Since the beginning of modern healthcare, medicine and dentistry have existed as separate healthcare domains. The systemic separation began a century ago, and health care policy has historically reinforced it. While this separation appeared to serve well for many years, significant changes in healthcare have occurred and this separation is now obsolete and may in fact be harmful. This artificial division of care into organisational silos ignores the fact that the mouth is part of the body.

The emergent understanding of how oral health affects overall health, and vice versa, suggests that continuation of this separation leads to incomplete, inaccurate, inefficient and inadequate treatment of both medical and dental diseases. We are entering an era of accountability and need to focus on oral and craniofacial health as well as its connection to systemic health, research and education. This will assure the highest quality of care and safety for the patients and the communities.

Growing evidence supports the need to integrate medical and dental patient care and data. Very few organisations in Nepal are positioned to address this issue and medical and dental practices continue to remain silo-ed in delivering healthcare. Focus should be on developing health information technology infrastructure to share the patient information seamlessly across medical and dental providers. This not only promotes delivery of effective and high-quality care but also cost-effective healthcare.

Given the approach to oral health in health care policy in Nepal, it ought to be no surprise that children, especially from low income families are seeing increasing rates of unmet dental care needs and rising emergency room visits for oral conditions. It is also not surprising that financial barriers to dental care are more severe than for any other health care service. Dental care is less readily available compared to medical care within government health care facilities. 

Emerging evidence shows a relationship between poor oral hygience, cardiovascular disease and other chronic diseases—the common link is inflammation. Periodontal disease is caused by bacteria. When your gums are inflamed, bacteria from the mouth are getting into the bloodstream. There have been evidence based scientific findings worth highlighting. The presence of periodontal disease may be associated with heart attacks, respiratory disease, diabetes, preterm births, erectile dysfunction and osteoporosis. There are links between human papillomavirus and oral cancers. Periodontal disease can kill more than just your smile.

Nepal’s healthcare policies status quo approach of maintaining separate medical and dental care delivery systems needs to be reevaluated. We need to develop medical-dental model of care to facilitate cross-disciplinary care wherein primary care practitioners engage in oral health screening and dental providers perform basic history and physical assessment, with triage to appropriate care; and tracking of compliance and outcomes.  

There are major challenges ahead for Nepal’s health care system. For this integration to happen, there are important conditions that need to be met. These include defining a core set of dental care services deprived areas in the country to promote flexibility for specialty care services. Core priorities should include access to dental care for disadvantaged population by integrating medical and dental care to improve overall health. The focus should be on prevention through inter-professional education and collaborations. Primary care physicians and nurses should engage in the early intervention on the importance of maintaining good oral health. Telemedicine, patient portal, social media and mobile technologies can be used in managing oral-systemic diseases. Most importantly, train next generation of medical and dental providers, educators, and researchers in the new integrative model. 

Technology and digitalisation are really changing dental and medical care in the world. The patients are aware. Consequently, access to the latest information, best practices and expertise is more important than ever. Even though technology and the market are constantly changing, there is one thing which always remains the same—the human concern for health. The strength of overall healthcare in a community relies on an interdisciplinary approach.

Dr Kayastha is a Consultant in Oral and Maxillofacial Medicine and Daignostic Sciences at Dental Health Solutions Inc., San Francisco, California