Commentary: The vital role of oral health

University of Utah Dental School students | Courtesy University of Utah

Most of the colleges and schools within University of Utah Health are in easy proximity. Separated by a pathway. The School of Dentistry, though, is a quick car trip or shuttle bus ride, jog, or vigorous walk from the heart of the health campus to our building in Research Park. Some may say the distance reflects common longtime notion that oral health care is removed from or separate from general medical care.

It isn’t. And I say this resoundingly.

There are well-established connections between oral and systemic health.

Many patients visit their dental team more frequently than they do their other health care providers. Most dental teams now routinely take patients’ blood pressure at each visit, so that they can alert both the patient and their medical providers if problems are apparent.

It is extremely well understood that bacteria from infected areas in teeth or gums can enter the bloodstream and cause either endocarditis (an infection of the inner lining of the heart, and/or heart valves, in patients at risk) or infections in artificial joints. In either case, outcomes can be catastrophic. Because of this, both physicians and dentists routinely prescribe or administer antibiotics before any dental procedures are carried out in such patients.

There is very strong evidence that untreated gum disease increases the difficulty and cost of managing diabetes. Conversely, uncontrolled diabetes increases the risk of gum disease, most probably because of microcirculation pathology. Because of these strong links, it is becoming increasingly common for medical providers to request help from the dental team in oral health management for pre-diabetic and diabetic patients, and to request their help in monitoring patients’ blood sugar during dental visits, either by inquiry, or by hemoglobin A1C testing, or both. The dental team can then alert both the patient and the patient’s medical providers to the need to adjust medication, if required.

Comprehensive oral care makes a dramatic difference to outcomes in individuals in substance use disorder (SUD) programs. Clinical research at the University of Utah has demonstrated conclusively that individuals in SUD programs who also receive comprehensive oral care have a significantly higher SUD program completion rate; a 3 times greater increase in employment; a 2.5 times greater decrease in homelessness; and a 2.5 times greater decrease in drug abstinence than those not also receiving oral care.

Almost all drugs that affect mood, and many that are used to reduce blood pressure, lead to reduced saliva flow and therefore to increased risk of tooth decay and gum disease. Close communication between prescribers, pharmacists and the dental team can reduce these risks while optimizing therapeutic outcomes.

There are clear connections between untreated gum disease and premature birth, low birth weight and post-childbirth complications. Relatively simple and low-cost dental hygiene interventions before and during pregnancy can reduce both disease risk and health care costs substantially.

Dental teams have a direct interest in counseling for, and administration of, human papilloma virus (HPV) vaccine. HPV is a significant risk factor for the development of oral cancer, as well as other cancers.

Dental teams have an equally strong and direct interest in counseling for tobacco use cessation. Tobacco use is a significant risk factor for oral cancer, as well as for other cancers, and is also a major risk factor for gum disease.

Finally, the U of U Health School of Dentistry is the first in the country to integrate oral health records with the regular electronic health records in the Epic system. This means that patients who receive oral health services and traditional health services at the U of U will have both of those records integrated into one.

Rory Hume | University of Utah Dental School

Rory Hume, DDS, Ph.D. is dean of the University of Utah School of Dentistry and associate vice president for academic affairs and education.