In the line of duty

zoom

Collaboration between physicians and dentists is needed.

The problem with Vernillo's plan, unfortunately, is one of resources. Dentists have to decide where to invest revenue in order to grow their practices, and having even a part-time nutritionist is a big ask for the industry.

While it might help patients, where is the return on investment? Vernillo argues that it is part of a dentist's role to work with patients to deal with chronic illness and shifting sole responsibility to physicians is not an admirable solution.

However, he declares, he does have a personal as well as academic interest in the matter. Vernillo himself has suffered with diabetes for over 35 years and knows first-hand how tough it is to stay the course with medication and lifestyle.

"I know from my perspective how important it is to control this disease," he admits. "It puts me on a much more level playing field and I find that patients are generally much more responsive to me because I can say to them that I know what a pain in the neck it is to control this problem."

Patient compliance is a perennial problem for dentists, as it for physicians attempting to treat diabetic patients. Most dentists struggle to affect good oral health habits in their patients.

Nevertheless, Vernillo believes that it is essentially the same process and dentists who take an active interest in their diabetic patients' condition could provide a much-needed boost to compliance-rates.

"Most people don't lose their teeth because they have some rare genetic disorder of the enamel - the vast majority of people that lose their teeth lose them because they ignore them," he notes.

"It means a daily regime of brushing and flossing their teeth - much in the same way that as a diabetic it means taking insulin, if that is the relevant treatment."

Putting money where the mouth is

When you look at the modern dental industry, whether in the United States or in the Middle East's supposed ‘boom' markets such as the United Arab Emirates, it is easy to feel pessimistic about Vernillo's comments.

The dental industry is booming not because of its role in combating chronic illness, but because of its advances in aesthetic techniques. And this is not to pass judgement; it's just the economy.

Even if a dentist were proactive about helping combat diabetes and other systemic diseases, under current insurance plans or free markets, who is going to pay for it? It would take a particularly enlightened individual to request either screening, preventive care, or chronic care to be included in a check-up - especially when the industry itself is yet to be convinced of the merits of such an approach.

"There is always going to be a financial component to this and it gets complicated further by the fact that a lot of the time these things are not covered by health insurance," admits Demmer. Yet it does not follow that screening for diabetes would necessarily be a non-start financially, he argues.

"There are two ways to look at it for your practice. It is an increased time burden but maybe your practice is growing because more people are coming in for screening. On the flip side you may be spending a lot of your time on things that you get a very low rate for."

Demmer is not suggesting that dentists are only interested in procedures that yield healthy profit margins - rather he cannot see diabetes taking priority when a dentist might be examining a patient for any number of oral problems.

"If their primary concern is that of the oral health of their patients then they have to place that as a priority rather than screening for something that is not present in the majority of their patients."

An inconvenient tooth

Perhaps the simplest barrier to implementing any sort of dental diabetes screening programme would be the relationship between the dental and medical professions.

Considering their similarity, it is sometimes beggars belief how little communication there is between the two disciplines.

The editor of the Journal of the American Dental Association, Dr Michael Glick, was recently quoted as saying that 15 years ago he imagined that within five years every dentist would be working in close collaboration with medical clinics.

"I'm wiser now, and so I'm saying that if 5% to 10% do something, that will have an impact" he told the press.

Interestingly, dental-medical collaboration could be an area that the Middle East, at least in government sectors, has the chance to become a pioneer in.

Many Middle Eastern health ministries are currently undergoing huge change and the advent of new protocols has the potential to bring dentistry and medicine closer together.

Dr Sultan Al-Mubarak is a consultant periodontist in practice at Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia. Al-Mubarak claims that both disciplines work together closely on new patients.

"Previously there had been a huge gap between dentists and physicians, although these two specialties are closely linked together," he states.

"Now there is increased awareness that, for some diseases, you will see the first symptom in the patient's oral health and vice-versa - here at Sultan Bin Abdulaziz Humanitarian City, we were one of the first hospitals in the Middle East to introduce a dental check-up as part of our standard general check-up for all in-patients."

It is this sort of collaboration that Dr Anthony Vernillo believes is integral to combating chronic illness. Unfortunately, for all his optimism, Vernillo still struggles to imagine a future when this will be a reality for the healthcare industry.

"It really requires a firm commitment to achieve this sort of relationship," he insists.

"It requires dentists to take a proactive role with both patients and other professionals and in today's world of turnstile medicine and turnstile dentistry then I really have concerns about whether or not, unless there is some form of compensation, practitioners are going to take the time to talk to patients about these things."

Print | Email | Discuss this article

| Share |

READERS' COMMENTS

Click here to post a comment

Add your Comment All posts are sent to the administrator for review and are published only after approval. ArabianBusiness.com reserves the right to remove any comment at any time for any reason. Please keep your responses appropriate and on topic. Arabian Business would like to point out that only comments relevant to the story will be published. Any containing personal insults or inappropriate language will not be approved.
Name *
Remember me on this computer
Email *	(Your email address will not be published)
City
Country
Subject *
Comment *
Notify me of further comments
Enter the words above *
Please click post only once - your comment will not be published immediately.

MORE FROM ARABIANBUSINESS.COM