Dentists' practice behaviors and perceived barriers regarding oral-systemic evidence: implications for education

Observational studies consistently support a relationship between poor oral health and systemic diseases like cardiovascular disease and diabetes mellitus. The purpose of this study was to identify current practices and perceived barriers among North Carolina dentists regarding the incorporation of oral-systemic evidence into the delivery of patient care. A survey questionnaire was developed, pilot tested, revised, and mailed to 1,350 licensed dentists in North Carolina. The response rate was 49 percent. Bivariate analysis was used to compare practice behaviors and barriers among age, gender, practice type, and setting categorizations using the chi-square test. Respondents were predominantly male (77 percent), in solo practice (59.4 percent), and in urban or suburban settings (74 percent). Half (50 percent) reported updating medical histories at every patient visit. Younger dentists were significantly (p<0.05) more likely to inquire about patient blood glucose levels and utilize blood pressure guidelines. Perceived patient objections to additional fees and lack of patient acceptance were reported as significant barriers, especially among younger dentists. Significantly more rural dentists reported lack of appropriate referral options as a barrier (p<0.05). In the multivariate analysis, gender and type of practice but not age were statistically significant predictors of respondents' perceptions of patients' objection to additional fees. Dental schools need to prepare dental students for future roles in the assessment, management, and interprofessional collaboration that will be needed in the future.