There’s an old spiritual whose lyrics tell how the head bone connects to the neck bone, the neck bone connects to the shoulder bone, and so on down the body.
Except the song leaves out a very important part: the teeth.
New research details how our teeth are crucial to having a healthy body, which is why two Kentucky doctors are leading a charge to unite oral care with overall health care in the commonwealth.
Dr. Wanda Gonsalves is a professor and vice chair of the Department of Family and Community Medicine at the University of Kentucky. Dr. Raynor Mullins is a public health dentist and a member of the emeritus faculty at UK’s College of Dentistry. They appeared on KET’s One to One to discuss the coordination of oral and primary health care services. Their conversation is part of KET’s Inside Oral Health Care initiative.
As they explore the links between overall health and oral health, researchers are discovering that dental and periodontal diseases can contribute to heart problems, certain cancers, premature birth, and low birth-weight babies. They are also learning how other conditions like diabetes, osteoporosis, and Alzheimer’s disease can impact our teeth and gums.
“It’s clear to me that oral health has many consequences that are not readily recognized by our public officials or in health care policy and finance,” Mullins says.
This lack of knowledge about oral health leads to significant hidden costs for Medicaid and Medicare as well as private insurance companies, according to Mullins.
If primary care providers and dentists and dental hygienists can begin to work together, Mullins and Gonsalves contend those costs can be reduced and oral health improved.
But that may be easier said than done.
Open Wide and Say “Ah”
Traditionally, doctors and dentists have been completely separate specialties, says Gonsalves. They attend different schools and join different professional associations. They have different office computer systems and different insurance policies to cover their patients. There’s so much separation between the specialties that Gonsalves says when your doctor tells you to open wide and say “ah,” he or she often looks straight to the back of your throat without checking the condition of your gums or teeth.
“We have the training to be able to do risk assessments and to be able to counsel patients, but what we really lack is the education about oral health,” Gonsalves says. “We only get about two hours of oral health in medical education, so we need a whole lot more to be able to effectively coordinate and incorporate oral health.”
One area where UK’s dental and family medical programs have collaborated has already yielded positive results. Gonsalves says the two departments got a federal grant to write an oral health curriculum that has since been folded into a national curriculum called Smiles for Life.
That national platform has been endorsed by both medical and dental professionals. The curriculum teaches doctors, physician assistants, nurse practitioners, medical students, and others how to integrate oral health and primary care.
Mullins says it’s especially important for Kentucky to enlist primary care doctors and clinics in dental health activities because there are only 2,500 practicing dentists in the commonwealth. He adds that although there are numerous clinics around the state where medical and dental care professionals are co-located, relatively few patients avail themselves of the oral health services. He believes that if more doctors can inquire about bleeding gums, aching teeth, or other problems, and then refer patients to dental care, the better off patients will be in the long term.
A collaborative venture between UK and Morehead State University is working to improve oral health and increase the number of dental professionals in the commonwealth. That Appalachian Rural Dental Education Partnership Program trained nurses at MSU’s student health clinic in the Smiles for Life curriculum so they can foster better oral health on campus. The program also works to recruit and train students who might be interested in pursuing a dental health career. Mullins says he hopes that program can be replicated at other state universities as well as within the community and technical college system.
Dental Sealants, Infant Exams, and Tele-Dentistry
Since 40 percent of children in the state have never been to a dentist, advocates are also devising other ways to bring better oral health to young Kentuckians. For example, Kentucky’s dental community has continued to expand what was one of the first dental sealant initiatives in the nation.
Mullins says in the late 1970s, dental hygienists applied sealants to the permanent molars of some 15,000 Kentucky school children to help prevent tooth decay. Funding for that initiative waned in subsequent years before rebounding in the early 2000s. Now, oral health advocates hope to make the application of dental sealants available to all public school students.
“Sealants are very, very, very effective and there’s no reason that every child should not receive those preventive behaviors,” Mullins says.
Mullins also pushes for initiatives that target expectant mothers in order to reinforce the importance of dental health for babies. Mullins says dentists now recommend that infants should receive their first dental exam shortly after their first teeth come in, usually between the ages of 6 to 12 months.
Technology is another way to improve oral health. Mullins says patient registries will help dentists identify and monitor those who may be at risk of oral health or general health problems. He also says tele-dentistry could help primary care doctors in rural communities consult with dental professionals about a patient’s specific oral health issue.
And Gonsalves recommends common computer systems that will enable doctors and dentists to communicate better and make patient referrals more easily.