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Building professional referral relationships with physicians

Dec. 1, 2006
Dentistry is no longer just about teeth, jaw joints, tartar, and pretty smiles. The finding that periodontal disease creates systemic inflammation promises to redefine dentistry as we know it.

by G. Lee Ostler, DDS

Dentistry is no longer just about teeth, jaw joints, tartar, and pretty smiles. The finding that periodontal disease creates systemic inflammation promises to redefine dentistry as we know it. This means that periodontal disease is now being defined as a medical problem.

In a modern age beset with major life-threatening medical problems, which affect three out of four lives and cost an untold amount of money, dentistry suddenly occupies a key role in the general health and well-being of the population. Astute dentists will quickly discover this untapped market and unprecedented opportunity.

Every week yields more studies that show the harmful effect inflammation has on the body. In fact, chronic inflammation may be the engine that drives many of today’s most feared diseases. This proposition has physicians and researchers of all specialties suddenly talking to each other. They have discovered that they are looking at the same thing. The entire arena of inflammation research is ready to explode. Dentistry finds itself as one of the key players in this explosion.

Inflammation is one of the body’s frontline defense mechanisms. It is a lifesaving biochemical process that enables the body to defend itself against bacteria, viruses, parasites, and injury.

In the case of a bacterial invasion, white blood cells gather in the endangered tissue where they secrete chemicals (inflammatory proteins called cytokines) intended to limit potential infection by amplifying inflammatory activities. These signaling proteins help coordinate the defensive activities of the local immune system’s activities.

But this inflammation also has a dark side. When inflammation persists beyond its immediate usefulness, it can significantly elevate the risk for such maladies as heart attack, stroke, diabetes, pregnancy complications, cancer, and Alzheimer’s disease.

As periodontal disease breaks down inflamed gingival tissues, it stimulates the release of inflammatory proteins (cytokines and chemokines), along with C-reactive protein from the liver. Thus, physicians and dentists can identify any inflammatory response by measuring levels of these protein markers, the presence of which documents that something is going awry in the body.

Remarkably, recent research has shown that elevations in CRP are a significant risk factor for heart disease, and are a stronger predictor for future coronary events than are elevated lipid levels. As such, periodontal disease in its own right is an important and independent risk factor for cardiovascular disease. Perio is also a profoundly important risk factor for preterm, low birth-weight babies due to the oxytocic effects of PGE2 and other cytokines. Removing or controlling chronic oral infections in pregnant women has shown to remarkably decrease the incidence of pregnancy complications, which is estimated to occur with one in eight births.

Despite being discounted for decades, research indicates an oral-systemic connection. This new science will forever impact the role of dentistry in the lives of patients and the world of medicine. With its connection comes a heightened responsibility for physicians to identify at-risk patients and refer them to dentists. Conversely, dentists need to become a knowledgeable and valued part of the health-care team.

The medical-legal standards of care are starting to shift to include careful multidisciplinary management of compromising health conditions. Among these conditions are diabetes, heart disease, and pregnancy. As this standard of care shifts to embrace oral health status, physicians and dentists are recommending - if not insisting - that patients deal with chronic oral infections.

Indeed, malpractice attorneys and insurance risk-managers are focusing on this growing problem. Some attorneys are “trolling” for patients who have survived a heart attack or stroke, and whose physicians did not investigate their oral health status. As these cases wind their way through the courts and regulatory boards, and once settlements and/or case law is established, this pendulum quickly should swing in dentistry’s direction and result in multitudes of prospective and at-risk patients seeking direction from dentists.

This new science brings with it an unprecedented opportunity for dentists to work closely with physicians in their communities to help them understand how and why they need to refer at-risk patients for periodontal and dental care. Those dentists who proactively position themselves and work with physicians to build professional referral relationships should benefit the most.

As demonstrated in the Physician Marketing Handbook, referral relationships are best secured through offering Personal Patient Reports to medical doctors. Specific outbound marketing efforts will be designed to educate physicians and demonstrate that a dentist can be a trusted and knowledgeable partner.

In addition to the standard perio evaluation, testing for CRP, HbA1c, PGE2, IL6, and lipid profiles is now becoming standard fare in dental offices that offer modern perio tissue therapy programs and refer periodontal patients to physicians for management of heart-disease risk factors. With every patient visit comes a natural opportunity for dentists to interact with their patient’s physician to report on periodontal and systemic inflammation status, whether good or bad. Every physician should know the periodontal status of his or her patients in regard to systemic inflammation, heart disease, and diabetes. But since most don’t know to ask for it, the onus falls on the shoulders of the dentist to provide this information in the form of a personalized report.

Here is the marketing and practice-growth gem inherent to this new paradigm shift. If the medical science on the oral-systemic connection is to be believed that gum disease is a systemic medical problem - and if medical insurance will now cover its treatment, and if malpractice attorneys and liability risk managers have their way - then physicians must begin to screen and refer at-risk patients to dentists for proper diagnosis and treatment for periodontal disease.

Along with the power of these physician referrals and the fact that Baby Boomers want to reduce risk factors, people presenting for care also bring with them a mouthful of problems that must be corrected to maintain health and dignity. This anticipated surge of referred patients presenting to dental offices, along with many self-referrals from media and advertising exposure, should create a welcomed - if not unprecedented - Renaissance in dentistry as hundreds of thousands of physicians begin actively referring patients to dentists for periodontal care.

Dentists who have developed hygiene departments capable of providing this expert care can significantly increase their profits, gain a source of new patients, and enjoy a new respect in their community. Providing physicians with a documented paper trail, then helping them render better health care to mutual patients, is a higher calling that has come full circle for dentistry. This could rival insurance and cosmetics in terms of its impact on dentistry’s fortunes and legacy.

Learning how to market to and get referrals from physicians will certainly become one of dentistry’s hot topics as practice management consultants race to implement proven strategies for working with physicians.

The oral-systemic connection promises to solve two of the biggest problems dentistry has faced through the years - new patient flow and profitability in hygiene departments. As dentists learn how to position themselves and to easily market to and interact with physicians - and as physicians sense the need to refer patients to dentists - the face and fortunes of dentistry will change forever. Perhaps dentistry will more fully take its rightful place in saving lives - one smile at a time!

Click here to enlarge image

G. Lee Ostler, DDS, practices general dentistry in Richland, Wash. A former instructor at the Las Vegas Institute, he owns a specialty marketing company, DREAMarketing. Dr. Ostler is the author of “The Physicians Marketing Handbook,” and has created the Physicians Referral and Education Program (PREP) Marketing System. For additional information about MDReferrals, visit or

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