By Dan Sindelar, DMD
Periodontal disease is now considered a complex oral and systemic disease that needs to be addressed by an integrative coordinated care team that includes both dental and medical professionals. Oral-systemic health (OSH) has become a movement.
The research is exploding. Just over the last year, research has found:
- It appears up to 50% of heart attacks are triggered by oral pathogens.
- Addressing visual and microbial periodontal disease slows if not reverses CIMT progression.
- Six oral spirochetes appear to be causal of Alzheimer's.
- P. gingivalis, an oral bacterium, raises risk for a heart attack by 13.6 times when present -- that's twice the risk of a heavy smoker!
- Periodontal disease is as big a risk as high blood pressure for strokes.
Over the last six years, a lot has changed:
- I cofounded the American Academy for Oral Systemic Health and was fortunate to be president for nearly two years. AAOSH has played a significant role in expanding the dialogue on oral-systemic health.
- I had the opportunity to be one of the first dentists to take a preceptorship in heart attack, stroke, and diabetes prevention.
- I have attended more preventive cardiology symposiums than family reunions (and I really do like my family!).
- I am blessed to now be the oral-systemic health director of a group of over 35,000 preventive, integrative medical professionals that are interested in oral-systemic health as a part of their care to improve patients' care outcomes. They are looking for you!
- Medical and dental schools are presenting oral biofilm and its impact on cardiovascular disease, Alzheimer's disease, diabetes, etc.
- I'm helping several medical schools plan departments of oral-systemic health.
- Large oral care companies are directing their future at oral-systemic health.
I'm not saying all of this to brag -- it's not about me! When it comes down to it, I'm still a dentist with a practice in St. Louis, Missouri. Yet this is a significant health-care movement, one that I've been privileged to be a part of since its inception. Oral-systemic health plays a key role in integrative health, and integrative health is the future of health care!
Thanks to my journey in the OSH movement, I have a unique perspective and insight into the direction of health care.
Dentistry has experienced the greatest era in its history over the last 30 years. Huge increases in awareness and demand for both restorative and esthetic dentistry have given us huge success. And while we will continue all of the above, we are now faced with stumbling blocks: rising practice expenses, "boomers without benefits," and a population with dental cost fatigue. These are paradigm shifts for our practices. If you are not changing, you are dying!
At the same time we face these problems, research resulting from the advancements of the Genome Project are showing us the importance of oral care and its impact on systemic health problems. Integrative health professionals understand the importance of oral health, but they can't do it without your help.
Health care is moving from volume-based to value-based. Physicians know it, and they know oral inflammation impacts their care and their patient outcomes. While everyone is complaining about the Affordable Care Act and its payment systems, the greatest opportunity for improved outcomes and lower health-care costs is at our doorstep.
Research released this year by United Concordia Wellness found significant reductions in health-care costs and number of in-patient hospital admissions for patients with type 2 diabetes, cerebral vascular disease, coronary artery disease, and pregnancy. Health-care costs were reduced by more than 40% for patients with diabetes and cerebral vascular disease (a savings of $2,840 and $5,681 respectively), while costs for coronary artery disease were reduced by 10% (down $1,090). Meanwhile, medical costs in pregnant women were reduced by over 70% for a savings of $2,433.
It's these health-care cost savings that demand the coordinated care of integrative medical and dental professionals. Oral biofilm is a dental disease, but it has significant triggers from the host. It's also a behavioral disease with huge impacts from home care. Integrative health professionals understand the importance of oral health, but they can't do it without your help.
The definition of periodontal disease in the medical community is currently a hot topic. Historically, it has been viewed as a visual disease. But it's quickly becoming evident that the destructive forces of periodontal disease (oral biofilm) are the destructive forces of systemic diseases such as cardiovascular disease, stroke, diabetes, rheumatoid arthritis, Alzheimer's disease, etc.
Make sure you check out AlzheimersOralCare.com to learn more. There is new research on oral biofilm and Alzheimer's disease that will astonish you!
