The Oral Cavity: The Gateway to the Body

The prevalence of oral diseases such as dental caries and periodontal disease is still a significant concern in the US population and results in a large number of children and adults being diagnosed with some form of oral disease. Dental caries is recognized as the leading chronic childhood disease in the United States (US), and according to the Centers for Disease Control findings from the NHANES III 47% of adults in the US have some form of periodontal disease .^7,8,9,10 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…¹¹ As the need for oral healthcare continues to grow, oral healthcare providers will be looking for new and innovative dental delivery systems to meet the growing need in our population, while simultaneously addressing the Triple Aim. In addition, poor oral health is linked to poor systemic health, with several chronic diseases, such as diabetes, cardiovascular disease etc.^12-17 Meanwhile, new life-preserving medical treatments for serious medical conditions and disabilities are discovered and the US population is living longer creating the need for increased collaborative practice.¹⁸ 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.^19-21The most commonly known example of the oral systemic link is with periodontal diseases and diabetes mellitus. Studies have demonstrated that 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 suggesting a bidirectional relationship.^22,23 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.^24,25

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, oral healthcare provider skills will be more in demand. 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.^26,27 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.^28-31 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. Changes continue to evolve and it has become more common for other health professionals to provide traditional services such as application of fluoride varnish and oral examinations.