Integrating oral health into primary health care

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integrating oral health into primary health care
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Oral health has been linked to a number of chronic non-communicable diseases including cardiovascular disease, diabetes, and cancer. Periodontal disease has been linked to acute infections such as endocarditis and pneumonia, and may be associated with the development of Alzheimer’s disease and related dementias. 

This is not news for many dentists. However, while these links make it clear that oral health doesn’t exist separately to the rest of a person’s general health, dentistry continues to sit in a silo separate from general health medicine. 

The Australian Network for Integration of Oral Health (NIOH) is one organisation that is pushing to change this. Founded in 2017, NIOH is a network of professionals and organisations committed to driving the systems and social change that is required to integrate oral health into a more collaborative approach to overall healthcare. 

“That’s really the key to this. There’s a systems aspect needed to enable interprofessional collaboration on a practical day-to-day basis. But to widely implement such systems, we need social change across the entire healthcare sector to build the willingness to move forward,” explains Rachel Martin, director of NIOH and Clinical Associate Professor, Melbourne Dental School, University of Melbourne.

Putting patients first

This social change begins with advocating for a person-centred approach to healthcare that recognises patients’ individual needs and the complex matrix of co-occurrence, comorbidities, and interrelated conditions that often requires a holistic or whole-body approach to healthcare. 

Person-centred healthcare is essentially built around individualised care plans, interprofessional collaboration, and continuity of care. Care plans are tailored to the specific needs and goals of each patient, and managed by the relevant healthcare providers through open communication and shared decision-making. There is also a focus on building long-term relationships between patients and healthcare providers to ensure continuity of care over time.

“There are significant benefits to this approach for both patients and dentists,” says A/Prof Martin. “Patients obviously benefit from an integrated, long-term approach to their individual health needs and contributing factors, with potentially more focus on preventative healthcare. Meanwhile dentists become part of a wider informal referral network, and are better placed to connect their patients with other healthcare providers.

We need national dental leadership that can drive progress towards a person-centred, integrated, and collaborative health system that includes oral health as a critical component. But there is currently no national chief dental or oral health officer to lead this change.

A/Prof Rachel Martin, director, NIOH

“While this is happening in pockets around Australia, we realised that there is a need to find opportunities to share and connect with each other to boost some of the work that has been done, and help to replicate successful integrated healthcare models in other parts of the country.” 

The software solution

Person-centred healthcare is certainly a powerful concept, but what does it actually look like in day-to-day practice where time is often in short supply? Modern software that efficiently connects healthcare providers and supports communication and information sharing offers much of the solution. 

For example, electronic health records (EHR) systems are used to centralise patient health information—such as medical history, diagnoses, medications, care plans, and laboratory results—and health information exchange (HIE) systems enable the secure sharing of patient health information among healthcare providers.

Likewise, care coordination platforms can be used to efficiently facilitate collaboration among the various healthcare providers involved in a given patient’s care plan. And patient-facing portals can encourage patients to take a more active role in their treatment planning and management with the ability to access their health records, communicate with their healthcare providers, schedule appointments, request prescription refills, and view educational resources. 

“The good news is that these kinds of software platforms already exist,” says A/Prof Martin. “However, even where they’re in use, oral health is typically left out. We need national dental leadership that can drive progress towards a person-centred, integrated, and collaborative health system that includes oral health as a critical component. But there is currently no national chief dental or oral health officer to lead this change.”  

Change starts at home

NIOH was part of the push to change that at the Select Committee into the Provision of and Access to Dental Services. The committee’s final report was presented in November 2023, and cites “virtually unanimous support” for establishing a chief dental or oral health officer. NIOH also advocated for the establishment of a multidisciplinary national oral health unit to support the chief dental or oral health officer.

While that’s a positive step forward, we’re still a long way from seeing any kind of integrated, nationwide collaborative system rolled out to dental practices. In the meantime, A/Prof Martin says the path forward for dental practices lies closer to home. 

“I think dental practitioners should certainly reach out to other healthcare providers in their own communities,” she says. “Pharmacists are on the frontline of healthcare in our communities, so making the time to build relationships with your local pharmacists is a good first step to build an informal referral network. Likewise, building relationships with your local GPs can be beneficial for both parties, and reaching out to diabetes educators can also help to make oral health part of diabetes care plans.” 

A/Prof Martin also encourages all dental practitioners to help educate other healthcare professionals about the role oral healthcare plays in patients’ overall health.

“We’ve all got to be active in attending workshops and conferences to get the message out that including oral health in integrated, person-centred care plans is not only critical for patients, but will also benefit all healthcare providers,” she says. “We also welcome dental practitioners to join us at NIOH or to donate to help support our work in advocating to bring oral health into patients’ integrated treatment plans.”  

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