Improving Oral Healthcare Delivery

By D. Walter Cohen, DDS, Editor Emeritus

Reflecting on my 60 years in the practice of dentistry and in academic institutions, I have witnessed many fascinating changes in this field. Since its founding in 1948, the National Institute of Dental and Craniofacial Research at the National Institutes of Health has appropriated hundreds of millions of dollars to oral health research at academic institutions throughout the world. Notable changes have been influenced by the advances in research made possible by this support, which have had a tremendous impact, not only on the profession of dentistry, but on the medical profession as well.

Although the quality of care has certainly improved, there’s still a significant part of the US population without regular care to improve their oral health. The Surgeon General’s first report on Oral Health in America, published in 2000, pointed out that the greatest amount of oral disease occurred in the underserved populations—and this has not improved greatly during the last 10 years. The problem is not only with distribution of dental healthcare providers, but the nation also appears to be heading toward a manpower shortage that will worsen the situation.

Fortunately, efforts are being made to encourage more young people to enter the profession. For example, "pre-dental" programs have been introduced successfully at various high schools throughout the US, giving young people, especially those from underserved communities, the opportunity to go into the dental profession and perhaps help to alleviate some of these anticipated shortages.

The pre-dental academy at the Randolph School in Philadelphia is one example. Through this program, students are introduced to dentistry, in addition to their regular sciences, beginning in ninth grade. The school is also building a dental clinic where these students, when they reach tenth grade, can learn dental assisting. The goal is that when these students graduate, they will have completed enough coursework and have enough clinical experience to become dental assistants. When they go on to college, and perhaps on to dental school, they will have a head start in the profession.

Another opportunity to expand healthcare is more collaboration and communication between dentists and physicians, spurred by ongoing research on the relationship between oral disease and systemic involvement and the potential for oral diagnostics to uncover systemic problems in a patient who has yet to show symptoms.

Oral diagnostics, especially the use of saliva, are uncovering more and more systemic problems, and this will probably expand as research continues. This puts the dentist in a unique position to work closely with medical colleagues. However, it’s not yet clear whether the ability to isolate certain conditions will be the responsibility of the dentist or of the physician. For example, many dentists today, in taking a history and looking at a patient’s oral cavity, may suspect hyperglycemia, but they are not the ones to make the diagnosis. They can only report their findings to the patient’s physician, who would then make the diagnosis.

These advances are bringing the dental and medical professions closer together, which should benefit patients. In an effort to encourage physicians to learn more about the oral cavity, an initiative has been developed at the Drexel University College of Medicine, through which second-year medical students may elect to attend lectures on oral health. In addition, they can spend time at the Kornberg School of Dentistry at Temple University observing in the emergency clinic and in the pedodontic department. These experiences should enhance their patient care when they begin their clinical practice as physicians, because they will be much better informed about the oral cavity.

These are only a few long-term initiatives in improving oral and systemic health. There are other glimmers of progress on the horizon. Attention to the significance of caries in children increased following the tragic death of Deamonte Driver. This was a harsh wake-up call for many people, especially those in Congress, who are beginning to recognize the plight of the underserved, especially when it comes to oral disease. Medicaid insurers are now realizing that the administration of fluoride varnish by dentists and other healthcare providers can reduce the amount of early childhood caries, which is, in a sense, a plague for children in underserved communities. It is hoped that long before the 20th anniversary of the Surgeon General’s Report, significant progress will finally be made in reaching the underserved.

About the Author

D. Walter Cohen, DDS, is Chancellor Emeritus of Drexel University College of Medicine in Philadelphia where he is also a Professor of Dental Medicine.