THURSDAY, December 15, 2011 (Health.com) — Each year, nearly 20 million men, women, and children in the United States fail to see a family physician or similar health-care professional but do pay at least one visit to the dentist, according to a new study in the American Journal of Public Health.
For this segment of the population, dentists may be the only doctors in a position to spot the warning signs of chronic illnesses, such as diabetes, and provide referrals or advice to prevent serious complications, says Shiela M. Strauss, PhD, the lead author of the study and an associate professor at New York University's Colleges of Dentistry and Nursing, in New York City.
Oral or dental abnormalities can signal a broad range of body-wide health problems, including HIV, sexually transmitted diseases, eating disorders, and substance abuse, in addition to diabetes. In a previous study, for instance, Strauss and her colleagues found that 93% of patients with gum disease (such as gingivitis) also met the criteria that should trigger blood-sugar screening under American Diabetes Association guidelines.
"I'm not advocating for dentists to become general health-care providers," Strauss says. But, she adds, dentists can easily measure blood pressure and administer simple screening questionnaires—both of which could potentially make a big difference to the health of someone at risk for diabetes who hasn't seen a doctor recently.
In the new study, Strauss and her team analyzed data from the Medical Expenditure Panel Survey, a nationally representative government-sponsored survey of health-care use. In 2008, the researchers found, roughly one-quarter of adults did not see a physician, nurse practitioner, or other general health-care provider—but of that group, 23% did see a dentist. The pattern was similar among children.
It's not clear what's leading these people to see a dentist but skip medical care. Most of the adults—and nearly all of the kids—had health insurance, so lack of coverage can't fully explain it. In fact, the authors note, the dentist-only group was "quite diverse" ethnically, socioeconomically, and geographically.
It could be that dental problems—unlike some chronic diseases—are often too painful to ignore, Strauss says, or it could be that dentists are simply better than doctors at reminding patients when it's time for a checkup.
Getting dentists in the habit of screening for health conditions will probably require changes to dental-school curricula, the researchers say. However, dentists and dental hygienists are typically already trained to check blood pressure and conduct other types of general medical screening, Strauss says.
And while they might be hesitant to take on more patient responsibilities, Strauss says, doing so may have unexpected benefits. She points to the experience of some Swedish dentists who participated in an insurance plan that required them to implement diabetes screening for their patients.
"The reputation got out there that these were dentists that really cared about the patients," she says. "It was an initial investment of a bit more time on the part of the dentist, but it reaped great rewards for them in terms of growing their practice."