BRIDGING THE DENTIST-DOCTOR DIVIDE By Russ Banham Does your doctor examine your teeth at your annual physical? Does he or she request your dental records? The answer to both questions is likely no, despite the potential link between one’s oral health and several systemic diseases. Multiple epidemiological studies indicate that the inflammation that occurs from periodontal disease and dental caries, or decay, is connected with higher incidences of coronary artery disease, renal disease, Type 1 and Type 2 diabetes, and cardiovascular disease — and may have an adverse effect on pregnancy outcomes. The culprit: the inflammation-inducing toxin produced by the bacteria in our mouths. One would think this linkage would urge doctors and dentists to share their patient medical records. But separate silos continue to exist, with a potential risk to the health of patients. That risk is one that employers must shoulder. “By getting everything on the same platform, we can reduce overall health care costs,” says former practicing dentist and dentistry instructor Mary Lee Conicella, DMD, chief dental officer at Aetna. “Better health outcomes also result in fewer hospital admissions, reduced employee absenteeism and greater productivity.” Obstacles to Integration It wasn’t always this way. In the 19th century, many doctors were convinced that a wide range of diseases was related to a patient’s dental health. In the 1880s, for instance, German physician Robert Koch suggested in his germ theory of disease that bacteria found in the oral cavity may be the cause of several systemic diseases. In 1900, British surgeon William Hunter concluded that Koch was correct and that colitis, arthritis, rheumatism, anemia and even mental depression were the result of oral bacteria. These theories gained momentum until the 1930s, when several rheumatologists treating arthritis took the radical step of removing their patients’ teeth in hope of a cure. Sadly for the patients, the arthritis persisted. The relationship between oral health and general health lost credibility in subsequent years, reaching a crescendo in 1952, when an editorial in the Journal of the American Medical Association unequivocally stated that the removal of teeth did not prevent or treat any systemic illnesses. “Physicians read the article and simply stopped thinking about a connection,” says Conicella. “The pendulum swung the other way.” Today, it is swinging back again. At a 2013 meeting organized by the European Federation of Periodontology and the American Academy of Periodontology, a panel of medical experts reviewing 17 epidemiologic studies concluded that periodontal disease has a potential effect on three medical conditions — diabetes mellitus, atherosclerotic cerebrocardiovascular diseases and adverse pregnancy outcomes. Another study indicated that health insurance plan members who were being successfully treated for gum disease had lower medical care costs overall. Despite the various study findings, there is a pronounced lack of interprofessional care by doctors and dentists and little in the way of integrated medical and dental health records. Although the Health Information Technology for Economic and Clinical Health (HITECH) Act requires meaningful use of electronic health records and imposes financial penalties under Medicare for failure to comply with the regulation, few dentists participate in Medicare, as the government social program does not pay for outpatient dental procedures. Another challenge is the solid wall that exists between dental schools and medical schools. While they may share a campus and virtually the same curriculum for dental and medical students during the first two years of study, the classes are rarely integrated with both sets of students. Moving Forward There is some progress to report. At more and more hospitals, electronic health care records are now integrated with patients’ dental data. Some health plans also are identifying those plan members with diabetes as well as cardiovascular and other systemic conditions who have not visited a dentist in more than a year. “We send them a postcard reminding them of the vital medical importance of oral health,” Conicella says. “More than 50 percent subsequently go to the dentist in the next 12 months.” Other medical facilities and employer-sponsored health plans are beginning to move in this direction, due to the prospect of better medical care and improved outcomes. But experts say that until the U.S. government mandates the use of integrated electronic health and dental records, the onus is on physicians and dentists to carry the mantle forward. Russ Banham is a veteran business journalist and author. His new book, Higher, a history of Boeing, will be in bookstores in December. RECOMMENDED LINKS
Posted on: Tue, 30 Dec 2014 12:39:27 +0000
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