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Integrating Dental and Medical Care for Children and Adolescents with Obesity and Diabetes Mellitus
Sara G. Grossi, DDS, MS
An abundance of evidence supporting a relationship between periodontal disease and chronic systemic conditions, such as diabetes mellitus, heart disease, obesity, and upper respiratory diseases, has established clearly that oral health is integral to overall health. Although self-evident, this concept is rather new and represents a significant shift from the commonly accepted notion that oral diseases are self-limiting to the oral cavity and tissues. From this emerging evidence, paradigm changes are occurring in dentistry and medicine alike. Dental professionals are significantly more aware of patients’ medical backgrounds. Conversely, medical professionals are increasingly more concerned about their patients’ oral health and how oral disease may impact morbidities. This paradigm change in the relationship between medicine and dentistry, although still in its infancy, has swung the pendulum towards medical professionals working closer with dental professionals.
Nowhere is this new and improved partnership more evident than in the one between pediatricians and pediatric dentists. Pediatricians, similar to other medical professionals, have traditionally believed that oral health is important to the overall well-being of the child or adolescent and as such have been involved in providing anticipatory guidance for the prevention of dental caries and oral health problems. As evidence builds regarding the strong relationship between oral disease (especially periodontal disease) and chronic systemic conditions, the focus should be on applying and implementing these new concepts to patient care. All patients, especially those at high risk for chronic conditions, deserve this level of integrated care.
Patients with diabetes have a greater risk for more severe periodontal disease. In addition, diabetes is more severe and effective glucose control more difficult when periodontal disease is present. Health professionals have the responsibility to apply this knowledge to patient care, implementing changes in the delivery of dental and medical care that are already within their reach. This includes comprehensive management of patients with diabetes or those who are at high risk (eg, overweight and obese) in a clinical setting where dental professionals work closely with medical professionals. In this integrated setting, these medical and dental professionals are intimately involved in patient care, enabling better management in the patients’ overall health.
This integrated model of healthcare is important especially in managing children and adolescents with diabetes and obesity, which, combined with poor oral health, are lifestyle-associated conditions, sharing similar health-risk behaviors. Children and adolescents who are overweight and have diabetes may have adverse lifestyle behaviors, such as unhealthy diet, which promotes obesity and tooth decay. Poor lifestyle behaviors, such as low activity levels, are comparable to poor habits of proper oral hygiene.
One such novel model of healthcare is the establishment of the first-of-its-kind Pediatric Healthy Weight Research and Treatment Center at the Department of Pediatrics, Brody School of Medicine, East Carolina University in Greenville, NC. In this new model of integrated healthcare, children with certain conditions (eg, type 1 or type 2 diabetes, obesity, cardiovascular, endocrine, cancer, hematologic, and pulmonary) receive oral/dental care. Rather than traditionally referring patients for dental treatment, pediatric specialists work with dental professionals in the same clinic (Figure 1) to manage chronic conditions in children and adolescents comprehensively in a clinical setting where oral disease is managed as yet another health condition instead of an isolated event. The patient’s detailed and complete health information is in a central electronic record, which facilitates access of health-related information for dental and medical professionals. Communication among these professionals is continual. The treating dentist is completely aware of and familiar with the patient’s comprehensive and detailed medical history, medication history, and medication regimens. Likewise, the pediatric specialists are completely informed of the patient’s dental history: diagnosis, treatment history, treatment outcome, and follow-ups.
The message to the young patient is clear: Health is interconnected and important, and following “doctor’s orders” and treatment schedules is essential to health and well-being. The increase in the number of patients with chronic conditions, especially obesity and diabetes, and the rise in oral diseases require a new breed of dental and medical professionals trained to recognize, treat, and manage chronic conditions with a more holistic approach. This integrated model is just what the doctor ordered.
About the Author
Sara G. Grossi, DDS, MS
Department of Pediatrics
Brody School of Medicine
East Carolina University
Greenville, North Carolina