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ORAL INFLAMMATION: THE TIPPING POINT OF HEALTH CARE B Y D A N I E L L . S I N D E L A R , D M D
’m going to let you in on a secret. We are entering the greatest era of opportunity dentistry has ever seen — the era of health and wellness. Don’t get me wron g. We still address pain, restorations, and esthetics. But as Bradley Bale, MD, o the Bale/Doneen Method, states, “Don’t “Don’t ever orget; dentists are saving lives every day.” How? By addressing oral infammation and overall health. By addressing these issues: 1. Our care is elevated 2. Patients’ lives improve drastically 3. Dentists succeed like never beore Te “tipping point” or health care and the dental proession is undeniable. Oral infammation causes and increases infammatory disease, such as heart attack, stroke, diabetes, rheumatoid arthritis, kidney disease, sleep apnea, Alzheimer’s disease, dementia, pneumonia, preterm births, and birth deects, just to name a ew. It doesn’t take “trench mouth” to initiate the infammatory response. When you compile the research by leading health-care institutions on oral infammation, dentistry’s role in overall health and disease prevention is remarkable. At the Second Annual AAOSH Scientic Session, the “rubber hit the road.” Some o the world’s leading health-care experts exper ts and institutional representatives presented just how important the infuence o oral infammation is on major diseases.
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“Periodontal disease is now considered a medical disease.” Dr. Marc Penn, MD, PhD, ormer director o Cardiac ICU at Cleveland Clinic. Fity percent o heart attacks and strokes occur in people with normal cholesterol levels. Inammation is the key contributor to heart disease and cardiac events. TIPPING POINT:
Dr. Yiping Han’s research shows that the traditional view o periodontal disease is insufcient to address the eects o the oral apparatus on overall health. Dr. Han’s research determined the cause o death o a etus was oral bacteria Fusobacterium nucleatum rom the mother’s mouth. Tough the mother lived a healthy liestyle and had no visual signs o periodontal disease, she had a microbial burden and tested as a hyper-responder to inammation. She lost her baby in the 36th week. Tis rarely happens. It’s not just what we see visually; it’s the bacteria present. “Periodontal disease is an inammatory disease caused by speci!c or groups o speci!c microorganisms.”— Clinical Periodontology , 9th Edition; Carranza 2002 I still practice what is considered traditional dentistry. Every week, we reduce pain in patients and restore their teeth. We restore their smiles. But I have added our health centers that launch dentists into the uture o health care. Tey include: • Oral Inammation Reduction Center • Sleep Center • Malocclusion Center • Wellness Center Te centers are organized, operational, and eective. Best o all, my patients love the act that we help them protect not only their teeth, but also their overall health. How many times have you thought that patients just want to get their sixmonth recall, reshen up, and leave? In the era o health and wellness, your o-
!ce is no longer just a cleaning station. It’s part o a heart attack, stroke, and diabetes prevention center. Dental proessionals have always been “prevention specialists,” with recall visits, prophies, radiographs, uoride treatments, sealants, and more. It’s time now or us to be “disease prevention specialists.”
Genetic diseases such as cystic brosis and neurobromatosis are present rom birth. Te key to reduction in disease involves genetic variations, which do not cause disease on their own. Tey inuence susceptibility and the clinical severity o our worst diseases. Genetic variations aect the inammatory path way and release cytokines — a key player in inammatory disease. TIPPING POINT: “Periodontitis is a complex genetic At a time when most o the country is disease.” (Yoshe, Kobyashim, ai, Galiburied in ear o the economy and rising cia; Perio 2000, Vol. 43, 2007, 102-132) health-care costs, dentistry is positioned to bene!t rom whatever health-care TIPPING POINT: agenda is ollowed. Oral bio!lm-associ- One out o three people are IL-1 positive. ated diseases are now the largest health- Tis means they are hyper-responders care cost o this nation. to all inammation — especially oral inammation — and have the same risk or Te act is that dentists today are ac- heart disease as smokers. Every patient ing serious problems: should now be tested or the genetic vari• At age 64, only 4% can retire comortably ation IL-1. It’s a simple 30-second rinse • Health care is being commoditized test that needs to be done only once. Pa• Insurance companies are reducing com- tients are either positive or negative. pensation by 20% to 