Medical-dental integration: It's time to treat the whole patient

The Coronavirus pandemic has led to a renewed focus of how we can keep ourselves, our families, and of course, our patients as healthy as possible. To reduce the spread of this dreaded disease, we wear masks to cover our nose and mouth, knowing that this is the primary portal where the virus and other bacteria are spread. Yet, for too many other serious and life-threatening diseases, we ignore the obvious and well-documented mouth-body connection.

While our current focus is understandably on COVID-19, the clinical literature is replete with numerous other examples of where our mouths can be the primary site for the etiology of serious chronic diseases including heart disease, stroke, diabetes, certain cancers and Alzheimer's/dementia. Yet, save for ENT specialists, physicians are comfortable viewing the mouth as the domain of the dental, not medical profession. As explained below, it's time for this anachronistic and illogical chasm to change – and to put the mouth back in the body where it obviously belongs.

In my medical school training going back over 30 years ago, there was not great emphasis on the examination of the oral cavity. Sure, we looked for ulcerations, strep throat and tonsillitis, however, the exam was relatively limited. Yet, as both a practicing primary care physician, as well as the Associate Chair of Medicine at a large academic teaching institution, I witnessed numerous cases where adverse conditions in the oral cavity, such as periodontal disease and the presence of infections and bacteria, were correlated with serious medical conditions. But, rarely, if ever, did we as physicians seek to coordinate care with our dental colleagues to address the undeniable connection between oral and overall health.

Following my academic role, I formed a physician-led medical group that grew to over 1,000 practitioners serving the healthcare needs of over 1.5 million patients. Five years ago, we determined that it was time to break down the medical/dental barrier so that our patients’ oral and overall health needs could be addressed. Unfortunately, we ran into the legal obstacle that exists in most states that prohibits physicians and dentists from practicing together in the same group. Again, this goes back to the same problem – an absurd historical chasm between two vital healthcare services.

To achieve our goals, we developed a unique model of "clinical affiliations" between medical and dental practices with the following key goals in mind:

• Educate the public about the importance of oral health – and that dentistry was a lot more than just restorative and cosmetic care of our teeth.
• Educate physicians and dentists about the need to work together and coordinate care for the betterment of the patients they serve.
• Educate the insurance industry that coverage for oral health services will save vast sums in future costs of healthcare – and help their insureds lead healthier and more productive lives.
• Develop coordinated care protocols for diseases where the literature is clear that poor oral health is a causative or exacerbating factor.

Today, ProHEALTH Dental's clinical affiliation mission and model allows us to reach out to over 3.5 million patients in the New York metropolitan and Tri-state area. And we're working with major health insurers and academic institutions to help us implement our programs and conduct research on this important issue.

As we tell our patients, let's all "Put Our Health Where Our Mouth Is." It's time for healthcare professionals, Medical & Dental schools, respective professional societies and governing bodies, and insurers to work together to do the same.

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