Primary Care and Dentistry: A Pilot Project

Natalie Bacheldor; Jacqueline C Childs; Eric Leikert; Nikolaus C Fulbright

doi:10.69735/001c.1413389

MI Medical Education and Health Bulletin

Bacheldor N, Childs JC, Leikert E, Fulbright NC. Primary Care and Dentistry: A Pilot Project. MI Medical Education and Health Bulletin. 2025;2(2):18-20. doi:10.69735/001c.1413389

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INTRODUCTION

Periodontitis and gingivitis have been linked to several chronic conditions, such as diabetes, coronary artery disease (CAD), and even chronic kidney disease.^1–4 Primary care physicians are responsible for the prevention of a multitude of health conditions. Dental care tends to be emphasized less than other areas of primary care.^5–7 In primary care physician offices, limited oral health examinations occurred prior to the coronavirus disease 2019 pandemic.^8,9 This paucity of oral exams was presumably exacerbated by mask wearing. The objective of this study was to determine if provider education increased oral health screening during annual exams in a family medicine primary care office.

METHODS

This retrospective chart review study was approved by the Ascension Providence Institutional Review Board (#RMI20240164). We reviewed history of present illness (HPI), review of systems (ROS), and physical exam (PE) questions asking about the last dental exam and/or dental health, physical exam of dentition, and if referral information was provided.

Patient records from November 2019 were compared with records from February 2023, 6 months after an August 2022 educational intervention for providers. The intervention was provided via a provider education module and covered the importance of oral health screening and how to complete an oral health screen. We also conducted a brief electronic medical record documentation review and presented a patient dental referral handout that providers could use for patients needing care.

The medical record variables were compared regarding oral health exams from records approximately 3 years before and 6 months after the intervention. Descriptive statistics were generated, and inferential analysis was performed. For inferential analysis, a Chi-square test was performed using IBM SPSS version 25 (IBM corp., Armonk, NY) to analyze the data. Statistical significance was set at p value <0.05.

RESULTS

A total of 50 exams from each time period were reviewed. There was no statistically significant difference between pre and post intervention by type of visit (p=0.461). Adult annual exams (58%) were the predominant type of visit but there was no difference between pre and post intervention. There was no statistically significant difference between pre and post intervention by smoker status (p=0.141). The majority were non-smokers (71%).

Table 1 shows the frequencies and percentages of mention of oral cavity during HPI, ROS, and PE pre and post intervention. There was no statistically significant difference between pre and post intervention by HPI (p=0.362). No HPI was higher in proportion at both pre and post intervention. There was a slightly higher root canal HPI post intervention (8% vs 2%), but it did not reach statistical significance.

Table 1.Differences in frequencies and percentages of mention of oral cavity during history of present illness (HPI), review of systems (ROS) and physical exam (PE) pre and post intervention.

Factor	Group	Time				Total N=100		p value
		1=pre N=50		2=post N=50		Total N=100
		N	%	N	%	N	%
HPI	None	49	98%	46	92%	95	95%	0.362
	Yes, root canal	1	2%	4	8%	5	5%

ROS	None	35	70%	30	60%	65	65%	0.295
	Yes, mention of dentition	15	30%	20	40%	35	35%

PE	None, there is no mention of oral cavity	12	24%	34	68%	46	46%	0.0001
	Yes, mention of oral cavity	38	76%	16	32%	54	54%

There was no statistically significant difference between pre and post intervention by ROS (p=0.295). No ROS was higher in proportion at both pre and post intervention. Similar to HPI, mention of dentition ROS was slightly higher (40% vs 30%) post intervention, but it did not reach statistical significance.

There was a statistically significant difference based on PE (p=0.0001). Pre-intervention, there was a higher proportion of mentioning oral cavity during the PE. However, post intervention, there was a higher proportion of not mentioning oral cavity.

DISCUSSION

Despite the educational intervention, our providers were doing more oral health screenings in 2019. A recent scoping review indicated the continuing limited integration of dental care in patient-centered medical homes.¹⁰ The largest contributing factor in our case was likely the initiation of in-office mask mandates and limited services during the coronavirus disease 2019 pandemic. Moving forward, we need to improve the intervention and continue educating our providers.

AUTHOR CONTRIBUTIONS

Conceptualization: Natalie Bacheldor (Lead). Data curation: Natalie Bacheldor (Supporting). Methodology: Natalie Bacheldor (Supporting), Jacqueline C Childs (Supporting), Eric Leikert (Supporting). Visualization: Natalie Bacheldor (Lead). Writing – original draft: Natalie Bacheldor (Supporting). Supervision: Jacqueline C Childs (Supporting), Nikolaus C Fulbright (Supporting). Writing – review & editing: Jacqueline C Childs (Supporting), Eric Leikert (Supporting), Nikolaus C Fulbright (Supporting).

FUNDING

The authors have no funding to report for this study.

DISCLOSURES

The authors have no disclosures or conflicts of interest to report for this study.

Submitted: December 16, 2024 EDT

Accepted: May 01, 2025 EDT

References

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Primary Care and Dentistry: A Pilot Project

INTRODUCTION

METHODS

RESULTS

DISCUSSION

AUTHOR CONTRIBUTIONS

FUNDING

DISCLOSURES

References

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