. This means that our patients see us more often than they see their primary care physician. Dentists also usually have longer appointment times with their patients (dental visits and procedures can typically take longer than primary care physician visits), which means we have more time and opportunity to bond with our patients and take note of anything we may want to (politely/reasonably) discuss further, according to an article in the Journal of Family Medicine and Primary Care. We could even be key players in identifying child abuse, mitigating smoking cessation and providing alcohol screening.
The journal article asks, “As the population ages and chronic illnesses affect a large percentage of those seeking and requiring dental services, will the dental profession be prepared to comprehensively treat these kinds of patients?” My personal guess is yes. I think we’ve already begun incorporating various screenings into our comprehensive care, and I do hope to see more of that integration incorporated into our practice.
As for the treatment portion, learning to work with our colleagues in health care is the best step forward. Seeing my institution and other institutions around the nation begin to integrate their patient records system makes me optimistic for the future of interprofessional education and interdisciplinary care.
~Rand Khasawneh, North Carolina ’22