Should Dentists Partner with Physicians for Better Diagnoses and Treatment?
Once upon a time, dentistry fitted into a neat little box. Dentists dealt with teeth. Physicians dealt with the rest of the body. The only time a dentist would chat with a physician was if they happened to belong to the same country club. That tidy story no longer fits today’s medical reality. The mouth is part of the body, and systemic conditions also affect the teeth, gums, tongue and jaws. If you want to ensure that your patients have the best possible dental care and the best possible healthcare, it’s time to start thinking of physicians as your partners in practice, not just in tennis.
Shifting trends have also put dental practices on the front lines of primary care, whether or not they want to be. Why do you need to be ready to collaborate with your patients’ physicians?
- An Aging Population. More of your patients are entering old age and suffering from systemic diseases like diabetes and cardiovascular disease. These systemic diseases have a strong oral component.
- A Shortage of Physicians. Just as the US population needs increased access to primary care, the number of primary care physicians is shrinking. Your patients may have trouble getting appointments to discuss problems or order bloodwork. Meanwhile, they see you every six months. If they’re developing a systemic disease, there’s a good chance you’ll catch it before they feel sick enough to make an appointment with their primary care providers.
- Increased Focus on Whole Body Health. As a dentist, you’ve urged patients to eat well and take care of their teeth for your entire career. However, we now know that what’s good for the teeth is good for the whole patient. Your dental advice is also general health advice.
- A Confusing Array of Medications with Oral Side Effects. Many of your patients may take a huge array of medications and supplements, both prescribed by physicians and over-the-counter. Many of these drugs can cause symptoms like dry mouth either alone or in combination. You’re more likely to spot this and other oral side effects than a patient’s primary care physician will.
If you choose to remain in your dental health box and to ignore the oral-systemic health link, you won’t be providing your patients with the best possible care for their conditions.
The Dentist as Diagnostician
Since healthcare trends are shifting more of the diagnosis and treatment burden from primary care physicians to dentists, it’s time to start looking at your practice as a dental wellness center. In a dental wellness center, all staff are aware of the oral-systemic health link. Office policies and procedures facilitate the diagnosis and treatment of systemic diseases and make it easy for you to communicate with a patient’s primary care physician. (PCP).
Some basic tools for running a dental health center include: privacy statements which allow sharing of medical information with a patient’s doctors, intake forms which include a total medical history, the ability to order medications and refer patients to appropriate specialists, and protocols for drawing blood and/or ordering labs. When you’re prepared to diagnose and treat systemic health problems as they arise in your patients.
Your dental training has prepared you for the sorts of exams and judgement calls needed to make diagnoses and to arrange for treatment with your patient’s primary care physician. For instance, in one study, dentists were able to successfully diagnose 97% of new diabetes cases in their offices with a standard dental exam and an on-site A1C blood test.
Nearly 1/3 of undiagnosed Crohn’s disease patients also have oral symptoms of the disease, and the oral symptoms can help chart the progress of the disease’s intestinal symptoms. Patients with Crohn’s often exhibit swelling of the lips and gums, cobblestoning, and ulcers as well as other symptoms. In fact, oral symptoms alone can be enough to recommend follow-up care with a gastroenterologist.
Dental providers are also at the front lines for diagnosing GERD, TMJ, sleep apnea, and other conditions. If you see signs of one of these diseases in a patient, it’s essential that you make the diagnosis and help your patient arrange for follow-up care from a specialist. You can’t assume that someone else will notice the disease further down the line. You may literally be the only medical provider your patients see on a regular basis.
Treating Systemic Disease in Your Dental Office
Once you’ve committed yourself to looking for and diagnosing systemic diseases in the dental office, you also have an important role to play in the treatment of many diseases. For instance, diabetics are prone to periodontitis. Active gum infections can make their blood sugar harder to control, which in turn leads to long-term damage to sight, limbs, and kidneys. Thus, periodontal treatments can be an essential part of a diabetes management plan, and should be considered a medical treatment.
You can also play an important part in managing the diets of patients with systemic diseases. Many Americans tune out dietary advice from their physicians because they expect to be hectored about their weight. As a dentist, you can talk about healthy eating in terms of teeth and avoid triggering your patients’ body-image issues. By placing concerns about sugar consumption or a lack of fruit and vegetables in the context of dental health, you can improve your patients’ overall health as well.’
When you’re treating patients with systemic diseases, it can be helpful to share your diagnostic information with their primary care providers. For instance, a physician ought to know if a patient with heart disease struggles with gum infections, since there’s evidence that periodontal disease can lead to heart attacks and stroke. Active infections can also influence the treatment of diabetic patients, or even which tests are ordered. Imaging from dental exams may help with tracking osteoporosis, and often a sudden decline in oral hygiene can be a sign of Alzheimer’s or dementia.
Finally, if you’re diagnosing and assisting in the treatment and management of medical conditions in your dental office, you should take steps to receive appropriate payment for your services. Many dental providers have found it helpful to bill medical insurance when they perform medical services in their offices. If you’d like more information on how dentists can use medical insurance to help provide their patients with better treatment for systemic conditions, visit my website, www.links2success.biz. You’ll find tips and tools to help you bill medical insurance and learn more about how dentists can transform their offices into dental wellness centers.