By: Dr. Wanda Nazario
MCS Medical Director of Dental Services Administration
Primary medicine is the main entrance to our healthcare system. Currently, many patients go to primary care
physicians with a dental-related health condition. Although it’s important to refer these cases to a
dentist, the primary care physician can provide effective and well-known treatments. This care is essential,
as patients may have conditions related to oral health that affect other areas of the body.
Common examples include patients with inflammation inside their mouths, and it extends to extraoral areas.
The clinical scenario may also include fever, general discomfort and/or a hot reddened area, suggesting a
diagnosis of an abscess related to the oral cavity, or cellulitis. The American Dental Association (ADA) has
created care guidelines that help determine when an antibiotic is indicated, what type of antibiotic to
prescribe, and if necessary, the indicated follow-up1. According to the guidelines, patients should receive
antibiotics when the infection becomes systemic. The first treatment option is always amoxicillin. However,
for allergic patients, other options are provided. An additional factor to consider when choosing a
treatment is the availability of a dentist for an evaluation appointment.
Another common condition that leads patients to visit their primary care physician is oral pain. The ADA
specifies that opioids should not be the first therapy recommended to manage this type of pain2. Dental pain
is mostly inflammatory in origin, so drugs commonly used for pain, such as acetaminophen, or in combination
with ibuprofen, or some other nonsteroidal anti-inflammatory drugs have proven to be more effective. In
January of this year, the CDC published that 60% of young people, when going to the emergency room for a
dental condition, receive a prescription for opioids3. This is concerning, as it exposes patients to these
drugs, along with the risks that accompany their abuse.
During the medical visit, it’s important to emphasize that the use of antibiotics or analgesics only treats
the symptoms, and a dentist must resolve the cause of the problem. Many patients believe the condition has
been taken care of when they feel relief from the symptoms, and do not follow up. It’s common to hear
patients say they avoid going to the dentist because it causes them anxiety, they fear dental procedures, or
do not have dental coverage in their insurance. Any reason that causes the patient to delay a visit to the
dentist will lead to complications, and as a result, to more complex and expensive treatments. At times, the
patient’s situation may even require hospitalization.
A good practice to optimize the service provided by the primary care physician is to establish relationships
with dentists who can provide services near your medical office. This strategy facilitates the continuity of
treatment, promotes the proper use of the healthcare system and teamwork, and ensures the patient’s health.
Integrating oral healthcare services for patients affected with chronic conditions has a positive impact on
them. We want complete health, and this integration of services is an important step in achieving this goal.
References:
-
American Dental Association. 2022. Oral Analgesics for Acute Dental Pain. [online] Available at:
https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-analgesics-for-acute-dental-pain.
Accessed June 29, 2022. Last Updated: September 15, 2020.
- Dental pain. Centers for Disease Control and Prevention. Available at:
https://www.cdc.gov/acute-pain/dental-pain/index.html. Published January 28, 2022. Accessed June 29,
2022.
- Lockhart, P., Tampi, M., Abt, E., Aminoshariae, A., Durkin, M., Fouad, A., Gopal, P., Hatten, B.,
Kennedy, E., Lang, M., Patton, L., Paumier, T., Suda, K., Pilcher, L., Urquhart, O., O’Brien, K. and
Carrasco-Labra, A., 2022. Evidence-based clinical practice guidelines on antibiotic use for the urgent
management of pulpal- and periapical-related dental pain and intraoral swelling. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270006/
