A large majority of people who have dental pain contact their primary-care provider (PCP) for help. Untreated periodontal disease is the most common cause of tooth loss among adults, and dental care is often cited as the greatest unmet health need of children, which points to access-to-care issues for the general population that can be improved by PCPs with adequate oral-health screening techniques. 

Nurse practitioners (NPs) and physician assistants (PAs) should be aware that oral health is linked
 to many systemic diseases, including cardiovascular disease and diabetes, as well as to preterm labor. 
The connection stems from the inflammation response from the gingiva to the rest of the body.
 The mouth can also exhibit pathological markers for medical problems such as leukemia, bleeding disorders, and sexually transmitted diseases.

Many health providers have difficulty recognizing the initial signs of periodontal disease, including chronically bleeding gingiva, bad odor from the mouth, and loosening of the teeth. Even when providers do note the presence of periodontal disease and understand its connection to diabetes and cardiovascular disease, the intervention is often to refer the patient to a dentist rather than initiating a shared treatment plan to co-manage the condition. 

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The American Cancer Society estimates that about 36,000 new cases of oral cancer will be diagnosed this year in the United States, and approximately 6,850 people will die of these cancers.1 As noted by the National Cancer Institute, most lip and oral-cavity cancers are squamous cell carcinomas, which arise from the oral mucosal lining.2

Despite the fact that the oral cavity is highly accessible for direct examination, these malignancies often are not detected until a late stage. Oral mucosal changes can be subtle, and NPs and PAs who can recognize these changes can make timely and appropriate referrals to increase the patient’s chance of survival.

Patients should be screened for tobacco and alcohol use, as these are risk factors for oral problems. NPs and PAs also may encounter persons who develop oral lesions as a result of chemotherapy and radiation treatment.

With appropriate training, the NP and PA could be instrumental in detecting early tooth decay and administering preventive services such as applying fluoride varnish. Fluoride varnish is a professionally applied, highly concentrated topical fluoride that prevents decay. In the past decade, it has become more widely available in the United States and is used on children in many settings, such as pediatric practices and public-health centers. Fluoride varnish treatment, which has high reimbursement rates among Medicaid recipients, is an attractive option for the primary-care setting as it takes less than five minutes to paint the solution onto the person’s teeth, is generally acceptable to patients, and requires no special preparation of the teeth or expensive equipment. 

Many health facilities and organizations are making oral screening a crucial component of the general patient assessment. This effort will ultimately promote health and prevent disease as well as foster collaboration between medical and dental professionals.

Kelly Anderson, RDH, MHS, is an associate professor in the Department of Dental Hygiene at Wichita State University, Wichita, Kan.


  1. American Cancer Society. Oral Cavity and Oropharyngeal Cancer. Cancer.org. 26 Feb 2013. Available at http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/, Accessed 1 May 2013.
  2. National Cancer Institute. Lip and Oral Cavity Cancer. Cancer.gov. 16 July 2011. Available at http://www.cancer.gov/cancertopics/pdq/treatment/lip-and-oral-cavity/HealthProfessional, Accessed 1 May 2013.