Five frogs

Nov. 25, 2013
The connection between the mouth and the body is a part of the fabric of health care at this point in time, and many forward-looking practices have modified the manner in which they address disease ...

By Richard H. Nagelberg, DDS

The connection between the mouth and the body is a part of the fabric of health care at this point in time, and many forward-looking practices have modified the manner in which they address disease, dental practices included. That's right, medical practices across the country are incorporating salivary diagnostic technology and the oral-systemic links into their patient care protocols. The author recently received an email from a physician in California. Dr. Marcy Zwelling has been using bacterial DNA testing for her patients with elevated Plac-2 levels of unknown etiology. She indicated amazing success in those patients who prove to have gum disease and who undergo intense periodontal therapy. In some cases, the Plac-2 levels have been cut in half.

This is a very revealing situation. MDs are acting on the available research and using the available dental technology, rather than debating, delaying, and procrastinating, all for the benefit of their patients. It is important to understand that elevated Plac-2 levels are multifactorial and must be handled by a physician. It would be unethical for dental professionals to address high Plac-2 levels without a physician acting as the primary provider. The danger is thinking that all cases of elevated Plac-2 can be addressed with periodontal therapy, and this is simply not the case.

Nevertheless, while much of the dental profession is fiddling, our patients' arteries are burning. The process starts with identifying periodontal disease, which does not happen consistently. It is beyond necessary to have every patient's periodontal health evaluated for reasons beyond the oral cavity. The other interesting part of physicians' implementation of the oral-systemic research and technology is that it is done with no fanfare. Outstanding doctors are caring for their patients in an extraordinary manner. The patients, who are being cared for by physicians such as this, are very fortunate indeed.

The health that we each enjoy is clearly impacted by the care we receive, and unfortunately, it is not uniform. Plac-2 is measuring the activity of atherosclerosis in arterial walls. Patients with elevated Plac-2 levels have an elevated risk for cardiovascular events associated with atherosclerosis. Dr. Zwelling's patients are having their risk factors managed before a crisis develops. Patients who have a doctor who is unaware of the Plac-2 test may sometimes have their event managed successfully, but sometimes they may not. It is not melodramatic to state that lives are saved when physicians practice in a leading-edge manner. You have to admire those providers who identify valuable information, tests, technology, etc.; who are not distracted by debate, fads, naysayers, or agenda-driven individuals; who are dedicated to delivering the best possible care to their patients; and then they act. That is the key -- acting on the advances and then bringing them to their patients.

Dentistry has historically been slow to change. We are bombarded by research, advertisements, manufacturer product claims, blogs, webinars, etc. It is not difficult to understand reluctance to try every new thing that comes around the corner, many of which are having the clinical research essentially carried out on our patients. This, however, is different. This is about acting in the oral cavity and affecting the whole body. Procrastinating, ignoring, and failing to act isn't acceptable. It is always first and foremost about our patients. The vast majority of patients expect that we are keeping up and providing the best available care. Our patients do not know what CE courses we take, what journals we read, which colleagues we interact with. They trust us, which is an enormous responsibility. Similarly, the vast majority of doctors have their patients' health in mind. Unfortunately it is not enough.

The story of the five frogs is appropriate to illuminate this concept. Five frogs are sitting on a log. Just sitting there, not doing anything in particular, minding their own business, enjoying the day. Two of them decide to jump off, leaving three on the log. Well, actually, it does not leave three on the log. There are still five sitting there, because two decided to jump off, and while deciding is important, it accomplishes nothing. The only thing that matters is what we do. Deciding does nothing for our patients. The information is out there, so jump off the log!

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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