The Missing Member of Many Healthcare Teams: The Dentist

25 Sep The Missing Member of Many Healthcare Teams: The Dentist

Posted at 13:50h in Dental Health, In-Home Dentistry by House Call Dentists

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Estimated reading time: 7 minutes

Key Takeaways

Including a dentist in care planning can help healthcare teams:

• Identify oral pain, infection, dry mouth, and denture problems earlier
• Recognize when dental issues may be affecting nutrition, hydration, or behavior
• Coordinate care for patients with diabetes, cardiovascular disease, cancer, or other complex conditions
• Review medications and medical risks that may affect dental treatment
• Reduce barriers for homebound patients who cannot visit a traditional dental office
• Create a more complete, whole-person care plan

When healthcare professionals build a coordinated care plan for an older adult or a person with complex medical needs, the team may include a primary care physician, specialists, nurses, pharmacists, therapists, social workers, care managers, home health aides, and family caregivers.

One important provider, however, is often missing from the conversation: the dentist.

Dentists should be included in care planning when a patient’s oral health may affect nutrition, medication use, chronic disease management, communication, comfort, or the ability to receive daily care. Their role becomes especially important for homebound and medically complex patients who may not be able to report symptoms or visit a traditional dental office.

The mouth is sometimes described as “the gateway to the body.” While the phrase is simple, it reflects an important clinical reality: oral health is part of overall health. A person’s ability to eat, swallow, communicate, take medication comfortably, and live without pain can all be affected by conditions in the mouth.

For patients who are homebound, medically complex, living with cognitive or physical disabilities, or receiving care from multiple providers, excluding dentistry from care coordination can leave significant oral health needs unrecognized.

Oral Health Is an Essential Part of Overall Health

Dental disease does not occur in isolation. Medical conditions can affect the mouth, oral conditions can complicate a person’s daily health and care, and many of the same risk factors influence both.

The National Institute of Dental and Craniofacial Research identifies oral health as essential to overall health and well-being and emphasizes greater integration between oral and medical care.¹ The World Health Organization similarly defines oral health in terms that extend far beyond the absence of cavities. It includes the ability to eat, breathe, speak, socialize, and function without pain or discomfort.²

For medically vulnerable patients, these functions are central to quality of life. A painful tooth, unstable denture, oral infection, or persistently dry mouth may affect nutrition, sleep, communication, medication use, behavior, and participation in care.

These problems can be easy to miss when no dental professional is involved.

Chronic Conditions and Oral Health Can Influence One Another

Diabetes offers one of the clearest examples of why medical and dental providers should communicate.

People with diabetes are at increased risk for periodontal (gum) disease. The Centers for Disease Control and Prevention advises healthcare professionals to promote oral healthcare as part of diabetes management and notes that gum disease can affect insulin sensitivity, making regular dental care an important part of diabetes care.³

That makes oral health relevant not only to the dentist, but also to the physician, nurse, diabetes educator, care manager, and caregiver helping the patient manage the condition.

Other medical circumstances may also change the way dental care should be planned. Cardiovascular disease, bleeding disorders, kidney disease, cancer treatment, organ transplantation, immune suppression, osteoporosis treatment, neurological disorders, and a history of stroke can all affect dental risk, treatment decisions, or the appropriate location for care.

Dental teams, in turn, need accurate information about diagnoses, medications, allergies, recent hospitalizations, swallowing difficulties, cognitive status, and the patient’s ability to tolerate treatment safely.

A medication list placed in a chart is helpful, but true coordination often requires communication between providers.

Medications Can Create Oral Health Concerns

Older adults and medically complex patients commonly take multiple prescription and over-the-counter medications. Many can contribute to dry mouth.

Saliva helps protect the teeth, supports swallowing, lubricates oral tissues, and helps control bacteria. When salivary flow is reduced, patients may be more vulnerable to tooth decay, oral irritation, difficulty chewing or swallowing, and problems wearing dentures.

The National Institute on Aging notes that many medicines can cause dry mouth and that reduced saliva can make it harder to eat, swallow, taste, and speak while also increasing the risk of tooth decay.⁴ Yet patients and caregivers may not realize that a change in oral comfort, eating habits, or dental health could be related to medication.

A dentist can identify signs of dry mouth, assess its effect on the teeth and soft tissues, and recommend preventative strategies. The prescribing provider can determine whether a medication adjustment is medically appropriate. Neither professional should make that decision in isolation.

The Mouth Can Affect Nutrition and Hydration

Nutrition is often a major concern for older adults, patients recovering from hospitalization, and people with progressive neurological or cognitive conditions.

A dietitian may recommend nutrient-dense foods. A speech-language pathologist may address swallowing safety. A nurse or home health aide may track intake. But if the patient has painful teeth, oral sores, an infection, or a denture that no longer fits, following the nutrition plan may be difficult.

Signs of a dental problem may include:

• Avoiding foods that require chewing
• Favoring one side of the mouth
• Holding food in the mouth
• Refusing meals
• Removing dentures during meals
• Unexplained weight loss
• Facial expressions suggesting pain
• Increased agitation during oral hygiene or eating

For a person with dementia, limited speech, or an intellectual disability, these behavioral changes may be the only visible signs of oral pain.

Including a dental assessment in the coordinated care plan can help the team determine whether difficulty eating is primarily nutritional, neurological, behavioral, dental, or caused by several factors at once.

Oral Care Belongs in Conversations About Respiratory Risk

Oral health may also be relevant when caring for patients at risk of aspiration, particularly frail older adults, people with swallowing disorders, and residents of long-term care communities.

