Open up and say “Ahh” – That should just start the doctor’s oral examination


For more than a century and a half, medical education in the United States has treated medical and dental care as largely independent fields. And by not doing more to teach oral exam skills, medical schools and primary care residency programs have left trainees ill-equipped to identify oral conditions, refer them correctly, or help patients understand. the prevention of oral diseases.

Here are the highlights of an article published in the AMA Journal of Ethics® (@JournalofEthics) by Jesse Feierabend-Peters, MD, PhD, first-year resident of the Lawrence Family Medicine Residency Program in Lawrence, Massachusetts, and Hugh Silk, MD, MPH, professor of family medicine and community health at the University of Massachusetts Medical School, Worcester.

Using a hypothetical case of a physician who examines a patient and finds a large midline mass in the hard palate, the authors explored the importance of educating physicians in assessing and promoting oral health. dental patients. They also proposed study programs and defined a training framework.

In recent years, the definition of primary care has rightly broadened to include the social, economic and environmental determinants of health, and oral health falls squarely within this competency, the authors noted.

“Oral disease, while largely preventable, affects a significant portion of the U.S. population, with a disproportionate impact on poorer communities and communities of color,” they wrote, adding that health Neglected oral health contributes to a number of negative socioeconomic, psychological and health outcomes. .

Untreated tooth decay, for example, causes local pain and infection. But it also has social implications, such as school absences and difficulty finding a job, as well as dire medical repercussions, including an increased risk of death.

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Other oral health problems have similar effects. Consider periodontal disease.

“This chronic inflammatory process has far-reaching consequences, including worsening diabetes and heart disease and contributing to poorer birth outcomes,” the authors wrote. “Conversely, uncontrolled diabetes can affect oral inflammation and oral health.” They noted higher rates of caries and periodontal disease among historically marginalized racial and ethnic groups in the United States, as well as among patients from economically or socially marginalized groups.

Yet oral health receives little attention during medical training, the authors noted, citing a study of program directors from 195 family medicine residencies that showed most programs provided no more than three hours. oral health program. Some offered no training.

“Primary care clinicians must have the proper skills, knowledge, and training to avoid overdiagnosis, underdiagnosis, and inadequate management of common oral problems,” the authors wrote.

What they need is “the skill to carry out a regular and thorough examination of the mouth, face and neck; the ability to distinguish between normal and abnormal results; and an examination of oral cancer patients.

“There are already models that can help guide this training in oral health,” the article says.

National academic organizations such as the American Council of Graduate Medical Education, the Association of American Medical Colleges and the American Academy of Oral Medicine should adopt these guidelines and link them to educational requirements, the authors wrote.

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Every year, many in the United States see a GP but not a dentist, making doctor visits their only real chance of getting an oral exam and preventive advice.

Meanwhile, the consequences of untreated oral disease are dire, “including damage to psychological and financial well-being and increased morbidity and mortality,” the authors wrote.

This is a matter of health equity, they added, further stating that “it is unethical not to educate medical students and primary care residents in oral health “.

The January issue of AMA Journal of Ethics further explores inequalities along the medico-dental divide.


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