Strauss et al.1 used data from the 2008 Medical Expenditure Panel Survey and found that a significant number of individuals (children and adults), representing an estimated population of 19.5 million people, chose to visit only a dental practice in 2008 and not a general health care provider despite the fact that the majority of them had some form of health insurance. These findings point to great opportunities for dental professionals to participate in identifying patients’ systemic health disorders. They also point to the importance of access to dental care.
Dentistry today is a lot more than just beautiful smiles. We have more information about the role of microorganisms in oral diseases and about the association between poor oral health and an increased risk of systemic diseases. The study of the oral microbiome is currently at the center of dental science research, and the oral-systemic disease link has put dentistry in the spotlight of public health.2–5 This has catapulted the dental profession into a state of transition.6–8
I agree with Strauss et al.1 that dental practices can serve as alternate sites of identifying systemic health concerns and that the expansion of dental services would require significant changes in the dental school curriculum and to policies for dental practice and reimbursement. I believe a major emphasis should be placed on developing more detailed health questionnaires to be filled out by patients prior to dental appointments. This would give patients more time to provide detailed health information. A typical questionnaire for dental visits includes demographic and emergency contact information, medications and allergies, and questions about current dental concerns. I believe information about general health conditions, hereditary diseases, historic blood pressure measurements, and lipid cascade data, as well as surgeries, vaccinations, and results from preventive diagnostic procedures can be of great value for identifying or excluding risk factors. Short physical examinations (e.g., vital signs) could provide additional clues. Furthermore, it would be helpful to provide patients with visit summaries containing key points discussed during the dental office visit. Handouts with information about relevant risks and conditions could also help patients.
The idea of these extended services should not be to create information overload but rather to collect meaningful data that can be used by dental and medical professionals to immediately benefit patients’ health. It would also provide researchers with valuable information in their quest to advance professional knowledge to benefit the general population.
References
- 1.Strauss SM, Alfano MC, Shelley D, Fulmer T. Identifying unaddressed systemic health conditions at dental visits: patients who visited dental practices but not general health care providers in 2008. Am J Public Health. 2012;102(2):253–255 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Kolenbrander PE, Oral Microbial Communities: Genomic Inquiry and Interspecies Communication. Washington, DC: American Society for Microbiology Press; 2011 [Google Scholar]
- 3.Dewhirst FE, Chen T, Izard Jet al. The human oral microbiome. J Bacteriol. 2010;192(19):5002–5017 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Fratamico PM, Smith JL, Brogden KA, Sequelae and Long-Term Consequences of Infectious Diseases. Washington, DC: American Society for Microbiology Press; 2009 [Google Scholar]
- 5.Seymour GJ, Ford PJ, Cullinan MP, Leishman S, Yamazaki K. Relationship between periodontal infections and systemic disease. Clin Microbiol Infect. 2007;13(suppl 4):3–10 [DOI] [PubMed] [Google Scholar]
- 6.Lamster IB, Formicola AJ. The dental profession in transition. Am J Public Health. 2011;101(10):1823–1824 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Lamster IB, Eaves K. A model for dental practice in the 21st century. Am J Public Health. 2011;101(10):1825–1830 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Sparer M. US health care reform and the future of dentistry. Am J Public Health. 2011;101(10):1841–1844 [DOI] [PMC free article] [PubMed] [Google Scholar]