30% • Cosmetic dentistry is down 30% to 50% TIPPING POINT: • Malpractice lawsuits occur because o We are nding that traditional periodonsupervised neglect tal therapy is not enough. Periodontal disease needs to be dened by patho You will either become obsolete, or gens. Bad bacteria enter our blood you will change and greet the greatest stream through periodontal pockets opportunity o your lietime and release toxins. Ater this, our bodies trigger an inammatory response to TIPPING POINT: both. Te only way to have success is to “Genetics are the uture o all health treat early and eectively, and to address care.” (Dean Ornish, MD) the microbial burden. Dentists have a unique role in testing “No clinical parameters are able to and treating genetics. Yes, I said dentists. predict the progression o periodontal disease; salivary diagnostics can” (Dr. Tomas Nabors, a leading authority in molecular analysis and genetic risk as AT A TIME WHEN sessment) MOST OF THE When we simply use traditional therCOUNTRY IS BURIED apy (SRP), oral bio!lm and microbial IN FEAR OF THE levels return to their pretreatment levels ECONOMY AND in just three to seven days. So traditional RISING HEALTH-CARE care is ineective. We need to treat with COSTS, DENTISTRY antimicrobial therapy. (Petersilka et al. IS POSITIONED TO Perio. 2000 Vol 28, 2002) BENEFIT FROM Tink o it this way. I one o your paWHATEVER HEALTHtients is IL-1 positive and has PG, that perCARE AGENDA IS son had better get his or her afairs in order, FOLLOWED. because that person will die prematurely. When Porphyromonas gingivalis is present, www.DENTALECONOMICS .com |
the risk for heart attack increases by 13.6 When the walls o coronary vessels get ing an eective strategy to reduce oral times — more than twice the risk of a heavy hot, we have a problem — heart attacks inection and infammation.” (Charles smoker. (Stein JM et al., Journal of Periodon- or strokes. Oral infammation has a di- Whitney, MD, VP o American Academy rect eect on vascular walls getting hot. o Private Physicians) tology ) Yes. Dentists are saving lives. An intensive antimicrobial approach Lp-PLA 2 tells us how hot the walls are Every dental proessional needs to be reduces systemic infammatory mark- becoming. Lp-PLA 2 levels are measured aware o the relationship between Lpers and systolic blood pressure, and with the PLAC-test, a revolutionary PLA 2 and oral health. improves lipid proles with subsequent blood panel being perormed by preven Also, by addressing oral infammation changes in cardiovascular risk. (D’Aiuto tive cardiologists across the country. and periodontal disease, we can lower et al, Amer Heart Jour nal , May 2006) Te only actor to increase Lp-PLA 2 is A1c levels more than medications can According to John ucker, DMD, we periodontal disease and oral infamma- in many diabetic patients. now have “dental solutions or medical tion. When you eliminate periodontal Dental professionals are being asked to: problems.” disease, you lower Lp-PLA 2. 1. Determine IL-1 I am involved in case studies across 2. Determine microbial burden TIPPING POINT: the country where dentists, in conjunc- 3. Coordinate risk Oral biolm is the largest cause o oral tion with physicians, are lowering Lpinfammation, and oral infammation is PLA 2 by addressing oral infammation. So how do we start? reatment is the the No. 1 source o infammation in hu- Tis helps get at-risk patients out o risky last step on the list. First, discover the mans. territory or cardiovascular disease. “why.” One o my avorite quotes is rom “Don’t ever orget to look at periodon“Lp-PLA 2 is requently associated Mark wain — “Te two most importal disease as an important source o with high levels o causative oral bac- tant days in our lives are the day we are infammation in reerence to cardiovas- teria. I’ve watched countless Lp-PLA 2 born and the day we discover WHY.” cular disease.” (Dr. Marc Penn, MD, PhD) levels plummet by simply implementTis is the “why” or dentists. Te pur-
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pose or dentists is to assist in patients’ overall health. - Get it into your DNA! We save lives every day. - Get your team on board, and team members will love their new purpose. Hire the inspired and inspire the hired. - Learn the basics o oral-systemic health. Tat’s why AAOSH was ounded. - Become a leader o dentistry. Tis is your opportunity. - Become known or health. - Start the conversation. Patients know more about their health than you realize. Don’t be discouraged if they’re not used to hearing it from you. Patients will look forward to your leadership in this area. - People love hearing about themselves; nothing is more personal than one’s health. - Everyone needs to hear something about fve times beore recognizing it. So start the conversation immediately.
