Physicians Have Important Role in Oral Health

Vital Signs: February 2011

Tooth decay is the most common oral disease among children and adolescents, and it affects patients throughout their lifecycle. "Oral pain leads to missing work and school, not eating properly, and poor self esteem," said Hugh Silk, M.D., associate clinical professor at UMass Medical School and the UMass Family Medicine Residency. "In the adult years, periodontitis contributes to heart disease, diabetes, and possibly preterm labor. Overall, not having teeth increases a person's risk of dying from all causes."

There are significant gaps in access to preventive oral health services across the Commonwealth, and 53 areas of Massachusetts are federally designated as "dental shortage areas." To help fill the gaps, medical and nursing students at UMass are now being trained to screen for oral health. Dr. Silk says physicians should ask about their patients' dental hygiene habits during annual physicals and pay attention to teeth and gums when a patient comes in with a sore throat, for example.

"Pediatric patients see their physician about a dozen times before they ever see a dentist," Dr. Silk said. Consequently, physicians should counsel parents about developing good dental hygiene and nutrition habits for their children.

Fluoride Varnish for Pediatric Patients

A simple yet highly effective intervention for pediatric patients is to apply fluoride varnish, which reduces cavities by 38 percent. Health care providers must be trained to apply the varnish, but training is free, carries CME credits, and can take place at a physician's practice. MassHealth will reimburse $26 twice a year for each varnish application. For high-risk patients, MassHealth will reimburse for four applications each year.

Dr. Silk encourages physicians to develop relationships with dentists in their community and systems for sharing concerns about patients' health with them. "Get to know your local resources," he said. "Know who takes MassHealth, who's comfortable with prenatal patients, and who takes young children." Dr. Silk also recommends physician involvement in community efforts, such as a Head Start advisory committee, as a way to develop these relationships.

- Robyn Alie

For more information, contact Dr. Silk at hugh.silk@umassmemorial.org. For more information about fluoride varnish training, visit www.smilesforlifeoralhealth.org and click on "State Varnish Programs," or www.mass.gov/dph/oralhealth and click on "BLOCK Oral Disease."

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