The mouth can harbor microorganisms that may enter the respiratory tract when saliva or oral material is aspirated. Research has identified associations among poor oral hygiene, pathogenic oral microorganisms, and aspiration-pneumonia risk in older people receiving residential care.⁵

This does not mean that oral care alone can prevent every case of pneumonia. Aspiration pneumonia is complex and may involve swallowing impairment, frailty, neurological disease, feeding assistance, mobility limitations, and other medical factors. However, oral hygiene and professional dental care can be important components of a broader prevention strategy.

This is precisely where interdisciplinary planning matters. Nurses, speech-language pathologists, physicians, caregivers, dental hygienists, and dentists each see a different part of the risk picture.

Dental Problems May Present as Medical or Behavioral Changes

Not every oral health problem begins with a report of tooth pain.

Healthcare professionals may instead notice:

• Facial swelling
• Fever without an immediately identified source
• Bad breath that persists despite daily care
• Bleeding from the mouth
• Difficulty opening the mouth
• Reduced food or fluid intake
• Sleep disruption
• Pulling at the face or mouth
• New resistance to personal care
• Changes in speech or facial expression
• Sudden agitation in a person with dementia

These signs do not always indicate dental disease, but they should prompt consideration of the mouth as a possible source.

For patients who cannot clearly explain what hurts, a dental evaluation can help distinguish oral pain from other medical or behavioral concerns.

What Integrated Dental Care Looks Like in Practice

Including dentistry in care planning does not require every healthcare organization to employ an on-site dentist. It begins with recognizing when oral health information should be gathered, shared, or acted upon.

Healthcare teams can take several practical steps:

Include Oral Health in Routine Assessments

Ask about dental pain, chewing, swallowing, dry mouth, dentures, oral hygiene, and the date of the patient’s last dental evaluation.

Review Who Provides Daily Oral Care

Determine whether the patient can brush and clean between the teeth independently. When assistance is needed, clarify who is responsible and whether that person has the appropriate supplies and instructions.

Watch for Changes

Document changes in eating, behavior, speech, facial appearance, breath, denture use, or willingness to receive oral care.

Share Relevant Medical Information

With the patient’s permission, the dental team may need current diagnoses, medications, allergies, physician contact information, recent laboratory results, or details about hospitalization and planned procedures.

Establish a Dental Referral Pathway

Home health agencies, primary care practices, senior living communities, and care management organizations should identify a dental partner experienced in treating homebound, medically complex, and special-needs patients who cannot access a conventional dental office.

Include the Dentist in Complex Decisions

Collaboration may be especially important before invasive dental treatment, surgery, cancer therapy, organ transplantation, or when a patient takes anticoagulants, antiresorptive medications, or medications that affect immunity and healing.

Access Is Part of the Integration Challenge

Recognizing a dental need is only useful when the patient can reach appropriate care.

For homebound patients and people with significant mobility, cognitive, behavioral, or medical challenges, transportation to a dental office may be difficult or impossible. Some patients can be evaluated and treated in their residence using portable dental technology. Others may require sedation, an office adapted to complex needs, or treatment in a hospital setting.

The appropriate location depends on the patient’s medical condition, dental needs, ability to cooperate, treatment complexity, and safety considerations.

House Call Dentists works with patients, families, physicians, nurses, care managers, caregivers, and other healthcare providers to evaluate these factors and coordinate an appropriate dental care plan. When treatment can be completed at home, mobile dental services can reduce transportation and logistical barriers. When more complex care is required, the team can help identify a safer and more suitable treatment setting.

A More Complete Healthcare Team

A healthcare team does not become truly comprehensive simply by adding more providers. It becomes comprehensive when the right providers communicate and recognize how their areas of care intersect.

The dentist should not be viewed as someone involved only when a patient reports a toothache. Oral health can affect nutrition, comfort, communication, chronic disease management, daily caregiving, and quality of life.

For physicians, nurses, care managers, and home health professionals, including oral health in coordinated care planning may reveal needs that would otherwise remain hidden. For patients with complex conditions, that awareness can support earlier intervention, safer treatment planning, and care that considers the whole person.

The mouth is the gateway to the body. It should also be a visible part of the healthcare plan.

Is a patient or client having difficulty accessing dental care? Contact House Call Dentists to discuss their medical, dental, and access needs and determine the most appropriate next step.

Sources

1. National Institute of Dental and Craniofacial Research. “NIH/NIDCR Releases Oral Health in America: Advances and Challenges.” December 21, 2021.
   https://www.nidcr.nih.gov/news-events/nidcr-news/2021/nih-nidcr-releases-oral-health-america-advances-challenges
   
2. World Health Organization. “Oral Health.”
   https://www.who.int/health-topics/oral-health
   
3. Centers for Disease Control and Prevention. “Promoting Oral Health for People With Diabetes.”
   https://www.cdc.gov/diabetes/hcp/clinical-guidance/how-to-promote-oral-health-for-people-with-diabetes.html
   
4. National Institute on Aging. “Taking Care of Your Teeth and Mouth.”
   https://www.nia.nih.gov/health/teeth-and-mouth/taking-care-your-teeth-and-mouth
   
5. Khadka S, Khan S, King A, Goldberg LR, Crocombe L, Bettiol S. “Poor Oral Hygiene, Oral Microorganisms and Aspiration Pneumonia Risk in Older People in Residential Aged Care: A Systematic Review.” Age and Ageing. 2021;50(1):81–87.
   https://pubmed.ncbi.nlm.nih.gov/32677660/