Dr. Nathaniel Treister, DMD, DMSc, Brings His Expertise in Oral Medicine to the Integration of Oral Health and Primary Care

Dr. Nathaniel Treister, DMD, DMScDr. Nathaniel Treister, DMD, DMSc, has brought his time, his talents, and his expertise in Oral Medicine to the Initiative to Integrate Oral Health and Medicine since its inception. After receiving his DMD from the University of Pennsylvania School of Dental Medicine, Treister ventured to Harvard School of Dental Medicine (HSDM), where he received his Doctor of Medical Science in Oral Biology, as well as a certificate in Oral Medicine. Upon completing his oral medicine training, he joined the faculty in the Division of Oral Medicine and Dentistry at Brigham and Women’s Hospital (BWH), where he has worked full-time since 2005.

Treister currently serves as the division chief and associate surgeon at BWH, as the clinical director in Oral Medicine and Oncology at Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center, and consults at Boston Children’s Hospital. On top of all that, Treister is an associate professor of Oral Medicine in the Department of Oral Medicine, Infection and Immunity at HSDM. Treister is board certified in Oral Medicine with special interest in oral mucosal diseases, salivary gland diseases, orofacial pain disorders, and oral complications in cancer patients.

Treister provides educational sessions for the BWH primary care residents on the topic of “oral medicine for the primary care physician,” covering odontogenic conditions, as well as common oral medicine conditions. He also provides an annual continuing education course for BWH faculty that focuses on updates in primary care. His clinic at BWH is located directly across the hall from the primary care practice, allowing him to serve as a resource to his colleagues and collaborate on patient care when appropriate.

When the Initiative to Integrate Oral Health and Medicine was getting its start, Bruce Donoff, DMD67, MD73, and Jane Barrow, BA 84, MS87, recognized the value in including someone who specialized in oral medicine. Not only was Treister a highly regarded specialist in the field, he also worked in an environment in which oral health was already highly integrated and recognized. “A lot of the work we do in the Initiative focuses on the importance of primary oral health care in preventing oral and associated chronic diseases. Oral Medicine plays a critical role in helping providers and patients understand oral health beyond primary care in the context of secondary and tertiary medical and surgical management of disease,” says Barrow. “It is important that we integrate the oral health throughout the healthcare continuum so that we prevent and manage disease in ways that improve patient's quality of life and health outcomes in every way we can.”

Oral Medicine was recently recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards as a dental specialty, a huge win for the field. Treister, like many others who work in Oral Medicine, is excited for what this could mean for the future of Oral Medicine, patient care, and outcomes.

Oral Medicine was only recently recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards as a dental specialty. What does this mean for the field, and how will it impact patient care in the future?

This is a critically important milestone for the specialty. We anticipate that specialty recognition will provide a platform for increasing awareness and understanding of, and most importantly access to, oral medicine specialty care across the population. There are a number of initiatives being considered by the American Academy of Oral Medicine, targeting the general population, dentists, physicians, professional societies, healthcare organizations, and insurance companies, to work towards these goals.

Oral medicine being recognized as a dental specialty seems like an important step toward achieving a higher level of integration between oral health and medicine. Do you anticipate that this milestone will influence integrated care, and if so, how?

There is certainly potential for this to be realized. How individual medical systems determine their respective needs for integrated care will likely vary considerably, based on history/tradition, balance of service lines, populations served, available space and budget priorities. However, it can be easily argued that there is a critical role for an oral medicine service within any large healthcare system. Whether all integrated care is provided under a single roof, as part of a network, or in a partnership with the community (a model we have utilized at our center, for example, for dental oncology clearance protocols), will likely vary considerably.

Why do you think the integration of oral health and medicine is important in the changing landscape of healthcare?

As medical care reimbursement moves away from a fee for service model to a capitated or bundled care model, there is greater emphasis on efficiency and outcomes rather than tests ordered and procedures performed. While oral health care has for many years been delivered within a separate system with overall more limited access, there is increasing recognition that oral health can’t be considered separately, and an integrated model can contribute towards achieving these goals. It must be recognized, however, that there will be many forces within organized dentistry that will be opposed to such integration and potential loss of autonomy for the field. It will be essential to draw a roadmap that is mutually attractive for dentistry and medicine. 

How important are organizations like the Initiative to Integrate Oral Health and Medicine and the Center for Integrating Primary Care and Oral Health (CIPCOH) to advancing the national conversation regarding oral healthcare?

The conversation needs to happen, and key stakeholders and decision makers like those in the Initiative and CIPCOH need to be involved, listening and engaged. An important question, however, is what is the conversation, who is the audience, what are the intended outcomes, and what is needed for change? For example, integration at the primary care level and integration at the level of complex oncology care may ultimately be two different conversations and pathways.

Where do you see oral health and medicine in ten years?

I hope to see expanded coverage and access for oral health services, regardless of how and where it is delivered, and this will certainly be a critical component of integration. And from the standpoint of Oral Medicine, I anticipate considerable growth in the number of trained specialists, broad name recognition for the specialty, a greater proportion of larger healthcare systems with integrated specialists, and emergence of community-based specialists throughout the country.