摘要：Many disadvantaged adults visit physicians or hospital emergency departments to receive relief from dental pain. Physicians also see patients with general questions or concerns about their oral health. Unfortunately, because physicians generally have received little oral health training, patients often do not receive comprehensive emergency services or appropriate counseling. This situation has begun to change, as there has been a growing sentiment among the dental and medical communities that better integration and coordination between medicine and dentistry would be beneficial. Reports from the Institute of Medicine and professional associations and foundations reflect the need for better integration. I have outlined the rationale for and progress toward expanding the physician’s role in addressing the oral health of adults. There is a high prevalence of oral disease among disadvantaged adults, who face financial and other impediments to receiving dental services. 1 Although Medicaid provides dental coverage for many poor children, it provides only limited and in many cases no coverage for poor adults. However, physicians receive Medicaid reimbursement for treating adults with dental problems as do hospital emergency departments (EDs), which also receive reimbursement for facility charges. Dentists are not required by law to provide care to persons who are not able to pay, whereas EDs are. It follows that many poor adults lacking coverage choose to receive emergency dental care at EDs and physician offices. 2–4 Of course, physicians also see patients who have general questions about their oral health, because the physician is frequently the first source of information for many health-related issues. Most dental emergencies involve acute pain or infection. Relief of acute symptoms usually requires palliative treatment, at a minimum often involving nerve block, abscess drainage, a temporary sedative filling or dressing, and, less frequently, tooth extraction. The emergency encounter ideally should include appropriate health education and disease prevention counseling and an appropriate medical or dental referral as indicated. However, because physicians generally receive little training related to oral health, 5–7 patients seeking care from EDs or physicians usually only receive prescriptions for antibiotics and pain medications and thus do not receive comprehensive emergency services (i.e., diagnosis; treatment such as abscess drainage, local anesthesia, temporary sedative filling or dressing, and in some cases tooth extraction; counseling; and appropriate referral). 6–8 As a result, recidivism is common, which bogs down the system with repeat visits and may contribute to opiate dependency and antibiotic resistance. 9,10 Furthermore, the opportunity to counsel patients regarding the prevention of dental problems and the maintenance of good oral health is lost because of physicians’ general lack of comfort and knowledge regarding oral health–related issues.
