Journal Back Page Story

By Tanaya K. Porter, DDS, and Craig C. Spangler, DDS

Historically, hospital dentistry was a stand-alone service that housed oral surgery and general dentistry. Routinely the dentists and oral surgeons had to fight for privileges, as physicians were concerned about other disciplines encroaching on their territory. Today, the hospital based general dentist is a valuable member of the medical staff that helps them achieve the best patient outcomes. What brought about this change?

The shift is largely due to the vital role hospital dentists play, particularly for neurodivergent adult patients who are unable to be seen in traditional dental offices. When it is not possible for patients of differing abilities to easily access preventive and restorative care, they develop significant dental needs that cannot be addressed in any setting outside of general anesthesia in the hospital. Advances in medicine have improved the quality and longevity of the lives of these patients, resulting in increased dental needs.

Today, the hospital dentist plays an important role regarding inpatient and presurgical care as well. Patients in the hospital today are hospitalized for a good reason. They have acute problems, requiring skilled intervention, frequently due to chronic illness. This includes patients who are organ transplant patients, cancer patients, and those with cardiac problems requiring surgery. These patients often have other co-morbidities such as diabetes or hereditary diseases that complicate their current medical conditions. Quite often there are untreated dental issues as well. In attempting to diagnose the patient’s illness, it is not uncommon for the patient’s lab blood cultures to show infections due to bacteria commonly found in the oral cavity.

The patients presenting with these chronic illnesses range from as young as their late 20s to the late 80s. Demographic determinants such as race, socio-economic status, and urban vs. rural residence are more indicative than age of the patient. These patients usually present with missing teeth, which do not allow for adequate chewing and digestion. Rampant decay results from poor diet, xerostomia from medications, and lack of a daily oral hygiene routine. While the condition of the dentition does vary, many of the patients have non-restorable teeth. Conversely, those patients with well-maintained dentitions.

Surgeons, including transplant, head and neck, and cardiothoracic, are keenly focused on a successful outcome for their life-saving, and complex procedures. The last thing that they want is a dental issue threatening the success of this incredibly significant procedure. Hospital-based general dentists can evaluate, diagnose, and plan to prevent dental complications, considering both the patient’s dental history and future needs. Most importantly, they can provide follow-up care to make sure that the pre surgery prognosis for the dentition can be realized. As the patients start their post-surgery life, the general dentist can coordinate with both surgical and primary care providers to improve the quality of the patient’s life by restoring and maintaining the dental health and function for the patient.

However, fewer hospitals today have general dentists on staff, let alone facilities on site to deliver care. As the dental health of many citizens continues to decline, more patients will have unmet dental needs. Today many of these medical procedures are successful in extending the lives of the patient. Good oral health and a functional dentition are crucial for a good quality of life. Now, more than ever, general dentists in the hospital can improve the patient’s quality of life and facilitate successful outcomes for both the patient and the surgeon.

Dr. Porter is the section head, Hospital Dentistry, Henry Ford Hospital, Detroit, and Spangler is the former GPR Program director, Trinity Health Oakland, Pontiac, Mich.