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Why isn’t dental health considered primary medical care?

The list of connections between #oralhealth & systemic health is remarkable. For starters, 3 common #dental issues (cavities, tooth loss & periodontal disease) are associated with #heart disease.

Ailments of the mouth can put the body at risk for a slew of other ills. Some practitioners think #dentistry should no longer be siloed.


The patient’s teeth appeared to be well cared for, but dentist James Mancini did not like the look of his gums. By chance, Mancini knew the man’s physician, so he raised an alert about a potential problem — and a diagnosis soon emerged.

“Actually, Bob had leukemia,” says Mancini, clinical director of the Meadville Dental Center in Pennsylvania. Though he wasn’t tired or having other symptoms, “his mouth was a disaster,” Mancini says. “Once his physician saw that, they were able to get him treated right away.”

Oral health is tightly connected to whole-body health, so Mancini’s hunch is not surprising. What is unusual is that the dentist and doctor communicated.

Historically, dentistry and medicine have operated as parallel fields: Dentists take care of the mouth, physicians the rest of the body. That is starting to change as many initiatives across the United States and other countries work to integrate oral and whole-body care to more effectively tackle diabetes, cardiovascular disease, joint replacements and many other conditions. The exact relationship between health of mouth and teeth and physical ailments elsewhere in the body is not well understood — and in some cases, is contentious — but experts agree there are links that should no longer be overlooked.

In recent years, dental hygienists have started working in medical clinics; physicians and dentists have started a professional association to promote working together; and a new kind of clinic — with dentists and doctors under one roof — is emerging.

“We are at a pivotal point — I call it the convergence era — where dentistry is not going to be separated from overall health for much longer,” says Stephen E. Thorne IV, founder and CEO of Pacific Dental Services, based in Irvine, California. “Dentistry will be brought into the primary care health-care team.”

Sick mouth, sick body

The list of connections between oral health and systemic health — conditions that affect the entire body — is remarkable. For starters, three common dental issues — cavities, tooth loss and periodontal disease — are all associated with heart disease, the leading cause of death in the United States. “To me, the number one hidden risk factor for the number one killer in our country is oral health,” says Ellie Campbell, a family physician in Cumming, Georgia, and board member of the American Academy for Oral Systemic Health, founded in 2010 to increase awareness of how oral and whole-body health are related.

Periodontal disease, infection and inflammation of the gums and bone that support the teeth, is the main culprit. Nearly half of adults 30 and older have periodontal disease; by age 65, the rate climbs to about 70 percent. In the early stages, called gingivitis, gums are swollen and may bleed. Periodontitis, a more serious condition in which gums can pull away from the teeth, is the sixth most common human disease.

Periodontitis is associated with a slew of systemic ills: heart attacks, strokes, heart failure, diabetes, endocarditis, chronic kidney disease, recurrent pneumonia, chronic obstructive pulmonary disease, gastritis, rheumatoid arthritis, cancer and cognitive impairment.

Bad habits, including tobacco use, alcohol consumption and high-sugar diets, are implicated too. They raise the risk for cavities and most oral diseases, and are also linked to ills such as cancer, chronic respiratory disease and diabetes.


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