So now, I want you to think about this:
- A drop of saliva the size of a nickel has more bacteria (over 8 billion) than there are people on this planet!
- Over 500 good bacteria have been identified.
- Yet there are 8-12 known types of bad bacteria which are the destructive forces of periodontal disease and systemic inflammatory disease.
And the following triggers all impact oral biofilm:
- Stress -- Cortisol is released in the mouth and has a huge impact on the smallest amounts of bad bacteria, often with no visual signs of periodontal disease
- Sleep and airway -- Impact biofilm
- Nutrition and nutritionals -- Berberine is able to lower the systemic inflammatory impact of P. gingivalis
- Diabesity -- Huge impact on biofilm due to cardiometabolic disruption
But while all this research is going on behind the scenes, there are simple systems that can be implemented right now. I know; we do it daily in my practice, and we educate dentists on how to have your team easily incorporate this into your practice. It is time for dental professionals to address pathogens in their periodontal care. It's easy, it improves dental outcomes, and it reduces risk for disease.
The bad bacteria associated with both periodontal disease and systemic disease -- Treponema denticola, Porphyromonas gingivalis, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, and Tannerella forsythia -- can be tested for in any dental office with salivary diagnostics. A surprisingly large portion of our population is above threshold for these bacteria. When you see how many people are above threshold, it becomes apparent how big an impact this can have on health.40% of those under 30 years old are above threshold
- 61% between 30-40 years are above threshold
- 70% between 40-50 years are above threshold
- 77% between 50-60 years are above threshold
- 83% over 80 years old are above threshold
- Cortisol and stress play a key role
I'm asked all the time, "What should I do to integrate oral-systemic health into my practice?" Here's my advice:
Get up to speed on oral-systemic health. Unless you graduated less than five years ago, it wasn't part of your dental education. Educate yourself and your team so you can enjoy the satisfaction of providing excellent dental care that will have a huge impact on your patients' lives. With a web-based educational video series, you and your team can get up to speed on both science and implementation without ever leaving your office.
Address pathogens in all of your care. Treponemes can make up 50% of the bacterial load of periodontal disease. When you go after them, you reduce periodontal disease and you'll probably reduce risk for many diseases.
Form a coordinated-care team with physicians in your area. I've done it. It's easier than you think, and I'm here to help. I now work with a group that is involved with 35,000 integrative health partners that are on their way to understanding the importance of dental care in their medical outcomes.
Raise awareness. Patients rrely fix problems they don't know exist. My team and I have put together informational tools such as posters, infographics, and chair-side visuals that aid in starting the conversation on this subject.
Visit OSHNewsNetwork.com regularly. I can't tell you how often I'm asked, "Where can I find the research for myself, my team, and my patients to understand how important this is?" The OSH News Network provides updates on the latest oral-systemic health research. Subjects include Alzheimer's disease, heart disease, stroke, diabetes, and preterm births.
Is the cure for all disease in your dental chair? Probably not. Inflammatory diseases are multi-faceted and extremely complex. But you have the opportunity--and probably the obligation--to start reducing risk for most inflammatory diseases now.
If you are ready to start taking the easy steps to incorporating advanced care into your practice, go to OralSystemicSuccess.com. We have specific protocols to help your team start providing Advanced Integrative Oral Care.
Finally, I would personally like to invite you to attend the American Academy for Oral Systemic Health's 4th Annual Scientific Session, which will be held here in my hometown of St. Louis, Missouri, September 26-28, 2014. Visit aaosh.org to register.
Years ago, I dreamt of a time when physicians and dentists would coordinate their care. That time is now.
Dan Sindelar, DMD, is a practicing dentist, cofounder and recent president of the American Academy for Oral Systemic Health, Director of Oral Genomics, and Editor-in-Chief of the OSH News Network. He has a preceptorship in heart attack and stroke prevention. Dr. Sindelar's passion is to help dentists successfully incorporate advanced care into their practices. He lectures internationally on oral-systemic health and helps medical and dental schools incorporate it into their curricula.
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