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By Stacie Crozier

"Before you open wide, the doctor would like to take your blood pressure."

Will dentists in the not-too-distant future be more active in their patients' overall health care, as research continues to discover and shed light on links between oral health and medical health?

	Dialogue: Dr. Robert M. Brandjord, ADA president-elect (left), and Dr. Richard Haught, ADA president, participate in the Board of Trustees strategic discussion on the oral-medical connection.

The ADA Board of Trustees spent the afternoon June 13 hearing about the proven science behind oral-systemic relationships, learning the latest developments that could facilitate detection of disease in the dental practice and discussing how dentists can be responsive to scientific evidence and patients' well being.

The overreaching question, said Dr. Daniel M. Meyer, ADA associate executive director of the Division of Science, is: "What is our role as heath care providers as knowledge of oral-systemic relationships evolves and becomes more clearly defined?"

Timothy DeRouen, Ph.D., executive associate dean for academic affairs and research at the University of Washington-Health Sciences School of Dentistry, examined past studies that showed associations between medical conditions and oral conditions — in particular, periodontitis. Though many studies showed associations between periodontitis and a variety of systemic diseases, the studies don't offer a clear consensus on causal versus casual relationships or clinical versus statistical significance.

The most dramatic association, he stressed, is smoking as a risk factor for periodontal disease and many medical conditions.

"Maybe the best thing a dentist can do is to convince patients that smoking has many health risk factors and get them motivated to quit," he said.

James Beck, Ph.D., professor of dental ecology at the University of North Carolina School of Dentistry, provided a concise history of research connecting oral and medical disease, especially heart disease and adverse pregnancy.

"Treating periodontitis may be a cost-effective strategy for insurance companies," he said, "but researchers need to continue to study and develop more sophisticated testing, and the health professions, the public and state and federal officials need more education about the relationships and what they really mean."

The oral cavity can tell dentists a host of information about systemic disease, said Daniel Malamud, Ph.D., professor of biochemistry at the University of Pennsylvania School of Dental Medicine, and he and other researchers are working on methods to screen for and diagnose cancer, diabetes and infectious diseases using saliva instead of blood.

"Everything in blood is also in saliva," he said. "And researchers are working on the challenges to develop oral tests."

Treating oral disease can affect systemic conditions and treatment of systemic conditions can affect oral health, said Dr. Michael Glick, professor and chairman of the department of diagnostic sciences at the University of Medicine & Dentistry of New Jersey, New Jersey Dental School. But as scientific evidence continues to emerge, dentists — and all health care providers — need to shoulder the responsibility for a patient's medical health as boundaries between medicine and dentistry are continually redefined.

"For example, just taking blood pressure is an opportunity — a noninvasive way — for dentists to dramatically affect a patient's health," said Dr. Glick, who is also editor of The Journal of the American Dental Association. "Should dentists be in the business of checking blood pressure? According to the ‘Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure,' all health professionals should be active in hypertension prevention and management. And dentists can also have a role in trying to promote behavioral changes in patients that can improve overall health."

John F. Schneider, M.D., Ph.D., chair designate of the American Medical Association Council on Scientific Affairs, also sat in on the forum and welcomed dialogue between physicians and dentists that would ultimately result in better overall health for patients.

"What is needed from the next generation of reproducible scientific studies is greater clarification on cause and effect relationships," concluded Dr. Meyer at the end of the forum, "and how specific oral health interventions affect general health."

The ADA Board directed the development of a position statement for the profession and the media on the current state of knowledge on oral-systemic relationships.