Converting Science Into Practice
Deliver on the promise of making oral-systemic care a reality
In July 2000, the US Department of Health and Human Services published its landmark report, Oral Health in America: A Report of the Surgeon General, which made it clear that oral health is essential to overall health. This relationship, commonly referred as the oral-systemic link, has received widespread support and advocacy by clinicians in both the dental and medical communities. However, despite this support, dentists' ability to benefit patients with their knowledge of the oral-systemic link has been frustrated by several factors, including structural impediments and inertia, negatively affecting the ability to provide optimal care.
As a dentist who embraces not only the science but also the practice of oral-systemic care, I understand the value that health integration brings to both my patients and the overall success of my office. I have been able to streamline my practice's oral-systemic clinical culture, increase case acceptance and referrals to my practice, and ultimately, I believe, benefit the longevity of my practice through a patient-centric focus. To successfully integrate oral-systemic care, a series of necessary clinical protocols must be in place.
First, an electronic health record (EHR) system that incorporates the data from both dental and medical settings is is essential. My EHR system has given me the ability to comprehensively evaluate medical histories by reconciling complete health information. Patients can be forgetful, but the EHR system improves the safety of my practice by allowing me to catch conditions, medications, or hospital/surgical events entered by outside medical or dental providers. I can determine if a patient may have conditions that are uncontrolled or undiagnosed, such as elevated blood pressure readings, listed but undiagnosed medical conditions, medication the patient has stopped taking without physician knowledge, uncertain HbA1c or INR levels with anticoagulants, a lack of medical history or activity, etc. These data points are critical, especially when I diagnose periodontitis, which is known to exacerbate or even cause some of these conditions. In addition, the oral health records that I enter into the EHR system are available to my patients' medical providers, who can then "virtually collaborate" with me.
The oral-systemic link is about more than just doing our part to help preserve our patients' teeth; it's about increasing their quality of life. At my practice, when we identify that a patient needs a medical referral, if necessary, my team contacts a local medical group that can offer support with additional consulting and follow-up treatment. This system eliminates the unnecessary guesswork of finding a provider for the patient and provides a more pleasant and efficient experience. And one thing that I've learned through this process is that the sooner a patient visits a medical professional, the sooner he or she will return to my practice for dental treatment.
In instances in which I am coordinating with this medical group for a patient with severe periodontitis, I will complete salivary diagnostic testing, treat the periodontitis, and then send the pathogen report to the medical provider for an evaluation of the underlying health risks. The referral process that I have established helps the medical office prioritize my patients and increase their access to care. Conversely, the medical office also refers their patients with dental needs to my office, which grows my new patient count. In fact, after experiencing the success of this medical-dental collaboration, I decided to directly partner with a health group, and now we have a nurse practitioner who can offer primary care at the office. Realizing that any referral for a future appointment can present barriers to patients, we made the medical referral immediate and seamless.
Continuing to simplify and enhance the delivery of care involving the oral-systemic link can help us deliver on the promise of making oral-systemic care a reality. On the surface, it may appear that there are no financial rewards for these additional efforts in providing medical care and referrals, but they can be realized indirectly. We must be a part of the solution. In a dental emergency with elevated blood pressure, traditionally, dentists are left with the choice of calling an ambulance or trusting that the patient will visit the emergency room. This is unacceptable when alternatives exist. Through my nurse practitioner and medical-dental partnerships, I can instantly coordinate with medical peers to optimize the delivery of patient care. Furthermore, I have seen how the integration of medical and dental care has created patient loyalty to my practice because patients see how dentistry is part of an investment in their overall health. Patient knowledge regarding the oral-systemic link is elevating the dental profession, and patients will soon expect this standard of care from their oral healthcare providers.
About the Author
Cheng "Lulu" Tang, DMD, is the owner of Sahara Modern Dentistry in Las Vegas, Nevada.
