by Richard H. Nagelberg, DDS
Research developments over the past two decades have led to the conclusion that what happens in the mouth affects the body as a whole. That is not in dispute. This realization has taken us from repairers of teeth and gum scrapers for its own sake, to safeguarding and improving people's health and quality of life.
The primary beneficiaries of the knowledge we now possess regarding the connections between the mouth and body are obviously our patients and the public as a whole. The larger question perhaps is specifically who are the people who obtain the benefit of this knowledge? An even better question would be, on whom are these benefits conferred, and who decides?
It is still the case in 2013 that only about 20% of general dentists perio probe their patients on a regular basis. It is also still the case that 47.2% of adults between the ages of 30 and 70 have some degree of periodontitis, but only 5% to 6% of insurance submissions are for periodontal services. With these statistics in mind, it means that 80% to 90% of the patients in the United States are not having their periodontal disease diagnosed. Even if the number is off by half, that would still mean an unacceptable number of patients has undiagnosed, unaddressed gum disease.
The need for early diagnosis and intervention cannot be overstated. An accurate parallel would be the physician's office that does not check blood pressures for their patients. Knowledge of the complications associated with hypertension would be worthless for these patients since their disease is ignored. The continuous, ongoing accumulation of knowledge has driven us beyond the oral cavity. Failing to stay abreast of this knowledge, failing to incorporate it into our treatment considerations primarily affects our patients, negatively by omission. So, what do we do about it?
The manner in which we approach essentially everything in our professional lives is largely determined by attitude. Early diagnosis of periodontal disease and proper intervention is not a complicated process. There isn't a long learning curve, no additional training, no expensive equipment to buy, and no certification to obtain. It is all about attitude. It is merely deciding and acting -- that's all. There are innumerable reasons why we should do so for every patient, but they all are tangential to the central reason: our patients deserve to be diagnosed, and they trust that we are doing so. The letters after our names come with many, many benefits and some responsibilities, none more important than the simple act of examining and diagnosing disease.
Changing the numbers cited above involves nothing more than moving from the 80% column to the 20%. It will likely be the easiest and most impactful decision you could make in your entire career, and it can be done today. A committee is not needed to make the decision. It is as simple as making up your mind and doing it, without delay. Someone within each practice needs to take the bull by the horns and make it happen. There are probably lots of reasons why four out of five clinicians are not diagnosing periodontal disease, and they are not really important. What is important is to move forward by taking the simple action of picking up a probe and recording what you find, and then doing something about it.
The answers to the questions posed earlier are self-evident. The patients whose periodontal disease is diagnosed and managed conscientiously are the ones who will enjoy the benefits of the oral-systemic knowledge. The specific beneficiaries are patients in those practices that recognize and carry out their responsibility to examine and diagnose periodontal disease. Every clinician makes the decision for our patients about what we do, or fail to do, for them, every time they are guests in our offices. We are deciding who benefits from the ever-expanding information.
Why should we be diagnosing and treating our patients as early as possible? The reasons go beyond "because it is the right thing to do." The beneficiaries are not just our patients. We benefit as well. We will gain great personal and professional satisfaction from using the skills and knowledge we possess to improve the lives of those who trust us with their health.
Richard Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations, and he lectures on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity. Contact him at [email protected].
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