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The mouth reflects whole body health – but what does integrated care mean for dentists?

Professor Sonia Williams holds the Emeritus Chair in Oral Health Services Research at the University of Leeds and was awarded the MBE for her work in child and ethnic minorities dental health.

Here, Professor Williams explores how integrated oral health needs to consider the whole body, not just the dentition…
Integrated health implies that ‘the sum is more than its parts’ with emphasis on a holistic approach.
While dentistry may be perceived as limited to manipulation and maintenance of teeth, dentists are trained to be focused on the health of the oral cavity in the context of general health.

Definitions of oral health emphasise that it ‘is embedded in the wider framework of overall health’ (Glick et al, 2016). These authors focus on oral health being a fundamental aspect of physical and mental health and wellbeing and functionally important for speech, smiling, tasting, chewing, swallowing.

It is also important for conveying a range of emotions through facial expressions, while maintaining freedom from pain, discomfort and disease.

There are a range of common risk factors that influence both oral and general health. Hence, integrated oral health and care primarily involves taking a wider view rather than focusing just on the dentition.

 

There are a range of examples that can illustrate these points.  For instance, poor dental health in young children can disrupt sleep and compromise chewing ability such that children can fail to thrive.

Tooth removal is the most common cause of hospital admissions in this age group.

Conversely, tooth development and structure can be influenced by disease and nutritional status. For the elderly, a good functional dentition is important to enhance digestion as well as food choices.

The mouth reflects the health of the whole body.  Being sited at the entrance to the gut (with its own microbiome), oral conditions can reflect those of the gut and/or indicate nutritional deficiencies, lowered immunity or haematological status.

The mouth can also be a potent source of inflammation, often arising from the periodontal tissues, which can have associations with other chronic inflammatory systemic conditions and may even aggravate them.

Medications can cause xerostomia and promote tooth decay and gum diseases or can increase the risk of osteonecrosis.  In addition, poor oral health has been cited as exacerbating poorly controlled diabetes and recent evidence suggests that oral bacteria may be part of the aetiology of rheumatoid arthritis.

Diet and nutrition also represent key elements in oral health and care as they do for the maintenance of systemic health.

For example, frequent consumption of fermentable carbohydrates can promote tooth decay (and obesity), while acidic foods and drinks (including fashionable drinks such as Prosecco) risk erosion of tooth enamel. The patient’s nutritional status can link to periodontal health.

Complementary and alternative approaches can also be considered as complementary to ‘mainstream’ care, with varying levels of evidence cited for their benefit.

Dental hypnosis (British Society of Medical and Dental Hypnosis) can help support patients including those with dental phobia or help to reduce pain experience during treatment.

Acupuncture in dentistry (British Society of Dental Acupuncture) can, for instance, assist with pain relief and allay the tendency to vomit during dental care.  There is also a British Homeopathic Dental Association.

For the UK Faculty of General Dental Practitioners, holistic dentistry refers to strengthening the link between general and oral health.

For some others, the term also represents an ‘alternative’ form of dentistry, which may concern itself with the avoidance and elimination of ‘toxic’ filling materials, perceived potential harm from fluoride and root canal treatments and with treating dental malocclusion to put patients back in ‘balance’.

In the USA, there is a Holistic Dental Association, while in the UK, there is the British Society for Mercury-free Dentistry. Unfortunately the evidence base for many of these procedures is weak.

Nevertheless, pressure to avoid mercury in dental restorative materials is becoming mainstream.

In summary, integrated health and care in dentistry can mean different things to different people. The weight of evidence supports the contention that the mouth is an integral part of the body and that attention to the one without taking account of the other can have adverse consequences.


Professor Sonia Williams

Sonia Williams trained as a dentist at the Royal Dental Hospital in London, which lead on to hospital, general practice, community and academic dental appointments. She is currently Emeritus Professor in Oral Health Services Research at the University of Leeds. She was previously Director of WHO Collaborating Centre for Research in Oral Health, Migration and Inequalities at Leeds and Honorary Consultant in Dental Public Health at Bradford Health Authority. Her background in dentistry ranged from clinical practice to prevention, oral health promotion research and outside dentistry to evaluating SureStart programmes and promoting breast screening among minority ethnic groups. She founded the Yorkshire Regional Oral Health Care Services in Paediatric oncology. In 1999, Sonia was awarded MBE for services to children and ethnic minorities. She later studied nutrition, obtaining MSc in Nutritional Medicine at the University of Surrey and is now a registered nutritionist. She currently supports research and lectures in nutrition (including the functional medicine approach) on an MSc programme in Nutrition Science and Practice at the Northern College of Acupuncture in York.