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In Australia, the mouth has long been treated separately from the rest of the body, yet closer collaboration between dentists and GPs could improve patient outcomes. By Angela Tufvesson
In their view, dental hygienist Brenda Fry and GP Dr Paresh Dawda share a somewhat uncommon working relationship. “Paresh and I work closely together to ensure our patients are looked after as a whole,” explains Fry, who runs Bright Smiles Mobile Dental, a mobile in-home dental service for people living in Canberra and regional NSW.
Dr Dawda refers patients in need of oral health care to Fry, who works in his practice—Next Practice Deakin in Canberra’s inner south—one or two days each month. “We’re able to book people in with her, as you would with a physio or dietitian,” he says.
The practice also screens for oral health as part of its health assessments and care plans. Patients are asked about their oral health and whether they have a regular dentist; anyone without a regular dentist is offered a referral to Fry.
Fry, who has many elderly clients, also sees many of Next Practice Deakin’s more than 1000 residential aged care patients, as well as patients who are housebound. “We’ve got a lot of mutual patients, so we work quite closely together,” Dr Dawda says.
He says the collaboration extends to patients who need extra support. “We’ll say, ‘Brenda, we’re really concerned about this person. Would you be able to see them as a priority?’ And vice versa: if she’s seen a patient in a nursing home and there’s a medical issue she identifies, she’ll reach out to us.”
What sets this partnership apart is the way oral and general health are integrated. “I believe Paresh is ahead of the wave in his understanding of oral health as an instrumental part of overall health,” Fry says.
Despite the intimate connection between oral and general health, dentistry and medicine have historically evolved separately, with dental practitioners and medical practitioners working largely in isolation.
“In my experience, GPs tend to refer to us only when their patient reports dental pain or signs of dental infection. I have had a GP tell me they do not see the point of dental for aged-care residents as they eat soft food and don’t need their teeth,” Fry says, explaining that dental issues that prevent elderly patients from being able to chew and eat food can lead to weight loss and rapidly declining general health.
A 2024 New Zealand study identified “insufficient knowledge of the dental field among most GPs” as one persistent barrier to a better working relationship between the two professions. Research from Queensland’s BMC Oral Health highlighted that poor communication, and the “siloed behaviours of some practitioners”, contributed to ineffective collaboration between dental practitioners and primary care providers in rural and remote areas.
According to Dr Angie Nilsson, vice president of the Australian Dental Association (ADA), “oral health needs to be integrated better into general health” for people across the country and with varying health needs.
It’s important to recognise that there’s a bi-directional link and there are improvements to be made on both sides. With good oral health, you’re going to get good general health.
Dr Angie Nilsson, vice president, ADA
“It’s important to recognise that there’s a bi-directional link and there are improvements to be made on both sides. With good oral health, you’re going to get good general health.”
She cites a “long history of working alongside our medical colleagues” and the recent Rethink Sugary Drink campaign, an alliance of more than 20 leading oral and general health organisations working together to reduce sugary drink consumption. “We’re jointly advocating for measures to improve population health,” Dr Nilsson says.
At a grassroots level, she says education can help to foster better collaboration. “In Tasmania, [educators] do a lot of work with the doctors there. They show them [techniques] so they can manage dental trauma in a timely fashion and deal with it straight away. That’s not the norm—but it needs to be.”
Professor Tarun Sen Gupta, acting dean of medicine at James Cook University and an experienced rural GP, concedes “there is almost no teaching about dentistry in medical programs. People come in with dental problems and as a GP you develop at least a working knowledge of what you can do something about,” he says.
Funding arrangements also contribute to the siloed natures of medical and dental care. With dentistry generally not covered under Medicare, most of Australia’s dental services are provided by private practitioners who charge fees.
Prof Gupta says it’s common for people to see their GP about an oral health issue because they can’t afford to see a dentist. “Someone with a very tender tooth or with a facial swelling that could be an abscess needs fairly urgent dental review, but sometimes the funding gets in the way of that.”
Prof Gupta says general practitioners are “always keen to learn. If you run a workshop on dental problems, it’s always popular because we see it as something that we’re not that well trained on and could benefit from knowing more about.”
Simplifying referral pathways to dentists, either with digital tools or having resources on hand for patients during consultations with GPs, is another important step, Dr Nilsson adds. She also notes oral health reference guides for GPs can speed up referrals and lead to better oral health outcomes for patients.
“Doctors aren’t used to looking in people’s mouths for the sort of soft tissue lesions that we would see as urgent.”
Prof Gupta hopes to see “strong cross communication and shared discussion of cases” between dental practitioners and GPs, and changes to funding models that make it easier for people to access dental care.
Ultimately, says hygienist Brenda Fry, “we can better serve our patients and achieve better health outcomes by working together”.
