Oral-systemic questions

July 1, 2012
There is a mountain of evidence supporting the existence of associations between the mouth and the body.

By Richard H. Nagelberg, DDS

There is a mountain of evidence supporting the existence of associations between the mouth and the body. Some links are now established and accepted as facts by the dental and medical professions, while others are awaiting further research to achieve the same bulletproof status, one way or another.

How do we transfer the conclusions we have drawn as clinicians to our patients? How do we make sure our patients benefit from our knowledge? How would we proceed if it were our husband, wife, son, daughter, mother, father, grandparent, or other loved one in the dental chair?

Would we use all the tools in our toolbox and all the knowledge we possess to help them maintain health? Do we do that for every patient? Are we acting in an ethical manner if we ignore the impact of oral health on general health? Are we acting in an ethical manner if we promise patients they won’t have a heart attack if we help them achieve periodontal health?

Do we recognize our responsibility to stay current with scientific research? Do we avail ourselves of diagnostic and treatment advances? Are we among the clinicians who probe, or do we treatment plan veneers on bleeding gums? Do we fool ourselves into thinking that it doesn’t matter if we don’t know the bacteria we’re trying to control, and that guessing is good enough?

Do we examine risk factors and family histories and factor them into our treatment decisions? Are we treating disease or pocket numbers? Are we addressing our periodontal patients in a one-size-fits-all manner, or are we giving each patient their best chance for health? Do we ask our diabetic patients about their HbA1c levels? Do we ask how often they are tested? Do we understand what the numbers mean and the implications for our patients’ oral and general health? Do we understand the impact of periodontal disease on insulin resistance, glycemic control, and diabetic complications? Are we aware of the impact of periodontal pathogens on cardiovascular health, independent of periodontal disease status? Do we advise our periodontal patients who have a family history of cardiovascular disease to make their physicians aware of their oral disease?

Do we know what the abbreviations Pg., Aa., Td., and Tf. stand for? Do we make our patients aware of the oral contribution to the total inflammatory burden and how it affects their overall health? Do we talk about gingivitis with just a passive recommendation to floss more? Do we appreciate the effect of failing to address gingivitis adequately? Do we make our patients aware of this and give them the tools they need to achieve adequate biofilm control? Are we recommending whole-mouth disinfection rather than just brushing, flossing, and rinsing?

Do we know that the teeth represent only about 22% of the total surface area in the mouth? Have we carefully considered incorporating oral probiotics into our preventive and treatment regimens? Do we recommend sipping water or sucking on ice chips for xerostomia? Does that work for any of our patients?

Are we aware of research findings on the effect of antioxidants on xerostomia? Do we understand the interconnections between periodontal disease, atherosclerosis, diabetes, and cardiovascular disease? Are we aware of the single most important risk factor for periodontal disease, above all others? Are we aware of the primary biological and behavioral risk elements associated with periodontal disease?

Do we understand that a periodontal evaluation tells us nothing about the future disease course; that it merely represents the history of the disease process; that it is just a damage report; and that it tells us nothing about the causality?

Do we recognize that periodontal disease is a chronic, noncurable bacterial infection? Do we understand the difference between infection and inflammation? Do we appreciate that failing to prevent the progression of gingivitis to periodontitis condemns the patient to a lifetime of disease management? Do we test our perio patients for genetic susceptibility to periodontal disease when appropriate? Do we know when that is?

Have we made a serious effort to be excellent, well-informed providers? If we had periodontal disease, would we go to ourselves to have it managed? Are we the best we can be? It’s all about commitment to our patients, our profession, and ourselves. That’s all it takes!

RICHARD NAGELBERG, DDS, has practiced general dentistry in suburban Philadelphia for more than 29 years. He is a speaker, advisory board member, consultant, key opinion leader for several dental companies and organizations, and lecturer 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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