Partnering with Physicians
Dentists need new paradigm for better diagnoses and treatment
There was a time when dentistry fit into a neat, little box. Dentists dealt with teeth; physicians handled the rest of the body, but that no longer fits today’s reality. The mouth is part of the body, and systemic conditions affect the teeth, gums, tongue, and jaws. To ensure that patients receive the best possible dental care and the best possible healthcare, dentists need to start thinking of physicians as partners in practice.
Shifting trends have also put dental practices on the front lines of primary care. Dentists should be collaborating with their patients’ physicians for a number of reasons:
An aging population. More patients are entering old age and suffering from systemic diseases like diabetes and cardiovascular disease. These systemic diseases have a strong oral component.
A shortage of physicians. Just as the US population needs increased access to primary care, the number of primary care physicians is shrinking. Patients may have trouble getting appointments to discuss problems or order bloodwork. Meanwhile, they see their dentist every 6 months. If they are developing a systemic disease, their dentist may have the best chance of catching it before they feel sick enough to make an appointment with their primary care provider.
Increased focus on whole-body health. Dentists typically urge their patients to eat well and take care of their teeth. However, we now know that what’s good for the teeth is good for the whole patient. A dentist’s advice is also general health advice.
A confusing array of medications with oral side effects. Many dental patients may take a huge array of medications and supplements, both prescribed by physicians and over-the-counter. Many of these drugs, either alone or in combination, can cause symptoms like dry mouth. Dentists are more likely to spot this and other oral side effects than a patient’s primary care physician is.
If you choose to ignore the oral-systemic health link, you won’t be providing your patients with the best possible care for their conditions.
The Dentist as Diagnostician
Because healthcare trends are shifting more of the diagnosis and treatment burden from primary care physicians to dentists, it’s time to start looking at your practice as a dental wellness center. In a dental wellness center, all staff are aware of the oral-systemic health link. Office policies and procedures facilitate the diagnosis and treatment of systemic diseases and make it easy for you to communicate with a patient’s primary care physician.
Some basic tools for running a dental health center include: privacy statements, which allow sharing of medical information with a patient’s doctors; intake forms, which include a total medical history, the ability to order medications, and refer patients to appropriate specialists; and protocols for drawing blood and/or ordering labs. With these tools, you will be prepared to diagnose and treat systemic health problems as they arise in your patients.
Your dental training has prepared you for the sorts of exams and judgement calls needed to make diagnoses and to arrange for treatment with your patient’s primary care physician. For instance, in one study, dentists were able to successfully diagnose 97% of new diabetes cases in their offices with a standard dental exam and an on-site A1C blood test.
Nearly one third of undiagnosed Crohn’s disease patients also have oral symptoms of the disease, and the oral symptoms can help chart the progress of the disease’s intestinal symptoms. Patients with Crohn’s often exhibit swelling of the lips and gums, cobblestoning, and ulcers as well as other symptoms. In fact, oral symptoms alone can be enough to recommend follow-up care with a gastroenterologist.
Dental providers are also at the front lines for diagnosing gastroesophageal reflux disease, temporomandibular joint dysfunction, sleep apnea, and other conditions. If you see signs of one of these diseases in a patient, it’s essential that you make the diagnosis and help your patient arrange for follow-up care from a specialist. You can’t assume that someone else will notice the disease further down the line. You may be the only medical provider your patients see on a regular basis.
Treating Systemic Disease in Your Dental Office
Once you’ve committed yourself to looking for and diagnosing systemic diseases in the dental office, you also have an important role to play in the treatment of many diseases. For instance, diabetics are prone to periodontitis. Active gum infections can make their blood sugar harder to control, which in turn leads to long-term damage to sight, limbs, and kidneys. Thus, periodontal treatments can be an essential part of a diabetes management plan, and should be considered a medical treatment.
You can also play an important part in managing the diets of patients with systemic diseases. Many Americans tune out dietary advice from their physicians because they expect to be badgered about their weight. As a dentist, you can talk about healthy eating in terms of teeth and avoid triggering your patients’ body-image issues. By placing concerns about sugar consumption or a lack of fruit and vegetables in the context of dental health, you can improve your patients’ overall health as well.
When you’re treating patients with systemic diseases, it can be helpful to share your diagnostic information with their primary care providers. For instance, a physician ought to know if a patient with heart disease struggles with gum infections because there is evidence that periodontal disease can lead to heart attacks and stroke. Active infections can also influence the treatment of diabetic patients, or even which tests are ordered. Imaging from dental exams may help with tracking osteoporosis, and often a sudden decline in oral hygiene can be a sign of Alzheimer’s or dementia.
Finally, if you’re diagnosing and assisting in the treatment and management of medical conditions in your dental office, you should take steps to receive appropriate payment for your services. Many dental providers have found it helpful to bill medical insurance when they perform medical services in their offices. If you’d like more information on how dentists can use medical insurance to help provide their patients with better treatment for systemic conditions, visit my website, www.links2success.biz. You’ll find tips and tools to help you bill medical insurance and learn more about how dentists can transform their offices into dental wellness centers.
About the Author
Christine Taxin is the founder and president of Links2Success, a practice management consulting company to the dental and medical fields. She has more than 25 years’ experience as a practice management professional.