Medical-dental integration (MDI) has been discussed for decades, often framed as an overdue correction to an outdated healthcare model. The science is clear. The oral-systemic connection is well documented. Patients are increasingly aware that oral health is not separate from overall health.
And yet, in daily practice, dentistry and medicine remain largely siloed.
For this edition of Dental Duets, I spoke with Eva Allan, a healthcare innovation strategist and operations leader whose work spans clinical redesign, virtual care, insurance, and system performance. Allan has written extensively about why well-intentioned reforms stall and why awareness alone has never been enough to drive structural change.
Michael Ventriello: Dentistry and medicine have worked separately for generations. Why does this divide persist?
Eva Allan: We tend to explain the separation as an education or awareness problem. It isn't.
The research exists. Patients understand the mouth-body connection. Dentists are respected healthcare professionals. None of that is what's holding us back.
Dentistry and medicine remain separate because regulations block the math from working.
What does that mean?
There are very few profitable healthcare services dentists are allowed to provide, and very few profitable dental services physicians are allowed to provide.
That regulatory boundary, not lack of competence or capability, is what prevents integration from scaling. Incremental gestures, like allowing dentists to administer flu shots in a few states, are symbolically positive but financially irrelevant. They do not create enough momentum to change systems.
Physician-dentist collaboration seems like a no-brainer. Why doesn't it occur more frequently?
Eva Allan.
Physicians and dentists are among the most highly trained professionals in healthcare. Along with their clinical teams, they are capable of expanding scope in ways that would materially improve both access and outcomes. The limiting factor is compensation. Time, liability, staffing, and infrastructure all require economic justification.
What's particularly frustrating is that the regulatory system already contains pathways that could enable broader collaboration. They exist, but they're rarely operationalized at scale.
Fragmentation persists not because solutions don't exist, but because incentives have never been aligned strongly enough to make integration the default rather than the exception.
What we don't need is another study or awareness campaign. Instead, we need payment models modernized, barriers removed, and a leader (public or private) willing to push real regulatory and economic reform. Until then, integration remains aspirational.
Dental insurance is separate from medical insurance. How does that reinforce the divide?
At its core, this comes down to who absorbs the cost of integration.
Medical insurers understand the math. Roughly 40% of adults have periodontal disease, and treatment often costs thousands of dollars per patient. Dental care is relatively predictable, and much of the demand is suppressed by benefit design.
The structural difference between medical and dental insurance is critical. Medical plans use an out-of-pocket maximum, which caps what the patient pays while exposing the insurer to potentially high costs. Dental plans rely on an annual maximum, which caps what the insurer will ever pay -- often at levels that haven't kept pace with inflation.
Should dental insurance adopt the medical insurance model?
If dental were covered like medical by health insurers, their margins would collapse. Covering periodontal disease alone would upend actuarial assumptions. That's why even insurers that sell both medical and dental products preserve traditional dental benefit design. It protects the math.
Dental insurers face a different disincentive. Covering medical services that improve oral health often benefits the medical carrier financially, not the dental one. From their perspective, integration can mean subsidizing someone else's savings.
Employers add another layer of resistance. After years of relentless premium increases, simply folding dental into medical coverage is rarely feasible.
The system isn't malicious. It's rational in its incentives but broken in its outcomes. Patients feel misled and delay care. Dentists absorb mistrust for constraints they didn't design.
What would be the impact of integration if the barriers were removed?
The gums are among the most permeable tissues in the human body. When periodontal disease is present, the bloodstream is continuously exposed to bacteria and inflammatory mediators. This is not a localized issue, it's chronic systemic exposure. Any clinical assessment that ignores oral health is incomplete.
When clinicians treat downstream effects while ignoring upstream contributors, outcomes suffer. Integration allows both to be addressed at once. At scale, that means faster recovery, improved population health, and more efficient use of healthcare dollars.
What needs to change in education and culture for MDI to happen?
Education hasn't kept pace with modern science. Dental training devotes enormous time to low-frequency, highly advanced procedures, even though most clinical practice revolves around prevention, diagnosis, and chronic disease management. Some of that time could be reallocated to systemic health, risk stratification, and care coordination.
Medical education has its own blind spot. Physicians receive minimal exposure to oral health despite strong links to diabetes, cardiovascular disease, pregnancy outcomes, and immune dysfunction.
Both sides are trained to stay in their lanes, even when those lanes intersect clinically. Until a university's ranking and success are measured by population wellness rather than procedural complexity, that mindset won't change.
Editor's note: In Part I, Eva Allan makes it clear that medical-dental integration has not stalled because clinicians lack insight or intent, but because the system has never made collaboration economically viable. In Part II, we turn from diagnosis to design, exploring what could finally make integration operational rather than aspirational.
Eva Allan is a healthcare strategist and operations leader with experience spanning clinical redesign, virtual care programs, insurance, workforce planning, and multisite healthcare operations. She has held leadership roles across both startup environments and established healthcare organizations, where she has worked at the intersection of care delivery, technology, innovation, and system performance. She writes about the architecture of the healthcare system, its persistent misaligned incentives, and the urgent need for models that improve quality, access, and sustainability. Connect with Allan on LinkedIn.
Michael Ventriello is widely regarded as the "Dental Product Launch Expert" and is the owner and founder of Ventriello Communications and the co-founder and chief communications officer of Personify Group. Ventriello is an award-winning copywriter, former journalist, broadcaster, and frequently published author and dental industry pundit. Connect with him on LinkedIn.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
