Our society has a disconnect between dentistry and medicine that has developed over the last two centuries. This has led to public perception by many to disregard teeth and gum problems as a separate matter that isn’t all that important. Unfortunately, that couldn’t be further from the truth.
From my limited research on the topic, it doesn’t appear there was ever a specific decision made to separate dentistry from medicine, rather dentistry separated naturally as dental schools and dental regulations started in the mid 1800’s. At that time much of dentistry was considered a trade and not a branch of medicine due to most of the work involving extracting teeth (which even barbers did at the time) and fabricating dentures. The idea tooth decay and infections affecting the body did not develop until much later when dentistry was completely separated.
The insurance industry and organized dentistry has pushed to keep them separate for the last half century. Dentistry is a challenge for insurance because the prevalence of dental disease is so high in the population, therefore it would cut into profits of the insurance companies or raise premiums significantly.
Leap forward to today and the trend appears to be moving the other way as research has shown the strong correlation between many facets of dentistry and overall health. The most well-known are the connections between periodontal (gum) disease and several health conditions including heart disease, stroke, diabetes, premature births, cancer, Alzheimer’s disease, and dementia. Recent trends in public policy have begun the shift toward combining dentistry and medicine. The Affordable Care Act required children’s dentistry to be included with health insurance as an option, public health centers have dentists and physicians in the facility, and Medicare Advantage plans are beginning to have an option for dental care.
If our medical system were to be reimagined today, I assume dentistry would be tightly connected to medicine because patients visit the dentist on a regular basis which would allow for easy access to screen for both dental disease but also other health issues. This is difficult to see happening anytime soon as dentists and physicians are entrenched in being separate entities and we are mostly driven by for-profit insurance companies who aren’t looking for ways to spend more money. Therefore, the best we can do as dentists is educate and hope our physician colleagues will continue to see the connection. Thankfully, this has happened a great deal over the past 20 years that I have been in practice. It is now commonplace for physicians to refer heart patients to the dentist prior to surgery or when diagnosed with diabetes. Dentists often take blood pressures and screen for obvious health issues and refer to physicians. This isn’t a perfect situation, but it is a start.
This is a large topic, so I’ll finish with a few take home concepts on how to be proactive knowing the many connections between periodontal disease and many health issues. The first is to not ignore your teeth and gums. Bleeding gums are a sign something is wrong and increase your risk of systemic issues. Be diligent with your home care by brushing with an electric brush at least twice daily, floss at least once daily, use an antibacterial mouthwash, and visit the dentist at the recommended interval.
Many people think bleeding gums are normal – they aren’t. With periodontal disease, surface area of the gums that are red, inflamed and bleeding can equal the size of your palm. If you found a patch of red bleeding tissue anywhere else in your body the never healed, you would likely panic and call a physician and do whatever they recommended to clear it up. But for some reason this just isn’t the case with periodontal disease. The CDC estimates approximately 60-80% of adults have gingivitis which progresses to periodontal disease and 47% of adults over 30 have some form of active periodontal disease putting them at greater risk for the many systemic diseases previously listed. This is a challenge because dental insurance only occasionally reimburses periodontal treatment and when they do it is at a low rate. Thus, many patients will forgo the needed treatments.
It’s unfortunate the dental and medical are separate because it leads to less reimbursement from insurance if the patient has insurance and many people decide to forgo treatment and thus increase their risk for many health issues. Hopefully, the trend will continue to move toward a better system of health care that focusses on the risks and best practices; not on reimbursement models.