Latest from JAMA: Dentists Aren’t the Only Ones Who Can Effectively Examine the Oral Cavity

doctorExamMouth500The “integration of dental and medical health” theme is gaining traction nationwide, with the latest article appearing in the July 2018 Journal of the American Medical Association (JAMA). While the 1,200-word piece does not explicitly mention obstructive sleep apnea, authors Janice S. Lee, DDS, MD, MS, and Martha J. Somerman, DDS, PhD, write: “A healthy and pain-free mouth supports good nutrition and the ability to sleep and focus at school or work.” 

Should patients always go to the dentist to detect problems with the oral cavity? Lee and Somerman conclude that is not always necessary. They write: “To meet the challenge of widespread dental diseases, oral health examinations should be implemented in multiple venues beyond dental practices and clinics. Physicians have an important role by providing a thorough oral evaluation and referral when warranted (e.g. dental treatment prior to radiation therapy for the dental-oral craniofacial region). Federally qualified health centers and accountable care organizations are service delivery models that, with increased attention to coordinated interprofessional care, should help address the challenges of access to care.” 

Lee and Somerman point out that a 5-minute oral examination could help physicians recognize poor oral health, and detect clues to seemingly unrelated health issues. Examples of oral diseases with potentially debilitating consequences if undetected include: “oral or pharyngeal cancers (positive or negative for human papillomavirus), mucosal abnormalities that may lead to malignancies, xerostomia (dry mouth), temporomandibular joint disease and pain, extensive dental caries (tooth decay), and severe periodontitis (chronic inflammation of the gum tissue resulting in bone loss around teeth and potential tooth loss). Each of these oral manifestations may be an early indicator of systemic problems or an untoward response to systemic therapies.” 

The authors conclude that, “Physicians can help improve oral health and define signs of systemic diseases, while at the same time inform areas that require more research attention. To achieve such goals, clinicians can begin by performing oral health examinations in addition to those routinely performed in dental practices and clinics.” 

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