Hugh J. Silk wishes he had a time machine.

If he did, he’d go back to the year 1840 and persuade the staff at what is now the University of Maryland School of Medicine to accept a recommendation to include dental instruction in their curriculum. Instead, the medical school rejected the idea — and the Baltimore College of Dental Surgery, the nation’s first dental school, was born.

“That was a pivotal moment,” said Silk, an MD and professor of family medicine and community health at UMass Chan Medical School in Worcester, Massachusetts. “This divide where people who go to dental school are in the dental profession vs people going to medical school in the medical profession has really set us back.”

Today, the medical and dental worlds remain sharply divided, leaving many physicians ill-trained to spot oral health problems that could lead to systemic issues — and many dentists insufficiently educated on the oral-systemic connection.

The split has also created a major coverage gap — Americans without dental insurance now outnumber those without health insurance three to one, translating to lower rates of preventive dental care. Research suggests that more than 70 million US adults do not have dental insurance.

Now science is lapping tradition, as a new wave of research is drawing attention to the connection between oral health and systemic disease. Studies increasingly show that poor oral health isn’t just a dental issue — it’s tied to higher risks for cardiovascular disease, diabetes, obesity, cancer, and Alzheimer’s disease. On average, people with oral health problems are three times more likely to develop systemic diseases. Advances in oral microbiome science are accelerating this understanding, with mounting evidence that chronic gum inflammation may drive systemic inflammation and that oral pathogens may enter the bloodstream and affect distant organs.

“Oral health and overall health are highly connected,” said the American Dental Association in a statement, “and emerging evidence shows that greater collaboration across medical and dental providers could help improve patient health outcomes.”

A growing number of doctors and dentists agree. Over the past two decades, initiatives, pilot programs, and healthcare organizations have tried to bridge the divide. In 2022, the University of California San Francisco became the first to merge medical and dental records, giving clinicians access to both. In Ohio, a pilot program by the CareQuest Institute for Oral Health is integrating oral health services into primary care. The Harvard School of Dental Medicine has launched an initiative focused on uniting oral health and medicine through education, policy, and clinical innovation. And in 2024, the American Heart Association introduced its “Healthy Smiles, Healthy Hearts” campaign to highlight the oral-cardiovascular link — encouraging dentists to screen patients for high blood pressure and refer them to medical care when necessary.

While major technical, educational, and financial barriers to full integration remain, these efforts show that a total overhaul isn’t the only path forward. Instead, there are many practical, actionable steps doctors and dentists can take right now to help unite the two fields and improve patient care.

It Starts With Education 

The US has more than 70 dental schools and nearly 200 medical schools, churning out tens of thousands of clinicians each year. Most doctors treat every part of the body except the oral cavity. Dentists treat only the mouth.

Oral health is not a high priority in medical school, said Beomjune B. Kim, MD, DMD, a head and neck oncology and microvascular surgeon at City of Hope Cancer Center Atlanta, Newnan, Georgia. “For general medical students, education in that area is poor,” said Kim, who already had his dental degree when he attended medical school in 2008.

In 2011, researchers at UMass Chan Medical School, including Silk, found that among 88 medical schools surveyed, nearly 70% reported offering 5 hours or less of oral health education — 10% offered none at all. Since then, little seems to have changed. A 2018 national survey of family medicine residency programs found that although more physicians recognized oral health as important, fewer programs were actually teaching it — and most offered less than 4 hours of training.

Silk, who has been advocating for better dental-medical integration for 25 years, first recognized the problem as a resident in Worcester, Massachusetts. “I was blown away by how many patients I was caring for had poor oral health,” he said. “It seemed like the sickest patients had the worst mouths.”

Science tells us that the earlier a disease is diagnosed, the more treatment options are available — leading to improved outcomes.

