Gatekeepers for Health

Recent events have shown that an important responsibility that has been the province of the dentist has once more expanded in scope and significance.

We are reminded from time to time of the dentist's full role, which includes detection of oral cancer through intraoral examination; identification of patients who, without prophylactic medication, may be at risk for bacterial endocarditis; and recognition of patients with hypertension. Through review of patient medical histories and intra- and extraoral examinations, the dentist is in a unique position to uncover medical conditions that if left undiagnosed or untreated could jeopardize the well-being of the patient, particularly if dental treatment is undertaken without appropriate precautions. In some cases, the prospective dental patient has not recently undergone medical examination or tests that might identify conditions requiring treatment or preventive measures. Thus, the dentist may serve in a role as gatekeeper or guard in protecting the overall health of the dental patient.

This role -- which includes medical history review, patient interview, clinical examination and physical evaluation -- has recently taken on even greater importance and urgency in view of recent scientific reports regarding the effects or damage resulting from use of the diet drug commonly referred to as fen-phen. According to members of the ADA Council on Scientific Affairs, more than 4 million people in the United States may have used this drug, and up to 32 percent may have suffered some type of cardiac valve damage! Further, it is estimated that most dentists will see a dental patient affected by this potential problem. The specific guidelines for dental office management were published in the Nov. 14 issue of Morbidity and Mortality Weekly Report and in the mid-December issues of CDA Update and ADA News.

The important point here is that the recommendations of the Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes of Health, and the Department of Health and Human Services deliver the message that we must be even more vigilant in our efforts to make complete and thorough evaluations of all patients prior to undertaking dental treatment. Referral for physician evaluation is suggested whenever a history of this drug is revealed.

Since members of the dental team frequently play a role in the interview and history review process, they are key players in this process because patients are comfortable in confiding in them. A report in the ADA News provided an excellent related example wherein a dental hygienist, familiar with the dental effects (rampant caries) of antifungal medications used to treat conditions caused by radiation therapy not only isolated this problem but aggressively sought a solution to a serious oral condition. The solution was formulation of a sucrose-free antifungal medication.

Both of these recent reports illustrate what we believe to be an expanding and necessary role for dentistry. So often we are told that with the prevention of dental diseases, caries and periodontal disease, the scope and importance of dentistry are declining. The focus on what dentistry does continues to be on the reparative or cosmetic functions, for obvious reasons. But what role is potentially of greatest importance to the health of the population we serve? Perhaps this role as a gatekeeper will be more appropriately acknowledged in the future.

As time passes, it is quite likely that science will uncover more oral manifestations, systemic conditions or medical-history-sensitive conditions that will increasingly be screened in the dental office rather than in a more traditional health service environment. The dental office team is uniquely positioned to take on what we believe will become a more defined health role in the future.