The Oral Cavity: The Gateway to the Body

The prevalence of oral diseases such as dental caries and periodontal disease is still a significant global concern impacting the health of large numbers of children and adults.^12,13 A recent systematic review reported that untreated caries of permanent teeth was the most common health concern affecting an estimated 2 billion people worldwide.¹³ This review also reported that from 1990 to 2019 there was a decrease in untreated caries, however this was associated with individuals in higher Sociodemographic Index quintiles. In the United States (US), dental caries is recognized as the leading chronic childhood disease, and several studies report the high prevalence adults in the US have some form of periodontal disease.^14-17 It has been reported that in 2011-2012, 37% of children (age 0-8) have experienced caries of a primary tooth. In addition, there continue to be significant disparities in Hispanic and Black children, aged 2-8 resulting in a higher caries rate in these groups. A recent report from Kaiser Health News stated, “One in five adults reported that they had unmet dental care needs because they couldn’t afford care."¹⁸ Periodontal disease affects approximately 40% of the adults in the United States and 11% globally.¹⁹ Findings from the National Health and Nutrition Examination Survey 2009- 2014 report, estimated that 42% of US adults 30 years of age or older had some form of periodontitis.¹⁹ This high level of oral disease is problematic as poor oral health has been linked to poor systemic health, with several chronic diseases, such as diabetes, cardiovascular disease etc.^21-26 For example, a study demonstrated that patients with diabetes mellitus have a greater prevalence of periodontal diseases, and patients with poorly controlled type II diabetes have more advanced periodontal disease suggesting a bidirectional relationship.^27-30 Additionally, patients with diabetes mellitus type I or II have a greater prevalence of periodontal diseases, and patients with poorly controlled type II diabetes have more advanced periodontal disease.^31,32 As a consequence, dental practitioners are providing comprehensive oral care for more complex medically compromised patients that create the necessity for interprofessional collaboration to provide optimal patient care.^33,34

The major challenge for providing optimum care for the US population while simultaneously addressing the Quintuple aim, is the siloed nature of the health system, particularly the general isolation of oral health from other aspects of healthcare. A 2014 report from the ADA Health Policy Resources Center, stated that 27 million Americans visited a dentist, but not a physician and contrarily, 108 million visited a physician but not a dentist.³⁵ Additionally, the reimbursement model for dentistry is not considered essential care, and has not been a component of health insurance, and not a component of Medicare, which supports the care of the senior population.^36,37 This lack of integration of oral health into the broader health system will continue to limit the overall health of the US population and the achievement of the Quintuple Aim.

As our colleagues in medicine, nursing, pharmacy, physician assistants, etc. are becoming more aware of the importance of the relationship between oral health and overall health, the demand for the unique skills of oral health professionals will be more in demand. In addition, the advancement of life-preserving medical treatments for serious medical conditions and disabilities emerge, the result will be a US population that is living longer, and creating the need for increased collaborative practice.²⁷ While oral healthcare providers are trained to take a medical and medication history, most non-dental healthcare professionals have a gap in knowledge of how to assess and refer problems related to the oral cavity, due to the fact that, for the vast majority, it is often lacking in their training.^38,39 An Institute of Medicine report and the U.S. Surgeon General’s report have focused the spotlight on this gap in knowledge, and new oral health initiatives have been funded that focus on providing other healthcare providers with the skills to identify oral disease.^40-43 Formation of these types of interprofessional partnerships create an opportunity for oral health care professionals and other health and social care professionals to work together to improve both oral health and overall health for the patients under their care. One of the existing outcomes is the engagement of non-dental health professionals to provide traditional services such as application of fluoride varnish and oral assessments.