New directions

Aug. 1, 2010
This article was prompted by a conversation I had with the head of a state dental association a few weeks ago.

Louis Malcmacher, DDS, MAGD

For more on this topic, go to and search using the following key words: new directions in dentistry, nutrition, soft tissue, sleep apnea, Dr. Louis Malcmacher.

This article was prompted by a conversation I had with the head of a state dental association a few weeks ago. State dental associations and state dental boards are being forced to look at dentistry in a totally new light because, as a dental profession, we are finally realizing that what we do in the mouth has far-reaching effects in systemic and oral health and overall facial esthetics.

Let's take a look at some of the new directions of dentistry:

1 Nutrition – There is no question that dentists are frontline health-care professionals much like general physicians, and we interact with patients in a very personal way. With periodontal disease still being so prevalent, it may behoove us as dental professionals to take a new look at nutrition recommendations for our patients. There are nutritional systems now specifically available for dental offices. Certainly this requires some training, or at least interaction with dieticians and patients' physicians.

2 The oral-systemic health link – There is a tremendous amount of lip service given to the fact that the mouth is the gateway to the rest of the body and is a reflection of what's going on with the patient's systemic health. While just about all dentists agree this is important, very few dentists are truly involved in this oral-systemic link beyond a regular prophylaxis, some periodontal treatment, and eliminating infections to make the oral environment healthy. Some dental practitioners have taken this up a notch and provide screening of systemic diseases with DNA testing, take blood samples from the patient for testing, and use other commercial devices to prescreen patients. This directly ties in with nutrition, and specific recommendations can be made to patients about their nutritional needs. There have even been reports of dentists who literally saved lives based on this early testing.

3 Soft tissue facial esthetics – Botox and dermal fillers in dentistry is one of the fastest growing aspects of many dental practices. Estimates are that up to 16% of dentists perform these procedures. This would seem to be a natural addition to every dental practice, and is certainly substantiated by the dentists who are already providing these treatments. Botox and dermal fillers are simply soft tissue esthetic enhancement procedures that are done to complete and enhance the teeth esthetics by developing esthetic smile and lip lines. With proper training, dentists have the basic skill set to provide these services successfully.

4 Sleep apnea – Sleep apnea is an interesting area for dentists. Oral devices for sleep apnea have been available in dentistry for a long time. But certainly there are dental practitioners who really raise the bar in this area by being involved with sleep studies and investing in sophisticated equipment to measure and treat sleep apnea. The equipment investment and the need for a physician's guidance have held back many dentists from this field, but it certainly has attracted the attention of some dental practitioners.

A number of years ago, the concepts of conscious sedation dentistry and neuromuscular dentistry were new and almost outlandish concepts that many dentists rallied against. For whatever reason, they thought that conscious sedation and neuromuscular concepts were more medical treatments, and dentists were "trying to be physicians." Today, these two areas are very well established and are part of our everyday lexicon.

Certainly, any of the topics discussed or anything new in dentistry requires intensive training before a dentist can get involved in any new concepts. Let me say this as firmly as possible – I find it abhorrent when dentists think they can take an online course or a half-day lecture in some new concept, where the bulk of the course discusses how to make more money without offering any real benefits to the patient.

Dentistry is expanding rapidly into areas that can truly complement our practices. If any of the above concepts appeal to you, get some good solid training and add them to your practice. New concepts such as the ones described here will be a part of many dental practices for years to come.

Dr. Louis Malcmacher is a practicing general dentist and internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for CLINICIANS REPORT, Dr. Malcmacher is the president of the American Academy of Facial Esthetics at Contact him at (440) 892-1810 or e-mail [email protected]. His Web site is, where you can sign up for a free monthly e-newsletter.

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