A group of subjects including systemic health providers, oral health providers, and public health and health care administration providers mentioned in interviews that it is dentists could provide primary care in a limited scope such as vaccines, diabetes and hypertension.

Many in this group believed that a portion of the patients may be open to the idea of receiving primary care from dentists, while some might refuse to share personal medical information. One subject suggested that dentists could increase patient comfort by employing a nurse practitioner within their dental practice. Approximately one-half of U.S. adults have at least one of 10 common chronic conditions, such as hypertension, heart disease and diabetes. There are not nearly enough physicians to provide preventive care for everyone, and the American Association of Medical Colleges estimated that by 2025, America will face a shortage of 14,900 to 35,600 primary care physicians.

Statistics show that 9 percent of Americans visit a dentist annually, but not a physician. The shortage of physicians, combined with the more frequent number of visits paid to a dentist, creates an opportunity for dentists to fill the gap.

Research estimates that if dentists were to screen patients above 40 for chronic diseases, the health care system could save 5.1 to 65.3 million dollars. The concept of primary care scope in dentistry is already being researched in countries such as India, Germany, and Sweden, but the results may not be applicable to the U.S. due to differences in patient needs, educational systems, and practice models.

A certain research was conducted to interview 28 industry and government stakeholders in Massachusetts about the financial, legal, educational, social and attitudinal factors in the primary care scope of dentistry. Every oral health provider subject mentioned links between oral health and at least one systemic health condition. Systemic health providers in Massachusetts were aware of this connection. An epidemiologist stated that due to the nature of inflammatory process in the body, poor oral health could affect multiple systems at once. Overall, the conclusion was reached that oral health is necessary to improve general health and manage chronic disease.

It was mentioned that dentists are able to screen high-risk patients for prediabetes and type 2 diabetes using simple chairside screening.

This practice would benefit areas that face shortages of physicians. Needless to say, some areas face a shortage of dental health providers, rather than primary care providers. Even in areas that have adequate access to both, the health care system would still benefit from the flexibility of dentists to provide primary care when necessary.

However, there are certain concerns to this practice. Some believed that if a patient were to receive limited preventive care from their dentist, they might neglect visiting a primary care physician altogether. However, opinions varied based on hypothetical patients and service types. One subject believed that physicians might not have enough time to provide screening for every patient, so it would be better if a dentist were to provide these services as well.

Health providers also warned that an expanded scope of dentistry could lead to duplication of care, which would burden the healthcare system economically.

Interview subjects believed that physicians would be able to focus on more challenging tasks if dentists were to offer screening services. Dentists are uniquely positioned to handle this task, because they recommend more frequent dental appointments for chronically ill patients. However, some subjects believe that dentistry cannot wholly substitute physician care and dentists should handle patients whose chronic conditions are stable and well-managed.

Subjects mainly believed that dentists could help by providing prescreened patients to physicians as some argue that dentists should only support the role of primary care physicians, and not overtake it. Physicians and dentists are educated in different institutions and take different exams and often work in separate organizations.

Subjects recommended key reforms to the educational system of dentists and suggest that dentists study subjects such as physiology, anatomy, histology, and microbiology in their courses. There are programs, primarily one or two-year hospital residencies, providing additional training to dentists.

Some subjects believed that patients may prefer to see specialists rather than dentists, but a previous research indicates that patients were very open to the concept of medical screening in dental practices.

While there are many benefits to this concept, there are also problems such as the requirement of reform in educational systems, possible duplication of care, and the lack of an integrated electronic health record. Additional barriers among patients and providers alike may also hinder this process.

The ultimate goal of this research is to meet the quadruple aim of health care: enhancing patient experience, improving population health, reducing costs and improving the work life of health care providers. It is important that, in case of a reform, the proper training, resources and government oversight be provided, so that interprofessional collaboration can take place.

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Authors: David Leader, D.M.D., M.P.H.; Marko Vujicic, Ph.D.; Brittany
Harrison, M.A.
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This Research Brief was published by the American Dental Association’s Health Policy Institute.
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