Why I Think Dentistry and Medicine Can Do Better...
Reactive v. Proactive: Getting Ahead of Disease
Early in my dental career, I heard a quote during a lecture that has stuck with me since:
Despite all of our advances in medical knowledge and treatment technology, we still operate in a reactionary model of dentistry and medicine. Today's dentist and dental hygienists are exceptionally well-trained to treat the manifestations of oral disease. I am thankful that we have high quality, evidence-based treatments that help restore our patients back to proper function.
But with all of this knowledge and technology, can't we take things one step further? Why don't we double down our efforts on promoting health and preventing sickness, rather than simply serving as the fire department once disease has taken root?
That was the focus of the Preventive Intensive Wellness Weekend, an immersive course that I participated in this past weekend. Co-hosted by one of my mentors, Dr. Tom Larkin, this event brought together physicians and dentists who want to move beyond treating the harmful effects of disease and toward preventive practices that help our patients develop healthy habits to avoid these diseases outright.
I won't dive too deeply into the science behind periodontal pathogens, oral bacteria loads, disinfection protocols and the mouth-body connection. Here is a simple summary of the findings from the weekend.
The health of the mouth and the health of the body are inseparably linked.
The majority of oral disease (tooth decay, abscesses, gum disease) is caused by bacteria, which form areas of infection in the mouth.
A person's risk for infection can now be quantified through simple, in-office testing, and personalized anti-infective treatment regimens can be created and implemented.
Oral infections have effects on total-body health, and are directly implicated in chronic diseases like cardiovascular disease, heart attacks, stroke, diabetes, Alzheimer's disease, as well as other inflammatory diseases like rheumatoid arthritis.
"Getting your teeth cleaned" is not enough
I've written about this before, but it's high time that we stop talking about the mouth in such simple terms as "cleaning teeth" and "filling cavities." As providers, it is our duty to identify and treat the bacterial infections and areas of inflammation within the mouth before they lead to catastrophic results. The area where we can most improve is during the appointment that dental patients are most familiar with: the dental cleaning.
Every dentist and hygienist is trained to remove plaque and tartar (also called calculus) from the mouth during a standard dental cleaning. We've long known that what we call "plaque" is actually a biofilm made up of accumulated bacteria and debris. When you read "bacteria," it's important to note that not all bacteria in the mouth are harmful. But when you're "cleaning" teeth, how do you know if the plaque you're removing is simple, non-harmful debris or loaded with pathogenic bacteria that can cause tooth decay or gum disease? It used to require lab tests costing hundreds of dollars. Now, we can tell using a 25-cent slide and a microscope.
Taking a tiny sample of buildup from the tooth and placing it under a microscope allows us to quickly screen for the types of bacteria living in the mouth. If the bacteria we see are simple, non-aggressive bacteria, fantastic! Simple, preventive measures can be taken to make sure that the mouth and body stay healthy. If the slide shows a more aggressive type of bacteria, we know that we have to be proactive to keep these bacteria from causing symptoms further down the road.
The treatments are simple and based on each individual's risk. We're not talking surgery or extreme expense here. Rather than simply sending you out the door with a toothbrush, floss, and a "good luck!" we can treat the infection with anti-infective rinses and products during a standard "cleaning" procedure. What's more, we can send patients home with a specific anti-infection home care program. And the best part about this? It's cheaper than waiting for a problem to show up. Would you rather spend $20-30 for a disinfection treatment with no injections or needles, or $200 to fill a cavity (or more for crowns, root canals, implants to replace lost teeth etc.) caused by bacteria that could have easily been eliminated? I know which option I would choose!
What you put in is what you get out
Another topic that deserves much, much more discussion that what I'll provide here is the food that we put into our bodies. Just as our diet impacts our body weight, physical fitness, energy levels and mental capacity, our diet just might be the biggest factor in determining the health of our mouth.
I am no nutritionist, nor am I qualified to formulate a diet program for every one of my patients. However, I can clearly see the difference in the health of a mouth that has been fed high quality, real foods and a mouth that lives on sugary drinks and processed foods. As I've mentioned many times before, those low-quality foods are like rocket fuel for pathogenic (harmful) bacteria in the mouth. Looking beyond the mouth, a highly processed, carbohydrate-heavy diet can dramatically increase the amount of inflammation in the body, leading to diseases like type 2 diabetes, cardiovascular disease and stroke, erectile dysfunction, only to name a few.
I think it's no coincidence that the foods that promote a healthy body also serve to protect the mouth. Diet discussions get complicated quickly, and there is not always agreement upon the best practices among the so-called "experts." I suspect that there is no "magic diet" that works for every individual. There are too many genetic and hormonal factors at play. However, we will continue to research the most up-to-date studies on what foods are most beneficial for humans, and we will recommend these diets to our patients and provide resources to help families make simple changes toward healthier living.
This all sounds great, right? Being proactive, stopping infections before symptoms show up - all of these are lofty goals. How do we make it a reality? I am committing to make simple steps over the coming months to our practice's operations so that we can better serve our patients. Here are some of the things to expect if you come into our office.
- Risk Assessment: We will implement simple steps to provide each patient an assessment of their risk profile for tooth decay, gum disease and airway problems like sleep apnea, for which we can screen in a matter of minutes.
- Personalized Treatment Recommendations: Based on risk assessments and screening tests (like the use of the microscope), patients will receive treatment recommendations based on their specific risk profiles. Remember, these are not expensive treatments, but they are tailored to the individual needs of the patient.
- Detailed Home Care Regimens: On average, most people see the dentist once every six months. What about those other 363 days of the year? Rather than trying to treat these issues with old methods (just brush and floss), we will give specific recommendations on hygiene techniques, home care products, and diet modifications to prevent disease and promote health.
- Increased Preventive Treatments: I myself have looked at a tooth in a mouth before and said, "I see the first sign of decay, but it's not deep enough to need a filling yet. Try to keep it clean and let's keep an eye on it." To quote a presenter, that would be like your doctor saying "I see some Stage 1 cancer developing here. It's not bad enough to need chemotherapy or surgery yet, so let's check it in a few months and see what happens." We can do better, and we will do better in our practice. We now have the means to treat early disease with minimally-invasive techniques.
The future is exciting, and we are looking forward to continually improving the care we offer for patients here at Campbellsville Dental Care. We will continue to seek out the best ways to prevent disease and promote health, both for the mouth and the entire body.