Satcher reinforced the message that “oral health and general health are inseparable”, and that “oral health is integral to general health”. Another common thread running through the report was that the mouth “is a portal of entry for infections that can affect local tissues and may spread to other parts of the body” with references to the associations between periodontal disease and diabetes, heart disease and stroke and adverse pregnancy outcomes. The report went on to say that improvements in oral health depend on multidisciplinary and interdisciplinary approaches to research and on the ability of practitioners to apply that research effectively. The need to change nondental healthcare providers’ perception of the importance of oral health was also discussed. Satcher challenged medical and dental healthcare providers that they “should be ready, willing, and able to work in collaboration to provide optimal healthcare for their patients”. As a prerequisite for interdisciplinary services, the report highlighted the need for curriculum changes and multidisciplinary training. The report also called for the development of risk assessment tools and diagnostic markers to allow clinicians to determine which individuals are more susceptible to a given disease, thereby providing a basis for more targeted intervention strategies for those at high risk. Given the estimates of periodontal disease prevalence and speculation that it is dramatically underdiagnosed, early identification and appropriate treatment of periodontal disease is critical in achieving these intervention strategies.

The lack of a standard definition of periodontal disease and issues related to access to dental care for a substantial percentage of the U.S. population confounds the attempts of epidemiologists to pinpoint the prevalence of periodontal diseases. However, recent investigation into the validity of self-reported periodontal disease and its use in attaining more accurate measurements of periodontal disease prevalence is promising.¹⁵ It has recently been estimated that at least 50% of adults in the U.S. have some level of gingival inflammation, or gingivitis.¹⁶ Periodontal disease is highly prevalent, affecting about 34% of the U.S. population older than 30 years, with severe periodontal disease estimated in 13% of the population.¹⁷ Given the prevalence of periodontal disease and statistics generated from consumer surveys and practice management statistics, it appears that periodontal disease may be significantly underdiagnosed in the United States. In a 2005 paper entitled “Diagnosis and Treatment of Periodontal Disease: A Crisis of Direction”, Cobb¹⁸ wrote: “In spite of our current understanding of the etiology and clinical characteristics of chronic periodontitis, there is still a conflict between what many private practitioners consider to be chronic periodontitis requiring treatment versus the recent description and reclassification of periodontitis by the 1999 International Workshop for a Classification of Periodontal Disease and Conditions. In other words, when clinically defining (i.e., diagnosing) chronic periodontitis for the purpose of treatment,

dentistry is faced with the conundrum of ‘what is’ versus ‘what
should be’.”

If the medical profession begins to identify patients who have periodontal disease or who may be at risk for periodontal disease, and the dental profession screens patients for undiagnosed CVD and/or diabetes, the impact on the prevalence of these life-threatening chronic conditions may offer unprecedented gains in longevity. Over 70 million Americans have CVD.¹⁹ This translates into 1 in 4 people with some form of CVD. Statistics related to the failure to assess risk and diagnose CVD are haunting. For example, research indicates that for 50% of men and 64% of women who died suddenly of coronary heart disease, there was no previous recognition of the disease.²⁰ Furthermore, a significant proportion of the population with identified risk factors for CVD are not diagnosed with CVD, and are therefore not being treated adequately for CVD.²⁰

Current predictions suggest that by 2030 there will be 23 million individuals with diagnosed diabetes, 7 million with undiagnosed diabetes, with another estimated 70 million with impaired fasting or postprandial glucose.²¹ Direct costs of diabetes could be close to $175 billion/year; indirect costs could be an additional $75 billion/year. Even now the economic and personal burden of diabetes outpaces our current healthcare delivery system.

How might medical-dental collaboration impact these disease
trajectories? This was the focus of The Scottsdale Project.
ORDER OF PROCEEDINGS AND DESCRIPTION
OF OPINION BUILDING PROCESS

The Scottsdale Project was a 3-day conference. The conference was organized to provide an opportunity for professional organizations and other relevant stakeholder groups to observe the proceedings on the opening day. Several key organizations* were invited to send a representative to deliver a short presentation during the morning of the first day that specifically addressed several important questions:

1. Does your organization recognize the evolving body of evidence
that supports a relationship between oral and systemic health/
disease?
2. If so, what has your organization done to create awareness
among its constituency or develop clinical protocols that
address the oral-systemic relationship?
3. If not, what have been the hurdles to acceptance of the evidence
of oral-systemic links?
4. What future direction would your organization propose in
order to advance oral-systemic medicine and collaboration
among healthcare providers?

* American Academy of Periodontology, American Diabetes Association, National Dental Association, American Dental Hygienists’ Association, America’s Health Insurance Plans