An oral-systemic dental practice

April 1, 2013
The dental profession, and by extension most dental practices, is currently going through a significant period of change.

by Richard H. Nagelberg, DDS

The dental profession, and by extension most dental practices, is currently going through a significant period of change. Knowledge is advancing at a rapid pace, technology is finally keeping pace in dentistry, and the Internet is now an integral part of the profession. Practices that have harnessed the potential of the Internet are thriving. Just when we thought we were keeping up by having a website for our practices, we now have to master social media to attract new patients and keep existing ones in the fold.

How about the dental services we provide? Change is the only constant. Gone are the days of endodontic instrumentation with hand files, amalgam restorations, cast-metal partial dentures, and film radiography. Dental practices are now dominated by digital radiography, all-on-four full-arch restorations, tooth-colored composite, ceramic and hybrid restorations, rotary and reciprocal endodontic instrumentation. Services such as cast-metal partial dentures, amalgams, etc., will never go away fully. They will go the way of Kodak, The New York Times, Barnes & Noble, and J.C. Penney. They will survive, but never dominate the field again at the level they once enjoyed. They all failed to adapt and had their heads down while the world sped by. Practices that fail to expand their services and keep pace with the changes all around them will also fail to thrive.

In a similar manner, an oral-systemic dental practice has gone beyond providing periodontal therapy for every patient with any level of periodontal disease, every time a patient presents to the office. That will never go away, but more is now required. Keeping the knowledge in the forefront of our minds that periodontal disease is a vascular disease will help us focus on how we are impacting our patients' health beyond the oral cavity. Salivary diagnostics is here to stay, providing perhaps the most impactful information for us as we treatment plan periodontal disease cases. Gone are the days of guessing at the specific pathogens that cause a patient's periodontal disease, and hoping that we choose the right antibiotic without any data pointing us to the right adjunctive antimicrobials. Gone are the days of not knowing a patient's genetic predisposition to periodontal disease. Failing to use available technology, such as salivary diagnostics, means it essentially doesn't exist for patients in those practices.

Research has indicated that the mouth is connected to the body by two basic mechanisms. The oral contribution to the total inflammatory burden is one. The other is the direct effect of periodontal pathogens, independent of periodontal disease. For example, research findings published in the journal Molecular Microbiology in November 2011 by Fardini et al concluded that the periodontal pathogen Fusobacterium nucleatum increases endothelial permeability, allowing the bacteria and anything smaller to invade arterial walls, where they can wreak havoc. Similar research has demonstrated the direct effect of other periodontal pathogens such as P. gingivalis on atherogenesis. Bacterial DNA testing will tell us if a patient harbors these bugs. Without testing, we have no idea. Wouldn't that be similar to a physician failing to order blood tests, monitor diabetes, or identify the reasons for hypertension and just guess that the right medications were prescribed?

By keeping up with dental and medical research, we will have the knowledge to advise our dental patients to request testing for the levels of PLAC-2, MPO, and MACR, among others, if they are not included in the blood panel ordered by their physicians.

Gone are the days of one-size-fits-all periodontal protocols. We have the ability to provide individual treatment for each patient, taking into account their individual biology, family histories, and risk elements. We have more tools than ever before. Gone are the days of having nothing other than scalers and home-care instructions. We now have host modulatory medications such as Periostat®, true oral probiotics such as EvoraPro®, antioxidant agents such as AOProvantage®, and phenomenal power brushes and flossers such as Sonicare® and AirFloss®. Failing to incorporate them or your favorite power biofilm control devices into your practice means they essentially do not exist for patients who may benefit from them.

Now is the time we can make a difference in our patients' overall health, not just their oral health.

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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