Dentists could play a greater role in detecting systemic illnesses, given the links between oral health and conditions such as diabetes and cardiovascular disease, according to the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons, which has published its Position Statement on Oral Health and General Health.
“Good oral health is essential for our overall wellbeing. In recent years, there has been increasing evidence of the link between oral health and general health. Dentists and other members of the oral healthcare team always inspect a patient’s mouth in the course of treatment,” said FDS dean Michael Escudier.
“This provides them with an opportunity to monitor, on an ongoing basis, how their patient’s health is changing, While checking a patient’s oral health, they can look for relevant signs of other conditions. Chronic gum disease can be an indicator of diabetes and cardiovascular disease, for example,” Escudier said.
“They can also offer advice on what dietary and lifestyle changes patients could make to improve their overall health, which can also help to prevent conditions such as obesity and oral cancer,” said Escudier.
The National Health Service’s Long Term Plan emphasizes the importance of preventing ill health and includes commitments around improving the oral health of children, older people, and those with learning disabilities. The UK government’s Green Paper on Prevention is also due to be published later this year.
In this context, the FDS says, there is an opportunity to reflect on how oral health professionals can provide the best possible care. The FDS’s position statement suggests that they could play a greater role in supporting patients’ general health both by helping to diagnose certain wider health problems and by providing preventive health advice.
To maximize the impact that dentists and oral health professionals can have in supporting their patients’ general health, the FDS recommends that:
- Oral health should be included in the government’s upcoming Green Paper on Prevention, which the Department for Health and Social Care has suggested will be published later this year.
- The Healthy Living Dentistry program, which has already been established in Greater Manchester, should be rolled out nationally with lessons learned from the successful Healthy Living Pharmacy scheme.
- National and local public health campaigns should always use dentists in the delivery of health and lifestyle advice. Awareness also should be raised among the general public about the links between oral health and general health, particularly the importance of seeing a dentist on a regular basis.
- Initiatives to diagnose diabetes and cardiovascular disease, as well as other conditions such as childhood obesity and eating disorders, should engage dentists and oral health professionals wherever possible.
- All healthcare professionals should cover the links between oral health and general health as part of their initial training and continuing professional development so that this is understood across different disciplines.
- Concerted action is needed to improve oral care and access to dental services for other people, including those living in care homes.
In 2017, the FDS and other dental organizations supported as series of rapid research reviews that considered the links between oral health and broader health conditions. The Cochrane Oral Health Group also has conducted a series of reviews examining the impact of oral healthcare on health outcomes.
One such review highlighted current evidence indicated a number of associations between diabetes and oral diseases and that diabetes is a recognized risk factor for gum disease. The FDS says, then, that there is scope for oral health professionals to play a bigger role in supporting the diagnosis of diabetes, using gum disease as an indicator for the condition.
A Cochrane Oral Health review from October 2013 showed that visual inspection of the mouth by a frontline health professional is the most effective method of diagnosing mouth cancers, successfully detecting between 59% and 99% of cases.
The FDS also says there is a recognized association between oral disease, particularly chronic gum disease, and cardiovascular diseases. The link between these conditions means that dentists and oral health professionals are well positioned to support those at risk of cardiovascular disease, with cross-referrals and risk assessments conducted with other health professionals.
And, a Cochrane Oral Health review found that one-to-one dietary interventions delivered in a dental office or similar settings can change behavior, including fruit and vegetable consumption and alcohol intake. This suggests that dental care settings can be effective sites for the provision of healthy lifestyle advice to help tackle wider public health challenges.