In this issue Dr Romesh Nalliah discusses the problem of patients in the US seeking dental treatment in hospitals rather than practices and argues that dentists should be integrated into the hospital team.

Visiting a dental practice is seen as a luxury rather than a necessity among US patients and instead hospitals have to manage the burden of neglected dental disease. However, few emergency rooms have dentists and commonly dental problems are not managed efficiently: 'One of our earlier studies has shown that close to 300 people die each year in American hospitals after being admitted due to a dental complaint.' Romesh works closely with medical, pharmacy, nursing and social worker students to provide oral health training to them: 'When all health professions send a uniform message to their patients about the importance of oral health we will be able to change the dangerous attitude that oral health is a luxury.'

US dental healthcare delivery is greatly segmented with major differences existing between states: 'In terms of dentistry, the 'Un-united States' is a more appropriate term.' A large proportion of patients are uninsured and state funded public insurance Medicaid does not always cover dentistry, unless it reaches the emergency room and is considered a medical problem.

Romesh was raised, trained and worked in Australia, but after marrying his Chicago-born wife, he moved to the US and secured a job at Harvard University. Seeing himself not only as a dentist but a health services researcher and public health advocate, the US presents an exciting challenge.

Did you know? Romesh shares a birthday with Allan Lamb and his childhood dream was to play cricket alongside him for Northamptonshire County. Romesh spent hundreds of hours in his Adelaide backyard crafting an imaginary batting partnership!

You can read Dentists in the US should be integrated into the hospital team on page 391.