The Imperative of Integrating Medical and Dental Care: Synergistic Care, The Future of Health through Medical-Dental Integration.

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Dentistry is already integrated with medicine in some regions of Canada and the United States. However, despite these advancements, the division between medicine and dentistry remains deeply rooted, necessitating enhanced collaboration, particularly for patients with oral health comorbidities such as diabetes, cardiovascular disease, rheumatologic conditions, and others. We cannot continue to operate as an isolated branch of healthcare. A more collaborative approach to patient treatment is essential.7,8

The integration of medical and dental care within dental settings offers unique opportunities to bridge gaps in medical care, including the provision of immunizations and laboratory tests, compared to traditional non-integrated settings. The Medical-Dental Integration (MDI) model emphasizes coordinated communication between oral and systemic health environments, ensuring a patient’s entire holistic care. Through systematic and sustained collaboration, dental and medical professionals can identify disease precursors and underlying conditions, adhering to a patient-centered model of care. MDI-focused clinics have developed the capacity to diagnose and refer for chronic disease management, aiding vulnerable populations, including the elderly, children, and patients with non-communicable diseases.1,2

Systemic diseases such as cardiovascular disease, diabetes, and dementia are associated with poor oral health outcomes, highlighting the bi-directional relationship between systemic and oral health. Poor oral health can shed light on eating disorders and nutritional intake, especially in teenagers and children in older adults, tooth loss is linked to cognitive decline, socialization issues, mental health problems, and a decreased quality of life. Also, a good oral examination can give a lot of signs of drug abuse or sexual abuse, in children.1,2,12,13

Effective medical-dental integration requires interprofessional training and practice on both sides. Emerging trends such as telehealth and teledentistry can assist in treating complex patients and closing the referral loop. However, the main barriers to MDI include the integration of Electronic Health Records (EHR) and resistance in the organizational culture. 1,2,3,4

One MDI model is the co-location model, where dental services are physically co-located with medical services. This model improves access to oral health care and dental referrals while increasing oral health education and preventive procedures. For example, periodontal interventions in individuals with type 2 diabetes are associated with lower overall healthcare costs and type 2 diabetes-related medical costs.2

Value-based care models are essential to MDI implementation. Dental settings can promote preventive health and effectively close care gaps among older adults, providing a relatively low-cost way to improve health outcomes for this population. Preventive oral health programs have been shown to be cost-effective, reducing additional payments for hospital visits related to systemic health conditions, that is why, integrating periodontal disease surveillance with systemic health monitoring is crucial.1,3,4

Integrating oral health care and primary care is a promising strategy to enhance social justice, supported by evidence of the synergistic relationship between oral health and general health. Integrating health screenings for chronic diseases such as hypertension, diabetes, obesity, and tobacco usage into dental visits can significantly benefit patients and the overall healthcare system.5,6.9

Oral cancer risk assessment tools are available, with electronic versions utilized in dental schools. Systematic risk screening approaches using these tools are likely underutilized, limiting the ability to prevent oral and oropharyngeal cancers. Addressing tobacco use, alcohol/substance use, and HPV vaccination status through quality measures can advance oral/oropharyngeal cancer prevention and can be in the hands of a dentist to help in Public Health outcomes.10

There are around 36 contact points between medical and dental care that can be valuable for patient care or research. 11 Integrating medical and dental care, supported by informatics and quality tracking, delivers high-quality care at reduced costs, improving healthcare outcomes, patient safety, and satisfaction is a must. Dentistry must move beyond traditional isolation and embrace a collaborative approach with medicine to benefit patients and the healthcare system, holistically.

References

1.Medical-dental integration models: A critical review of the last decade. Delta Dental Institute.

2.Mosen, D. M., Banegas, M. P., Dickerson, J. F., Fellows, J. L., Brooks, N. B., Pihlstrom, D. J., ... & Keast, E. M. (2021). Examining the association of medical-dental integration with the closure of medical care gaps among the elderly population. The Journal of the American Dental Association, 152(4), 302-308.

3. Puzhankara, L., & Janakiram, C. (2021). Medical-Dental integration-achieving equity in periodontal and general healthcare in the Indian scenario. Journal of International Society of Preventive and Community Dentistry, 11(4), 359-366.

4. Simon, L. (2018). Medical-dental integration. The Journal of the American Dental Association, 149(6), 409.

5. Battani, K. (2024). Making Progress in Medical Dental Integration. American Dental Hygienists' Association, 98(3), 4-5.

6. Shimpi, N., Buchanan, E., & Acharya, A. (2022). How medical-dental EHR integration can improve diabetes care. AMA journal of ethics, 24(1), 99-105.

7. Rasmussen, C. M., McMillan, K. B., McMillan, D. C., Assael, L. A., & Arce, K. (2022). Education solutions to the medical-dental divide. AMA Journal of Ethics, 24(1), 27-32.

8. Welby, J., Hughes, D., & Pier, K. (2021). Hypertension Screening in the Dental Setting: A Pilot Program to Enhance Chronic Disease Management Through Medical-Dental Integration. Journal of the California Dental Association, 49(9), 575-585.

9. Tranby, E., Zokaie, T., & MAS, C. (2022, November). The Case for Medical-Dental Integration to Improve Oral and Overall Health. In APHA 2022 Annual Meeting and Expo. APHA.

10-Rindal, D. B., & Mabry, P. L. (2021). Leveraging Clinical Decision Support and Integrated Medical-Dental Electronic Health Records to Implementing Precision in Oral Cancer Risk Assessment and Preventive Intervention. Journal of Personalized Medicine, 11(9), 832.

11-Acharya, A., Powell, V., Torres-Urquidy, M. H., Posteraro, R. H., & Thyvalikakath, T. P. (Eds.). (2019). Integration of medical and dental care and patient data (No. 167796). Springer.

12. Teoh, L., Moses, G., McCullough, M.J. (2019) Oral manifestations of illicit drug use. Australian Dental Journal, 64: 213–222. https://doi.org/10.1111/adj.12709

13. Silva Júnior, I. F., Goettems, M. L., & Azevedo, M. S. (2016). Oral health status of children and adolescents’ victims of abuse: A literature review. RSBO (Online) vol.13 no.2 Joinville Abr./Jun. 2016.