Begin with the end in mind

Decide what it is you want to accomplish before beginning. For dental professionals it may sound so obvious that little reflection is required on what we want to accomplish.

by Richard H. Nagelberg, DDS

Decide what it is you want to accomplish before beginning. For dental professionals it may sound so obvious that little reflection is required on what we want to accomplish. We want to provide the best care we can for our patients. But what does that mean exactly? How do you define it? Is it static or dynamic? Is there a metric for measuring how close we are to our goals for our patients? Do all dental professionals have the same objectives for patient care? Do we think of ourselves or the patient's needs when treatment planning? Is the best care we can provide the same treatment for every patient? Will the technology we are buying help us reach our patient care goals? Are we saddled with so much debt that we cannot focus on what is best for our patients? Is the information you learned in dental school still relevant? Are we keeping up with advances in research?

Clinicians' responsibilities include identifying and controlling disease and restoring function and appearance -- in that order. Our efforts in the mouth are felt beyond the oral cavity. Virtually every interaction we have with a patient affects the rest of the body. Thorough, efficacious home-care instructions are vital for biofilm control, which is vital for vascular health. Diagnosis of periodontal disease and providing treatment until all areas have healed are vital to restoring health in and beyond the oral cavity.

Are we thinking of the patient's family history when we provide care? For patients with a genetic predisposition to cardiovascular disease or diabetes, dental professionals are in a uniquely influential position. It is not adequate to merely state that oral health impacts general health. Specific strategies to manage oral disease until complete resolution is achieved must be developed. Educating the patient about the noncurable nature of periodontal disease and the critical need for thorough, effective home care and frequent professional maintenance is vital to reducing a significant risk element for systemic disease. Cosmetic dentistry is challenging, fun, and lucrative, and of little or no importance for a patient with diseased gums, a family history of vascular disease, heart attack, stroke, or diabetes. Are we demonstrating our ability to provide beautiful restorations without adequate consideration for identification and treatment of disease? Are Botox injections for a patient with hypertension, uncontrolled diabetes, or intestinal polyps appropriate?

The saying An ounce of prevention is worth a pound of cure has never been truer than it is now. We may phrase it less eloquently and less succinctly as identifying the risk elements for disease and managing them prior to the development of an event such as periodontal disease or a heart attack, but the meaning is the same. Restoring a patient's mouth to pristine gingival health constitutes vascular disease prevention. Restoring a patient's mouth to pristine gingival health contributes to improved glycemic control for a diabetic individual and constitutes prevention for a prediabetic individual. Failure to diagnose and treat periodontal disease constitutes systemic supervised neglect.

Educating our patients about the overarching need to control biofilm every day and giving them the tools to do so constitutes vascular disease prevention, because oral bacteria have been identified as etiological agents of vascular disease. Educating the patient about the need for outstanding home care is vital to maintenance of health in and beyond the oral cavity. The effect of periodontal disease and perio pathogens on vascular health is comparable to the effects of cigarette smoking on vascular health. Physicians would salivate at the prospect of controlling smoking as predictably as dental professionals can control periodontal disease and reduce the population of pathogenic bacteria. We just have to do it.

It all starts with the end in mind. We have to decide what type of practitioner we want to be. Every decision that affects the manner in which we deliver care must start with the end result in mind: will this improve the care I provide for my patients? Providing the best care we can for every patient necessitates providing individualized care rather than a one-size-fits-all approach to patient care.

Dentistry and medicine are not interconnected. They are one and the same.

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

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