Background Info

While there is considerable overlap in the knowledge base of medical and dental care practitioners, there are often many differences in professional training that limit the integration of general health care and oral health care. These limitations have serious implications for quality of care and integration of the continuum of care for patients. It is our charge to help overcome these barriers and propose learning objectives for medical students, residents and physicians in several areas germane to oral health.

Four major topics comprise the knowledge and skill base that all medical providers should have regarding oral health. These four components include: Oral anatomy and Oral assessment; Oral Diseases/Disorders; The Oral Systemic Link; and Effects of pharmacologic agents on the oral cavity. In the following document, learning objectives and resources have been provided for each of the topics listed above.

To emphasize the importance of oral health as it relates to general health, the Surgeon General has released two landmark reports. In 2000, Oral Health in America, the first report was released, and in 2003, The National Call to Action once again acknowledged that oral health is a key interrelated component of general health.

The Report of the Surgeon General emphasizes the oral facial area as a “mirror of health and disease” because many viral, bacterial and fungal diseases frequently show lesions in and around the mouth and face. Recent research has uncovered early and intriguing associations between oral infections and cardiovascular disease, stroke, diabetes and low birth weight/preterm delivery. In the past, the oral systemic link as part of oral medicine focused primarily on the oral manifestations of systemic diseases. However, in recent years, research has demonstrated that oral changes may significantly influence extra-oral problems. Therefore, it is clear that the oral systemic link is a two way street backed by scientific literature.

It is our goal to reduce the gap in knowledge regarding oral health and improve the interface of general health and oral health. The recent emergence of new information as a result of research in the area of oral health has mandated that both physicians and dentists be aware of these findings in their efforts to provide optimal care. It is our intention to provide all healthcare providers with the knowledge and skills to effectively include a complete oral examination as part of every general physical examination. The term oral health is used to indicate a broad view of health of the entire orofacial complex, rather than just the health of the teeth. Health care professionals must realize the critical, interrelated role of oral health care within general health care. Consideration must be given to gender and ethnic disparities in oral health as well. In closing, to quote C. Everett Koop, former Surgeon General, “You are not healthy without good oral health.”

Disparities in Oral health

Gender and ethnic disparities must be considered when addressing the integration of oral health and general health. Women have special oral health care needs and consideration that men do not have. For example, female hormonal fluctuations associated with puberty, menses, pregnancy, use of oral contraceptives and menopause may cause changes in periodontal tissues. Cleft palate occurs more often in females. Women are twice as likely to report orofacial pain and nine times as likely to have Sjogren's Syndrome. Temporomandibular disorders are often more prevalent in women. Women are more susceptible to eating disorders and to being victims of domestic violence, both conditions which often involve the orofacial complex.

Ethnic disparities also exist in many oral diseases/disorders. Overall, oral cancer occurs twice as often in the black population as in whites. For example, black men have the highest rates of oral and pharyngeal cancer of any group. Oral cancer is the fourth most common cancer seen in black men as compared with the sixth most common cancer seen in white men. Destructive periodontal disease occurs in 59% of Native Americans as compared with 33% of blacks, 25% of Mexican Americans and 20% of whites.

Dental caries is the most frequent childhood disease, and is concentrated among poor, minority children. Of the youngsters who have experienced dental decay, African-American and Mexican-American children and adolescents have higher percentages of decay than Caucasian youth. Poverty-level African American and Mexican children aged two-to-nine are the most likely to suffer with large amounts of untreated tooth decay. (NIH, 2001) Latino preschoolers, the fastest growing child population in the US, experience 2.5 times more tooth decay than white children. African American children experience 1.5 times more tooth decay than white children. Ethnic disparities continue throughout the lifespan. For example, among retirees, 34% of Black older American have lost all of their teeth as compared to 23% of whites and 20% of Hispanic older adults.