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HERE ARE SOME KEYS TO THE CONVERSATION: • The conversation starts well beore patient s are in the chair. • My practice has produced a reception area video loop that is invaluable. It can be customized or any practice. • Oral-systemic health is newsworthy or your community. I have developed a system with the ounder o PRWeb or getting press releases out to the community. • My practice uses inographics, which helps patients understand our discussions easily. • When conf rming an appointment, conf rm just how important this visit is or the patient. • Make sure the importance o oral health and overall health is in your practice communications. • Make sure your website, social media, recall cards, appointment cards, and mailings reect oral-systemic health. • My practice uses MyDentalETC, a system to communicate oral health and its importance to overall health. • My practice has “health risk calculators” rom MyDentalETC on our website with links to videos and research. • My practice has a physician newsletter through MyDentalETC. • Use posters, brochures, and anything else that will help people understand just how important oral-systemic health is, and that you can be a solution to potential problems. • Make sure health is on your telephone’s on-hold message. • Intraoral cameras are not just or broken teeth. • Everyone has a Facebook page. By including reviews on Facebook and placing articles about overall health on Facebook, you can build up your social media. • Patients at the end o recall visits at my practice are handed a tag line card with risks about the lack o oral health, and most importantly, how it can aect them. • Meet patients where they are and always simpliy the conversation. • Always celebrate the victories.
In my practice, I have ound that once patients value the importance o the care they receive, they seek it. Tere is no greater value than improved overall health. With that as a baseline, here are some options and actions. First, perorm a “customized ull wellness visit.” • Screen patients or risks and current conditions • Have a our-tiered program in addition to traditional dentistry, including: • Oral inammation reduction • Sleep assessment and care • Wellness programs that supplement the care we give • Malocclusion ORAL INFLAMMATION REDUCTION
• • • •
patient’s health and risk actors Sleep programs (Cleveland Clinic Wellness) customized to a patient’s health and risk actors raditional recalls, customized to the patient’s needs Restorative dentistry customized to the integrity o the dentition and the patient’s overall health needs Periodontal restorations CAMBRA, CariFree Xylitol regimens Appropriate MD treatments, customized with stress reduction programs (Cleveland Clinic Wellness) Alignment and crowding issues addressed with Invisalign, Six Month Smiles, and orthodontic reerrals Removal o third molars that may be the ocus o inection and inammation
First determine a patient’s genetic and microbial risk via salivary diagnostics with OralDNA Labs. • ake an antimicrobial approach — treat the bugs • Coordinate care with patients’ physicians, according to their health and risks • raditional scaling and root planing • reat mechanically by removing biolm but taking an antimicrobial approach • Precondition with lasers • Precondition with antimicrobials • Microbial-specic treatments, as per their bacterial load • Systemic antibiotics, when appropriate • Localized antibiotics • Periostat, Periogard • Arestin • Oxygenate • Perio Protect • Advanced home-care systems • Nutritional and diet programs (Cleveland Clinic Wellness) customized to a patient’s health and risk actors • Smoking cessation programs (Cleveland Clinic Wellness) • Stress reduction programs (Cleveland Clinic Wellness) customized to a 60
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• As obesity becomes pandemic, sleep disorders are skyrocketing • Add a sleep center to your existing practice • Coordinate and work with sleep physicians and sleep center • Home sleep studies • Prescribe oral sleep appliances when appropriate • Ofer customized sleep programs (Cleveland Clinic Wellness)
BY ADDRESSING ORAL INFLAMMATION, WE ARE REVOLUTIONIZING HEALTH CARE.
Don’t be araid to initiate conversations with reerring physicians. Recently, a new patient came to the o ce. She did not see our website, did not receive anything in the mail about our practice, did not see any o our social media, and did not hear about the practice in the news. She was reerred by one o our inner circle physicians. Tis happens regularly in my practice. Tis is the cheapest, most practical, and most efective marketing that I have ound. By addressing oral inammation, we are revolutionizing health care. Te answer is simple. We now can and must identiy genetics, quantiy the bacterial load, and coordinate care. I am sure you will improve your care, improve your patients’ lives, and succeed. DANIEL L SINDELAR, DMD,
time in St. Louis, Missouri. As president of the American Academy for Oral Systemic Health, he is
O course, the most important point to involved in expanding the awareness of the whole program is to treat in conjunc- the link betwe en oral health and ov erall health to healthcare professionals and tion with physicians and coordinate care. the public. For more i nformation on the MALOCCLUSION CENTER
Four Centers of Oral Systemic Health
Research indicates that more than 45 million Americans sufer rom chronic headaches and migraines. Experts estimate that 80 o these symptoms could be dental-orce related.
and how oral-systemic health research can be harnessed to make your patients healthier and your practice more successful, visit www.drdansindelar.com or call (314) 394-1920.
• Wellness is the uture o health care • Become a disease prevention specialist • Screen or cancer with one o the advanced systems • Scan or antioxidant levels, and o%er pharmaceutical-grade nutritionals