2.6.1 A growing role for the dentist

health also has a broader impact. It has been linked to increased risk of cardiovascular disease, diabetes, and other chronic conditions. For example, research suggests a relationship between periodontal disease and diabetes (Bascones-Martínez 2012). Diabetic patients with periodontitis have six times higher risk of worsening glycemic control and the development of the macro- and microvascular complications of diabetes, in particular cardiovascular and kidney diseases (Watanabe 2011).

There is a growing amount of literature documenting the role of inflammation, common to periodontal disease and other systemic diseases (Cochran 2008; Genco 2008; Graves 2008; Ordovas and Shen 2008; Wilson 2008). Some research focuses on periodontal disease and bone loss (Cochran 2008), Alzheimer’s disease (Rogers 2008), Metabolic Syndrome (Ordovas & Shen 2008), and Atherothrombosis (Ridker & Silvertown 2008). Other studies have demonstrated a significant association between dental infection and atherosclerosis or coronary heart disease (Slavkin & Baum 2000).

Studies have also shown that adults who lost their teeth have a lower intake of fresh fruits and vegetables, and poor nutritional habits are one of the proven risk factors of noncommunicable diseases.

Dental health has even broader implications for children. Poor oral health has been shown to result in decreased academic performance and can adversely affect behavioral and social development. According to US Department of Health and Human Services over 51 million school hours are lost each year due to dental problems (US DHHS 2000). Dental health has national security implications as well. According to a study conducted by the U.S. Department of Defense, 52% of new military recruits were in dire need of dental treatment, which resulted in a delay of their deployment (Leiendecker et al. 2008).

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Dentists are often on the front line of prevention, early detection, and, in many countries, treatment of both oral and systemic diseases, and are in a good position to provide screening, diagnosis and referral services for systemic diseases. There is an increasing trend of dental professionals treating oral conditions in patients with concomitant chronic diseases or who are taking medications for systemic conditions. This trend highlights the need for dentists to be able to manage patients with systemic implications and also to collaborate with the medical profession (Sanz at al 2008). An inter-professional collaboration between dentists and other medical professionals would be beneficial to patients, particularly in underserved areas, where access to specialist physicians may be limited.

In light of the growing importance of oral health to general health, there are proposals to integrate it into primary healthcare services (Petersen 2014). The introduction of certain primary healthcare activities as part of routine oral care can ensure that dentists better manage the overall health of their patients. The provision of primary healthcare services in the dental office should focus on activities that directly impact oral health, such as smoking cessation, screening for osteoporosis, identification of undiagnosed diabetes, obstructive sleep apnea, hypertension, and nutrition and obesity management (Lamster & Eaves 2011).