Every year, thousands of Americans end up in emergency rooms for issues that could have been treated — and often prevented — in a dentist’s office.
From a small cavity that goes unnoticed to severe infections that can turn fatal, the consequences of untreated oral disease ripple across the healthcare system. Untreated dental problems are driving up healthcare costs to the tune of billions of dollars per year, while also pushing patients into crowded emergency departments that aren’t equipped to fix the problem.
For years, the medical field and dentistry have operated in parallel universes — with separate records, benefits and priorities. But the tide may be changing slightly.
Dental organizations, community health centers and health tech companies are working to integrate these two historically mutually exclusive spheres. Several challenges abound — ranging from disconnected data to inconsistent coverage, which make cohesive and coordinated care difficult.
Nonetheless, experts believe that addressing these gaps is necessary in order to effectively manage the country’s growing chronic disease burden and keep healthcare spending from ballooning further. And payers will need to play a role in this effort, according to experts from organizations including the National Association of Community Health Centers, Innovaccer and CareQuest.
Two different worlds
Medical-dental integration is gaining momentum through collaboration and local initiatives, said Jane Grover, senior director of the American Dental Association’s Council on Advocacy for Access and Prevention.
She said that medical and dental professionals have been increasingly partnering to form initiatives to expand access to dental care in recent years, citing her organization’s partnerships with the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. These organizations are working together through joint education, webinars and guidance, Grover explained.
She thinks these types of partnerships are starting to become more common because the medical community is realizing just how much a patient’s oral health can affect their overall health outcomes. Grover said clinicians are increasingly seeing that untreated dental issues can hurt outcomes for other conditions or procedures.
For example, oral infections can derail surgical healing. Bacteria from the mouth can enter the bloodstream, trigger inflammation and drive up the risk of post-surgical complications. And gum disease can impact pregnancy outcomes — inflammation and bacteria in the gums have been linked to preterm birth, low birth weight and other complications.
Poor dental health can also worsen chronic conditions like diabetes, heart disease and kidney disease. Grover pointed out that this is especially true for diabetes. Gum disease increases inflammation, which can make blood sugar harder to control, and conversely, uncontrolled blood sugar worsens gum disease — so it’s a vicious cycle.
Emergency physicians have expressed frustration that they often see patients with dental problems but lack the ability to treat the underlying issue, Grover added.
She recalled a pregnant patient she saw while working at a federally qualified health center in Jackson, Michigan more than a decade ago. The local emergency department had sent the patient over because they weren’t sure how to treat her.
“There was a woman eight months pregnant, sobbing, early to mid-30s. She had gone to the ED probably four or five times. She had an unrestorable wisdom tooth. It was a very small tooth, but it was rotted and was not in good shape. She had been in pain, she wasn’t eating. I numbed her up, I rolled it out, and it all happened within 15-20 minutes. She said, ‘Wait, that’s it? That’s all? It’s out?’ Yes, it can be that way,” Grover remarked.
She noted that dentists receive significant medical training in dental school, but physicians generally receive very little oral health education. This training imbalance has historically limited collaboration, but Grover believes it is slowly improving.
More has to be done, however, to address systemic hurdles that are still preventing widespread integration.
The role of community health centers
Grover spent 12 years working as the dental director at the aforementioned health center in Michigan, the Center for Family Health. There, she learned a lot about why it is important to integrate dental care into broader healthcare.
For instance, if a dentist were to identify bulimia based on a patient’s tooth erosion, they could easily refer to that patient to seek the care they need within the same building, she explained.
She highlighted another example, in which she detected advanced oral cancer after a referral from a physician within the center.
“Family Medicine was downstairs, and there was a young family medicine doc that came up and said, ‘We’ve got somebody down here with a sore throat. It’s an adult emergency walk-in — can you take a look at her? I’ve never seen anything like this.’ I said, ‘Send her right up.’ So she comes up, and she hadn’t been to the dentist for a while. I looked in there and immediately knew we’re looking at Stage Three oral cancer,” Grover explained.
