Addressing the Oral–Systemic Health Divide by Strengthening Dental Referral Pathways in Primary Care

CONTEXT: The bidirectional relationship between oral health and systemic health has been widely studied and has important implications for patient care. Despite the growing evidence of oral conditions being linked to systemic diseases and other adverse health outcomes such as cardiovascular disease, diabetes and other chronic conditions, and adverse pregnancy outcomes, oral health remains largely excluded from general medical practice. RATIONALE: This historical and persistent separation limits opportunities for timely intervention and interprofessional management of oral diseases. Factors contributing to this compartmentalization include the historical separation of dental and medical education training, the absence of a straightforward referral system, and lack of infrastructure to effectively guide patients through the referral process. KEY POINTS: To address these gaps, we recommend three strategies: (1) cross training primary care providers through targeted education in recognizing common oral conditions, assessing clinical urgency, and initiating appropriate referral; (2) leveraging user-friendly health IT referral systems facilitating two-way communication between medical and dental teams while enabling easy tracking and follow-up and (3) redesigning clinic workflows to include designated referral navigators (e.g., care coordinator, dental coordinator) who can address patient barriers to referral completion including appointment scheduling, insurance navigation, follow-up reminders and other logistical challenges. IMPLICATIONS: With these recommendations, our overarching goal is to strengthen dental referral pathways within primary care settings, ultimately integrating oral health into general practice.