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The DDS-MD Breakup: The Patient Health & Legal Consequences

History takes a toll on everything and, as we read earlier, on the dental and medical professions.

What gives?

Both professions are well and happy, but both still suffer from professional myopia—just cruising along on autopilot. Everything appears fine on the surface, but just like a large river there are some very turbulent currents below the surface and that is what is happening in the dental and medical professions.

Unfortunately, only a few of these mutual professionals see it and unless the rest get it, there will be enormous consequences to pay. This is one of the few times the dental profession appears to be a step ahead. Dentists—although predominately myopic in teeth and gums—do pay attention to a general health history, often telling patients to see their medical physician for things like blood pressure, diabetes, and prescriptive medication issues, but many physicians have little idea what the mouth is potentially doing to the rest of the body. When there is a failure in medical diagnosis—missing disease processes that can affect the whole body—legal red-flags begin to pop up.

Professional Dogma

The digestive tract holds hundreds of different bacteria types living in the billions. Many years ago, peptic ulcers were often considered an ulcerative process due to aberrant stress and lifestyle “stomach acids.” Physicians often used some antacid medications along with diet changes, but the problem would re-occur.  This condition of stomach inflammation (gastritis) and ulceration of the stomach or duodenum (peptic ulcer disease) caught the attention of two physicians, Marshall and Warren, in the 1980s.

Ultimately, their research won them the 2005 Nobel Prize in Physiology or Medicine when they discovered an unknown bacterial species (Helicobacter pylori) was present in almost all patients with gastric inflammation, duodenal ulcer, or gastric ulcer. They proposed that this bacterium was involved in these gastric disease states. Due to their tenacity, challenging prevailing dogmas by using a short regimen of antibiotics and acid secretion inhibitors where peptic ulcer disease is a far cry from what it used to be.

It took Marshall and Warren years to fight through medical dogma. Today, we have a similar professional dogma where most medical physicians fail to see the medical systemic link of the mouth to the rest of the body.  Periodontal disease is merely a “dental” problem to a majority of medical physicians who do not see the systemic link.

In a study titled “Periodontal disease: Mechanisms of infection and inflammation and possible impact on miscellaneous systemic diseases and conditions” this the study authors state:

“The total surface area of this inflammatory field [oral periodontal tissue] is estimated to be the size of the palm of the hand. A skin lesion of this size would prompt immediate medical intervention. However, the intra-oral (and similar-sized) infection is frequently ignored by health professionals [MD physicians], despite the fact that it may be associated with a range of systemic diseases/conditions.”

Patient Health Consequences

The implications of chronic inflammatory processes due to infections are enormous. Imagine the cardiologist who finds a palm-sized infection on his patient who has cardiac health issues. If this cardiologist ignores the infection or fails to refer the patient to a dermatologist specialist for treatment, there is the possibility the bacterial infection could become a septic vascular issue causing additional endocarditis issues. Along those same lines, if the periodontal surface area as large as a hand palm was infected, it could be described as Stage 3 or 4 periodontal disease (periodontitis) which we now know could play a major septic role in a patient’s general health.

In another study, “Systemic Diseases Caused by Oral Infection,” the authors propose that there are three pathway mechanisms that link oral infections to secondary systemic health effects. These pathway mechanisms of periodontitis can play a major role in oral infections affecting the patient’s susceptibility to other systemic disease conditions or magnifying pre-existing disease states. The human body is associated with dental and periodontal infections, where the oral microflora biofilm complex exists with approximately 500 bacterial species that can cause infections. These complex infections have the anatomic bloodstream proximity to create systemic septic conditions, spreading their negative bacterial products, components, and immuno-complexes. It is the spreading of this oral microflora complex that ultimately can cause or magnify systemic disease states.

Some of these known systemic diseases that can be associated with oral infections are cardiovascular disease, coronary heart disease (atherosclerosis and myocardial infarction), stroke, bacterial pneumonia, low birth weight, and diabetes mellitus. If this is the case, where infections (regardless of their source and site) can create systemic health problems, then how come few physicians utilize dentists as specialists in their patients’ complete care?

Presently, cardiologists are more and more starting to utilize a dentist’s professional opinion regarding their patients’ oral health because they are concerned that any unseen oral infections may negatively influence their cardiac procedures.

Professional & Legal Consequences

It would appear to be the medical standard of care for a prudent physician to utilize a dermatologist for any significant skin infection when there was a cardiac, respiratory, or reproductive health concern, correct? When a physician fails to recognize an oral, periodontal infection that could also have a negative effect on a patient’s cardiac, respiratory, or reproductive health, is there a breach in the medical standard of care?

The medical standard of care is one of the highest standards because it involves a patient’s health. Each patient is a son, a daughter, a mother, a father or a grandparent but still a person who has a high level of expectancy of care from their physician. Patients want know that their physician is taking every aspect of their health into consideration during their medical examination, diagnosis, and treatment—not merely thinking “Oh, that’s a dental problem.”

Why dentists are not an MD specialty like an odontology residency in medical school is a matter of history as discussed earlier. It is not possible for the physician and dentist professions to go backwards spouting off historical excuses, but maybe with increased discussions, a true professional dialogue can begin. Maybe the two professions can start coming together, bringing odontology under the medical umbrella where all physicians and patients mutually benefit from this positive odontology association.

Communication and education in this situation is pivotal because the standard of care is becoming ever greater, both in instrumentation, technique, and diagnostic abilities. Those who fail to recognize this will parish professionally and financially.

Patients’ health will potentially suffer, and the courts will be further burdened with more and more complex malpractice cases. Malpractice lawsuits will have the dentist “expert” witness stating that oral diseases can influence medical conditions, and a jury may well ask, “Why didn’t that doctor know this? It seems so obvious.”

In the end, the medical profession must take steps now to incorporate dentist-odontologists under their medical umbrella in order to avoid financial malpractice nightmares—or else increase their malpractice coverage.

“He who forgets the past, is doomed to repeat it.”