Medical‐dental collaboration in general and family medicine

Medical and dental interprofessional collaboration is crucial in general and family medicine. Oral health management can reduce oral bacteria count and aspiration pneumonia.1 Perioperative oral function management can reduce the risk of postoperative pneumonia and is covered by health insurance in Japan. Furthermore, prevention of pneumonia is very important, because pneumonia and aspiration pneumonia are common causes of death in Japan. Therefore, close medicaldental collaboration should be facilitated. However, medicaldental collaboration and knowledge of oral health management are insufficient in general and family physicians. Competency level of physicians, residents, and nurses was <30% for identifying tooth decay and oral pathology.2 Frequency rates for dental referral by medical providers were 32% “frequently” and 68% “infrequently”.2 A qualitative study exploring general practitioners’ and dentists’ experiences and expectations of interprofessional collaboration revealed that both general practitioners and dentists reported perceived knowledge deficits of the other profession.3 Moreover, most of general practitioners saw no need for medicaldental collaboration, although dentists were interested in extending medicaldental collaboration.3 Another qualitative study showed that general practitioners and dentists perceived knowledge deficits in other specialty and frequently criticized aspects of each other’s patient management.4 Furthermore, interaction between general practitioners and dentists is often limited except in cases of personal contact.4 Medicaldental collaboration is inadequate and should be improved in general and family medicine. Dental hygienists can play a central role in medicaldental collaboration in convalescent rehabilitation. The role of dental hygienists is screening and assessing of oral health and function, treatment, education and counseling in oral health management, oral and dysphagia rehabilitation, and interprofessional collaboration.5 Oral health management provided by dental hygienists improves not only oral status, swallowing function, and nutritional status, but also activities of daily living, home discharge, and inhospital mortality in postacute rehabilitation.5 Therefore, early detection of oral problems, early oral health management by dentists and dental hygienists, and medicaldental collaboration should be implemented in convalescent rehabilitation. The presence of dental hygienists is indispensable for convalescent rehabilitation hospital and rehabilitation nutrition.6 Interprofessional collaboration between general and family physicians and dental hygienists may promote medicaldental collaboration in general and family medicine. Some dental hygienists participate in multiprofessional conference and ward rounds such as oral health management team, swallowing team, nutrition support team, and rehabilitation nutrition team. In my experience, physicians can learn a lot about oral hygiene from oral health management ward round with dental hygienists. Interprofessional collaboration between general practitioners and dentists is clearly important, however often limited. Interprofessional collaboration between dental hygienists and other health professionals may improve access to comprehensive healthcare services.7 Therefore, I expect that many general and family physicians will collaborate with both dentists and dental hygienists to facilitate close medicaldental collaboration.