What a Patient’s Overall Health Could Reveal About Caries Risk

Researchers at Columbia University College of Dental Medicine (CDM) are using Epic, the integrated medical-dental electronic health record, to examine whether information about a patient’s overall health could help identify their risk for dental disease.

For Dr. Sharon Perelman, associate professor of dental medicine (in oral health informatics) at CUMC and associate dean for clinical informatics and innovation at CDM, the study builds on her work exploring new ways to use Epic and its integrated data to better understand connections between oral and overall health.

Earlier this year, Perelman and colleagues published research detailing CDM’s integration of Caries Management by Risk Assessment, or CAMBRA, into Epic, creating a standardized clinical workflow that connects a patient’s assessed caries risk with preventive treatment and follow-up care. That work established the infrastructure for CDM to consistently capture caries risk information alongside the broader medical information available in the electronic health record.

CAMBRA helps clinicians evaluate a patient’s current risk for developing caries by considering factors such as oral hygiene, fluoride use and diet. Because the framework focuses primarily on dental and behavioral factors, the researchers wanted to determine whether broader medical information could provide additional context for assessing risk.

Building on that foundation, the new study, “Systemic Factors Associated with Caries Outcomes: Toward a Medically Integrated Risk Model Using Electronic Health Record Data,” published in the Journal of Dentistry, examined medical and dental data from approximately 7,000 patients treated in CDM’s teaching clinics. 

“We have this health record with all this information,” Perelman said. “Let’s look at patients’ medical problems, their medications and their labs, and figure out what the relationship is, if any, to caries risk.”

To investigate, the team brought together dental data with information already available in patients’ medical records. The analysis found associations between caries outcomes and several chronic health conditions, including diabetes, gastroesophageal reflux disease, HIV, hypertension, hypothyroidism and obesity. The researchers also found associations with several types of medications.

The findings also point to some of the ways medical factors could influence oral health. Certain medications can reduce salivary flow, limiting the mouth’s ability to neutralize acids and protect teeth, while conditions such as GERD can increase oral acidity.

Hypertension emerged as a particularly consistent finding, remaining associated with several measures of caries even when researchers accounted for age. Age itself was also an important factor, influencing the relationship between several health conditions and caries outcomes. The study also found relationships between caries outcomes and measures of immune function among patients with HIV.

Rather than producing a predictive model, the study identifies factors that could inform the development of a future medically integrated approach to caries risk assessment. With additional research, those findings could eventually help clinicians identify patients at risk earlier and guide preventive care.

The research began as a project by Dr. Laura Babiceanu through CDM’s Lipton Fellowship. Perelman first learned about Babiceanu’s proposal while serving as a fellowship judge and, after Babiceanu received the fellowship, asked to serve as her mentor. Over the course of the project, Babiceanu worked with the research team through the IRB process, study development and data analysis.

“She’s gone from IRB to a publication in a pretty significant journal,” Perelman said. “That’s a real accomplishment for a student.”

The study also points to possibilities beyond caries, with the integrated health record allowing researchers to investigate connections between medical and dental health in ways that were not previously possible at CDM.

“This type of data was not available to us in the past,” Perelman said. “It really is the start of a big push for us to look at many other aspects beyond caries, including periodontal disease.”

Ultimately, Perelman sees the opportunity to translate those findings back into patient care, using integrated data to help identify risk earlier and guide clinical decision-making.