Survey: Most patients don't know oral health affects their overall health

More than three-fourths of Americans are motivated to take care of their oral health, but only 3% understand that oral health is connected with whole-body health.

That’s one of the key findings of a national survey of more than 2,000 adults that indicates how family physicians can help patients achieve better overall health. According to the survey, which was conducted by Ipsos in partnership with P&G and supported by the AAFP, 80% of respondents said oral care would be more important to them if they knew how it impacted overall health; more than 90% said proof of that impact would motivate them to improve their dental routine.

Hugh Silk, MD, FAAFP, said family physicians can draw on many examples to show patients how oral health can affect overall health for themselves or family members.

For example, research has shown that improving dental health can benefit children’s mental health.

For patients with diabetes, periodontal treatment can improve glycemic control.

According to the survey, more than 40% of Americans were unaware of the connection between oral health and cardiovascular disease. Awareness is even lower for other conditions, including diabetes (55%), respiratory disease (68%) and Alzheimer’s disease (77%).

“It depends on the patient and the issue, but there's lots of proof out there,” said Silk, professor in the UMass Chan Medical School’s Department of Family Medicine and Community Health and lecturer at the Harvard School of Dental Medicine. “We just have to make sure it’s translated for patients to understand.”

“Patients want actual data and not just a reminder to brush and floss,” said Brintha Vasagar, MD, MPH, FAAFP, chief medical officer of Progressive Community Health Centers, which operates three federally qualified health centers offering primary, pediatric, podiatric, behavioral and dental health care in Milwaukee. “They're looking for more information to say, ‘It's not just because we want your teeth to look pretty. It's because your overall health improves when you improve your oral health.’”

Vasagar said one challenge for primary care is that many medical schools don’t emphasize oral health.

“It's really been seen as somebody else's health behavior to maintain,” she said.

“First of all, we have to make sure that family physicians know about the relationship between the mouth and the body,” said Silk, co-founded Smiles For Life, which produces online educational resources related to integrating oral health and primary care.

Silk said getting oral health on a patient’s radar might be as simple as adding a question or two to patient intake forms.

“There's no reason some of this couldn't happen before the patient arrives or while they’re in the waiting room,” he said.

Vasagar acknowledged that physicians may struggle to address oral health in a typical office encounter, especially when a visit scheduled to address a different concern may only last 15 minutes. Longer annual visits, she said, were critical opportunity for family physicians to “look at the full picture, including mental health and oral health.”

Silk said addressing oral health should be a standard component of any annual visit. He pointed out that the American Academy of Pediatrics policy says it's “essential that pediatricians include oral health in their daily practice.” AAFP policy highlights the importance of oral health, and the American College of Obstetricians and Gynecologists has numerous recommendations regarding oral health and pregnancy. (Nearly 70% of survey respondents didn’t know that poor oral health can cause pregnancy complications.)

“When I look in someone's eyes, I ask about their vision and whether they need to see the eye doctor,” he said. “When I look in their mouth, I ask about brushing, flossing and do they need to see the dentist. You can kind of do a review of systems for multiple parts of the body and make it systematic. How do you make it easy for the clinician and the patient? With after-visit summaries, you can push a few buttons and the patient who needs it gets a handout about how to care for their teeth.”

Silk said sometimes physicians have to make time for oral health, even during shorter visits.

“When someone comes in for a sore throat, you might notice they have poor dentition,” he said. “That's a teachable moment. Can you do that for every patient? No, but you can do it for someone who really needs it.”

Of course, family physicians can only do so much about a dental problem. What should you do after identifying a problem for a patient who is uninsured or underinsured?

“Family doctors have always been a resource for our patients,” said Silk, who provides care in an outreach program for people experiencing homelessness. “We know the cardiologists. We know the podiatrists. We should know the dentists as well.”

Family physicians can help connect patients to care by being aware of resources in your area:

Physicians and patients can locate free and affordable dental care, and many other assistance programs, through the AAFP’s Neighborhood Navigator.

Silk said some accountable care organizations are holding primary care physicians accountable for applying fluoride varnish on children's teeth. The Affordable Care Act mandated that service be provided without cost-sharing. ACOs also expect primary care practices to make referrals to dentists, he said.

“When accountable care organizations start to make this part of practice, physicians are going to listen,” he said.