Embracing Integration

Dental and medical professionals alike have long been aware of the implications of the oral-systemic link, and today, many of our patients are too. Given that, how should our knowledge of this link affect the way that we practice? Many feel that it warrants more of a link between the professions through what has come to be known as medical-dental integration. In our November cover story, Inside Dentistry examines how the incorporation of dental preventive care into medical care not only closes gaps regarding access but also alleviates the burden of disease for patients and, subsequently, the cost burden placed on the nation's healthcare system. Conversely, the concept of medical-dental integration also involves the further incorporation of medicine into dental practice, including the adoption of electronic health record (EHR) systems, expanded diagnostics, increased referrals to physicians, and more.

In my experience, dentists are thrilled by the notion of providing a higher level of care for their patients, but the problem is getting compensated if you aren't exclusively fee for service. Reviewing and updating EHRs and conducting blood and other tests takes time and costs money, which affects profitability. Nonetheless, some dentists are embracing medical-dental integration and achieving profitability through the value that patients place on this approach. For example, Doug Thompson, DDS, who founded the Wellness Dentistry Network to help dentists accomplish this, employs a phlebotomist to do complete blood workups on patients. Practicing at that level may be out of reach for many dentists, but they can still work to diagnose and/or refer when oral-systemic issues are suspected. If I encounter patients with severe periodontal disease and suspect that they may be prediabetic, I conduct a simple blood glucose test to investigate, and if necessary, refer them to their physician for a complete blood count. True medical-dental integration with the structures needed to support it may still be far in the future, but assessing our patients for the possibility of oral-systemic conditions and at least referring them when necessary is part of our duty today. Dentists are often the only caregivers that patients see on a yearly basis, so it's our responsibility to get them to the right provider for the care that they need.

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
robert.margeas@broadcastmed.com