In her view, community health centers often serve as the most effective model for medical-dental collaboration because they already have integrated quality programs and team-based care.
In these settings, medical and dental clinicians work in close proximity, cross-referrals are easier and data sharing is more feasible, Grover stated.
Luis Padilla, chief health officer at the National Association of Community Health Centers (NACHC), said that community health centers are probably the best examples of medical-dental integration in practice.
Co-location and shared records help integrate care. Many community health centers have their medical and dental services under the same roof, and some centers have also integrated their EHRs, allowing providers to see medical notes, dental notes, medication lists and referrals, Padilla noted.
“That affords the opportunity to integrate a little bit more those dental health services and primary care services. A good example of that is hypertension and diabetes, where you have health centers now that are doing blood pressure checks and then noting in the chart those blood pressure readings and identifying patients who have hypertension and referring them back within the same electronic health record to the primary care providers,” he remarked.
Padilla added that some dental teams are now ordering hemoglobin A1c tests for diabetic patients who haven’t had them recently, which helps ensure that primary care teams are aware of any gaps in care.
Dental providers typically don’t manage the condition themselves — but flagging it allows dental care to function as another touchpoint for chronic disease management.
Connecting data systems
Not all community health centers have integrated their medical and dental records, though, Padilla pointed out. Some organizations still run separate EHRs for medical and dental care, typically because their legacy technology is too expensive to replace.
And other types of providers — such as health systems and retail health clinics — aren’t integrating any of their data with dental offices, so EHR fragmentation is still a major barrier preventing the progress of medical-dental integration. In the U.S., most people receiving dental care go to private practices and not community health centers, with about 93% of the nation’s dentists working primarily in a private practice.
Whether it’s a small health center or a larger hospital system, switching to a single EHR platform is a lengthy and costly process that probably isn’t realistic given providers’ thin operating margins, Padilla said.
So even though some progress is being made at the local level, this lack of data connectivity between the dental and medical worlds remains a major hurdle. With these systems being so siloed, Padilla noted that providers continue to face risks such as missing information about medications and poor referral tracking.
He thinks health plans can help improve coordination and integration because they have access to claims data showing whether patients receive dental services.
Plans can use this data to identify important care gaps. For instance, if a diabetic patient hasn’t seen a dentist for a while, a health plan might reach out and encourage them to schedule a visit, Padilla stated.
Another healthcare leader — Puneet Budhiraja, managing director of HumbiAI by Innovaccer — also noted that health plans are uniquely positioned to link dental and medical data.
HumbiAI is an actuarial software and analytics company that Innovaccer acquired last year. In February, it teamed up with the nonprofit CareQuest Institute for Oral Health to integrate medical and dental data, with the goal of helping providers, payers and lawmakers better understand the impact of oral health on overall health outcomes.
The fact that dental data and medical data are rarely connected has made it difficult to produce tangible evidence showing that preventive dental can bring down overall health costs, Budhiraja said. After bringing this data together, HumbiAI plans to build ROI models showing how preventive dental care can reduce medical costs, especially in Medicare Advantage and Medicaid populations.
Currently, many health plans view dental benefits as a marketing tool or competitive offering, not necessarily as a lever for improving health outcomes, Budhiraja pointed out.
“I think once they understand how dental benefits are helping them maintain the overall health status of their membership, they’ll start paying more attention. Right now for [payers], dental benefits are a market competitor benefit. They have to offer it because others are offering. They’re not offering because it’s keeping their members healthy,” he declared.
But in the future, Budhiraja hopes to start seeing health plans pushing for their members to visit a dentist the same way they encourage them to see a primary care physician. He thinks that increasing dental visits via health plan nudges would improve overall population health and lessen downstream medical costs.
Reducing overall healthcare spending
Katie D’Amico — vice president of growth and innovation at CareQuest, HumbiAI’s partner on the data integration project — is confident that the initiative will produce evidence showing how preventive dental care can reduce healthcare costs.
