Cast your mind back to dental school and try to recall how you answered the familiar question: "Why did you become a dentist?" If you’re anything like me, the response probably ran along the lines of, "I want to help people and be respected in the community." A little pat and oversimplified perhaps, but an answer that stands up well in retrospect. Our work clearly and significantly benefits our patients, and, if surveys are to be believed, dentists are consistently among America’s most trusted professionals.

But how many young dentists realize that they will be saving lives? By this, I don’t mean just enhancing the quality of life through functional and aesthetic improvements (though that’s a worthwhile topic in itself). I’m talking about life itself. And without exaggeration, dentistry does save lives.

Most of us have vivid memories of patients who came to our offices for a routine prophylaxis and checkup, during which the examination revealed something else—a suspicious lesion, a swelling or maybe just generalized symptoms—which suggested a serious pathology. We followed up, took a biopsy perhaps, referred the patient to a specialist and waited. Usually we could share in the patient’s relief when our suspicions proved groundless, but on other occasions, the news was not so good.

Although we usually don’t think in these terms, dentists are on the frontlines in the war on disease. For one thing, we see our patients on a regular, person-to-person basis over a period of years: 74 percent of Americans who have dentists visit them two or more times a year. Something akin to family feeling develops, and patients find they can discuss a wide range of personal and medical issues with their dentist.

Moreover, many conditions are manifested in oral or facial symptoms. Serious diseases whose primary focus is in the mouth are plainly in our territory (salivary tumors, epithelial cancers and so on). We also look for signs, symptoms and risk factors associated with systemic disease.

Thus, we have both the opportunity and the duty to be alert to our patients’ overall health and, in partnership with the physician, to treat and refer appropriately. Unfortunately, the communication between partners often is dysfunctional. We all know it can be a real exercise in persistence to get a physician to listen to the systemic health implications of our treatment plan. And how many notes have you received stating that the patient is "cleared for dental work"?

Dental care is no more interchangeable than medical care. It can be fine to replace restorations in a patient undergoing active chemotherapy, for example, but an implant surgery for an implant-supported prosthesis may need to wait. Picking the proper course through a complicated treatment plan justifies the few minutes required for thoughtful doctor-to-doctor consultation.

If this alliance is to work, we as dentists must continue our education in both dentistry and in the broader medical context of oral disease and treatment. Moreover, we must be primed to apply that knowledge. Keeping current across such a broad front is daunting, but there are many resources available for formal and informal continuing education. Dental schools are (or should be) putting more emphasis on the medical perspective in their curricula. This Journal, through both its tutorial and scientific articles, is committed to the same end.

For their part, physicians need to better understand the nature of our special expertise, and the value of a fuller partnership with their dentist colleagues. Most respond well to an informed referral or query, but sadly, relatively few have a clear idea of what a dentist is trained to recognize in the way of oral and other disease. Communication—two-way communication—is the key to optimal patient care. Perhaps it would help if our component dental societies made it a point to schedule joint dental/medical meetings where issues of common interest are presented.

In the meanwhile, here are a few tips for making your interactions with physicians more productive:

– Know your patients—not only their dental needs, but general health status as well. Take the time to get a good history.

– Do your homework. In particular, know the drugs your patient is taking and their interactions, their risks and their impact on dental procedures.

– Be prepared to explain your treatment plan clearly to colleagues, as well as patients, along with any risks.

– Be direct, succinct and, if necessary, assertive in seeking or providing information in the interest of the patient.

The dentist is a full partner in the health care enterprise. When we live up to the role, our patients are the big winners.

After all, it’s a matter of life and death.