By Mary Otto
Dental care and medical care have long been provided separately in America. New research and evolving models of care are challenging that traditional gap.
As former Surgeon General David Satcher said in his landmark 2000 report, “Oral Health in America,” the mouth is a “mirror for general health.”
A recently published study serves as a useful reminder of that fact. Researchers at New York University found that the blood that oozes from the gums during routine dental procedures can be used to screen for diabetes and monitor glycemic control for at-risk patients.
The team observed a nearly identical correlation between the results of tests conducted with samples of oral blood and those conducted with blood obtained with a finger stick, according to the paper, which appeared in the American Journal of Public Health. The findings suggest that dental visits could provide a new opportunity to reach people with potentially life-saving information about their systemic health, study authors said.
An estimated 29 million Americans have diabetes, but roughly 8 million of those cases have not yet been diagnosed, the researchers noted, citing the American Diabetes Association. Another 86 million adults in this country have prediabetes, but nearly 90 percent do not know they have the condition, so they are not getting treatments that could help interrupt the progression of the disease. Even many of the people who know they have diabetes are going without the regular testing to monitor their glycemic control, according to researchers.
The diabetes paper comes as part of a larger conversation about chairside screenings for common diseases in dental offices.
Chronic diseases are responsible for billions of dollars in health care costs and millions of deaths each year. Dental office screenings for diabetes, as well as other common conditions such as high cholesterol and hypertension could save the nation’s health care system as much as $102.6 million annually, researchers from the American Dental Association’s Health Policy Resources Center concluded in a study published in the American Journal of Public Health.
As many of 27 million Americans visit a dentist and not a physician in a given year, the researchers determined, drawing upon data from the federal Medical Expenditure Panel Survey. “This presents an opportunity for oral health professionals to be part of an integrated health care team working to combat these chronic conditions,” the authors wrote.
Some dentists see opportunities in chairside screening, yet many practical questions remain, Kelly Soderland reported in the July 13 edition of ADA News. Will patients, once informed, actually seek appropriate care? The health care system will only save money if they do.
“There is a segment of the population that sees the dentist more often than a physician or they don’t see a physician at all,” Craig Ratner, who chairs the health and wellness subcommittee for the ADA’s Council on Dental Practice told Soderland.
“Therefore, if these tests are done in the dental office, you would be identifying some of the patients who wouldn’t ordinarily be seen by a physician. However, the estimated savings is contingent on whether the patient follows up with a physician and is treated.”
Dentists also have concerns about billing, reimbursements and liability, Soderland wrote. The American Dental Association’s House of Delegates is expected to receive a report on the implications of chairside screenings for chronic disease at the organization’s annual session, scheduled for Nov. 5–10 in Washington, D.C.
Even as research is shedding new light upon the usefulness of oral blood in medical tests, quick and non-invasive salivary testing is becoming increasingly common.
Saliva, the fluid secreted by the salivary glands contains substances including proteins and bacteria that can serve as markers for a number of systemic conditions.
Salivary screening tests are already available for viral infections including HIV and human papillomavirus. Diagnostic tests for oral and systemic conditions are not as far along but progress is being made on a number of fronts.
One area of great interest is the potential value of oral bacteria in the detection of pancreatic cancer. Researchers have long faced challenges in finding reliable biomarkers for the early stages of this devastating disease. But two bacteria found in saliva have been shown to be significantly different in healthy individuals and those with the disease, according to a study.
Even as dentists continue to weigh chairside tests for patients who seldom go to doctors, health policy experts and medical providers are looking at new ways to offer preventive dental services to patients, particularly young children, who may not get regular dental visits.
A national curriculum called Smiles for Life trains nurses, nurse practitioners, physicians and physician assistants to do oral health screenings and to offer preventive care and dental referrals.
The project is among a number of emerging models featured in a recent In Focus report from the Commonwealth Fund, which looked at the integration of oral health into primary care.
Are researchers in your area exploring oral-systemic connections? Are health providers in your community taking innovative steps to integrate dental care and overall care? Maybe now is a good time to find out.
Mary Otto, a Washington, D.C.-based freelancer, is AHCJ’s topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.