Her organization has been tracking the extent to which oral health problems are exacerbating the nation’s rising levels of healthcare spending, and a recent report illustrated just how costly untreated dental issues can become when preventive care is out of reach. CareQuest found that Americans made roughly 1.6 million emergency department visits for non-traumatic dental conditions in 2022, costing the healthcare system about $3.9 billion — far more than treating the same problems in a dental office.
And many of these visits result only in temporary relief, such as antibiotics or pain medication, rather than treatment of the underlying dental issue.
D’Amico also noted that preventive tools are not being used to their full potential. One example is fluoride varnish, which pediatricians can be reimbursed for if they apply during routine visits, but they typically skip this, she said.
“There is a reimbursement model — primary pediatricians can do this in the medical setting. We know that’s an extremely untapped opportunity to make an impact and help kids, especially those who may not have access to other types of dental care or community water fluoridation,” D’Amico stated.
She pointed out that several states are working to ban or restrict water fluoridation, with bans already passed in Utah and Florida. These efforts are fueled mainly by concerns over potential, though debated, neurotoxic risks to brain development and ethical arguments over the preference for individual choice.
However, D’Amico views community water fluoridation as one of the most effective population-level preventive strategies.
She cited CareQuest research that analyzed how eliminating fluoridation would affect children’s oral health and state Medicaid spending in five states that have passed or are considering restrictions — Florida, Kentucky, Louisiana, Oklahoma and Missouri. The report found that banning fluoridation in those states would lead to more than 132,000 additional children needing fillings or tooth extractions within three years.
The additional dental treatment would cost nearly $40 million in extra Medicaid spending, which D’Amico said demonstrates how preventive measures like fluoridation can decrease public healthcare costs.
Whole-person health
To Natalia Chalmers, standardized dental data is key to linking oral health with systemic health conditions. Chalmers is a pediatric dentist and former chief dental officer at CMS. She currently serves as chief dental officer and head of clinical innovation at Overjet, which uses AI to help detect oral conditions sooner.
Drawing on her experience overseeing coverage for half of Americans through Medicaid, Medicare and the marketplace, Chalmers explained that one barrier has been the lack of consistent measurement in dentistry.
In medicine, doctors have “scores” they can track, like hemoglobin A1c for diabetes, she noted. But dentists have lacked a reliable way to quantify disease across a patient’s mouth — which is the problem Overjet seeks to address with its oral health score.
To produce the oral health score, Overjet uses AI to analyze X-rays and measure cavities, bone loss and periodontal disease. This score creates a standardized, easy-to-understand metric that allows dentists and medical providers to see the oral health burden and its potential impact on other conditions.
“In order to communicate this efficiently, we needed to translate this into something the medical side can understand,” Chalmers remarked.
Once generated, the oral health score should be shared with a patient’s medical team through an EHR integration or secure data exchange to give physicians a clear picture of the patient’s oral health. Doctors can use the score to identify patients at higher risk for complications from conditions like diabetes or heart disease and coordinate preventive care or timely referrals to dental specialists, Chalmers explained.
But a scenario like that is largely still theoretical because the systems that house dental and medical data rarely communicate. On top of that, payment structures often separate dental and medical care, so there is no clear financial incentive for payers and providers to share information or coordinate treatment.
These combined data and payment barriers make it challenging to translate innovations like the oral health score into everyday clinical practice, even though the potential benefits for patient outcomes are clear.
Some primary care associations, including the Primary Care Collaborative and the Oregon Primary Care Association, are beginning to test value-based care models for dental services and sharing best practices for collaboration between dental and medical teams. But Chalmers noted the industry needs more of these types of efforts.
The mouth is part of the body, so oral health cannot be treated in isolation. Dental organizations, community healthcare providers and startups are working to offer a path forward, but they are still figuring out how to overcome systemic silos, coverage gaps and fragmented records.
Until the country’s overall healthcare system fully recognizes these connections, patients and taxpayers will continue to pay the price for a divide that experts think shouldn’t exist.
“It’s possible to change this, and it really comes down to evidence and awareness,” Chalmers declared.
Photo: FG Trade Latin, Getty Images