“Patients with oral cancers that are found during a dental exam often experience better outcomes because the cancers are found earlier,” Kim said. “Medical doctors often don’t examine the oral cavity routinely unless a patient brings up some symptoms in the mouth. But if you go to the dentist for regular visits, any cancers or other conditions are likely to be found earlier.”

A 2012 study of 441 patients found that “never or rarely going to the dentist was associated with being diagnosed at higher stage for oral and pharyngeal cancer compared to those going to the dentist at least annually.” These infrequent visitors also tended to lack dental insurance, the study found.

A Dangerous Coverage Gap

Health insurance is often in the spotlight these days, but dental coverage is rapidly becoming a critical issue of its own. The three-to-one gap between those without dental and health coverage drives billions in out-of-pocket expenses, healthcare costs, and productivity losses. Emergency room visits for preventable dental issues alone cost Americans about $2 billion a year.

When health insurance emerged in the early 1900s, most plans didn’t include dental care. Medicare, established in 1965, left out dental services as well — even today, Parts A and B generally don’t cover them except in narrowly defined cases. Many Medicare Advantage (Part C) plans offer dental benefits, though coverage varies widely.

About 10% of American adults have no health insurance compared with 27% without a dental plan, according to CareQuest. The rates are higher among minorities and those in poverty, adding dental care disparities to well-documented healthcare disparities.

The divide complicates claims and reimbursements for clinicians, like Kim, with hybrid practices. “Whenever I submit a claim after treating teeth damaged by a medical condition, it is denied because it’s considered dental and not medical,” Kim said.

If a baseball player fractures the hook of hamate in his hand after being hit by a pitch, medical insurance would cover the surgery needed to remove the bone. But if the pitch strikes his jaw instead, breaking a tooth, insurance would not cover the extraction.

The cost to patients can be devastating — those with head and neck cancer may face thousands of dollars in out-of-pocket expenses for dental complications, according to a 2024 study.

How Health Professionals Can Get Involved

For those considering medical school, already out of school, or working in private practice, Silk offers these suggestions:

Look for a medical school with a robust oral curriculum. “If a medical school is not providing robust oral health education in this day and age, then it borders on medical education malpractice," Silk said. "Prospective students should definitely look for a school with an oral health curriculum that addresses knowledge, skills, and attitude change”

Include oral health topics in your continuing education. Clinicians across disciplines can benefit from strengthening their understanding of oral health. “Take it upon yourself to learn some basics,” Silk said. Know how to take an oral health history, do an exam, and give advice on how to care for the mouth, brush, and floss.

Smiles for Life offers accredited Continuing Medical Education and Continuing Dental Education courses for doctors, dentists, and other healthcare professionals. Topics range from pediatric to geriatric oral care, how to conduct an oral exam, recognizing the risks for dental caries, and applying silver diamine fluoride. For dental professionals looking to deepen their understanding of the oral-systemic health connection, a course on that is available as well.

Make dental referrals a matter of course. Medical and dental providers should treat referrals across disciplines as standard practice. “Figure out a workflow in your office to make sure that everyone gets a referral to the dentist,” Silk said. “It’s not huge effort. Make it a quality improvement project, and the next thing you know everybody’s on board.”

Get involved. Consider connecting with the 100 Million Mouths Campaign, a national initiative training 50 “oral health champions” — one in each state — to promote oral health education in medical and nursing schools and residency programs. Champions have been selected in 26 states so far and include doctors, dentists, hygienists, nurse practitioners, and physician assistants. Physicians can reach out to their state’s champion for guidance, resources, and support.

Other organizations that promote better oral health access and integration with medical care include:

• CareQuest Institute for Oral Health
• American Academy for Oral Systemic Health
• National Network for Oral Health Access
• Harvard School of Dental Medicine Integration of Oral Health and Medicine

“If you’re not learning about the mouth and addressing the mouth, it’s almost an ethical dilemma,” Silk said. “We don’t turn away from any other aspect of healthcare. It leads to your patients getting unhealthier with their diabetes or ending up in the emergency room. How could you not learn about this?”