Systemic health and oral health at a Federally Qualified Health Center

Federally Qualified Health Centers (FQHCs), like Community Health Centers, are unique in that they offer both medical and dental care. This makes them especially capable of taking a holistic approach to systemic health and oral health, which are intricately connected. The path to see the dentist is with a referral from the medical doctor. Physicians at FQHCs may not realize the pervasiveness of dental problems in their patient population, and they may not know how to best deal with these patients and optimize the process of referral.

To gather descriptive data concerning the dental referral process and population, chart review was performed on 420 adult patients who have received dental referrals at the FQHC in the past 2 years. Demographics were recorded for each patient as well as information concerning the nature of the referral. Data was analyzed using SPSS.

Out of all the adult patients seen in the FQHC Internal Medicine clinic, about 14% received a dental referral per year. Of those patients given referrals, about half actually ended up being seen by the dentist, and about half of those were subsequently diagnosed with periodontal disease. The most common reason cited for referral was dental pain, which was the reason in over half of cases. Caries were the second most common and diabetes mellitus was the third most common reason for dental referral. About one third of patients reviewed indicated that seeking dental referral was the primary reason they came to the clinic. Of those who had pain, 61% were given no prescription at all. Of those who received some prescription, 22% were prescribed non-opiate analgesics while 15% were prescribed antibiotics. Opiates were prescribed in 6% of cases, while topical gels and chlorhexidine rinses were prescribed in 3% and 2% of cases, respectively.

Dental pathology is commonly seen by primary care physicians at the FQHC, but most of them refer their patients to the dentist with no prescription for analgesics or antibiotics. This suggests that physicians do not feel comfortable managing their patients’ dental complaints. There is also little consistency in the treatments prescribed to dental pain patients. It may benefit the clinic and the patients to develop guidelines, in collaboration with the dentist, which would guide physicians in the management of these patients until they are able to see the dentist. Maintenance of patients’ oral health can significantly affect their systemic health and impact their quality of life.