Second Opinion: The Role of Teamwork in the Third Era of Medicine by Charles Whitney, MD

The Role of Teamwork in the Third Era
of Medicine

Physicians, dentists and hygienists must work together to develop a new standard of care.

by Charles Whitney, MD
Second opinions are common in health care, whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a "second opinion." Perhaps some of these observations will change your mind, while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession.
- Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

The Shortcomings of Neck-down Medical Training

It seems every day there's a new study published that further validates the belief that oral health has a great impact on overall health. In a February 2013 study published in Circulation, the Journal of the American Heart Association, it was discovered that up to 50 percent of heart attacks may be caused by oral bacteremia. A physician's effort to reduce our patients' risk of many systemic diseases is incomplete without the assistance of dental professionals.

But what good is this research to patients if their physicians and dentists can't connect the dots in clinical practice, to help their patients achieve optimal health?

As a physician, I was not always such a strong advocate of working closely with my dentist and hygienist colleagues. In seven years of medical training, my education regarding the oral cavity was exactly one lecture!

I did not know how much infected gums could wreak havoc on the overall health of my patients being treated for cardiovascular disease, arthritis, diabetes and many others. I did not realize that my young female patients may significantly reduce their risk of miscarriage and pre-term labor by simply creating a healthy oral cavity.

My Oral Health Epiphany

I have since had a postgraduate oral health epiphany thanks to the teaching of Dr. Bradley Bale and Amy Doneen, LNP, the originators of the Bale/Doneen method of heart attack and stroke prevention. These medical pioneers, who lecture at places such as the Cleveland Clinic, showed me that bacteria in the oral cavity are significant contributors to heart disease, and may often be the trigger for an event such as a heart attack.

As an advocate of the third era of medicine, which is focused on the prevention of disease rather than managing illness, this was great news! If I could reduce the bacteria load in my patients' mouths and prevent the passage of bacteria into the bloodstream, I could significantly lower their risk of heart attack and stroke. But I could not do this alone. I needed to work closely with a dentist. Today I work with many dentists and their hygiene teams as I strive to help my patients achieve optimal health.

Another pillar of the third era of medicine is collaborating with other health-care providers to provide comprehensive care, with the ultimate goal to empower the patients to create optimal health. In fact, if it were not for the valuable alliances I've forged with my local dental community, I would not be able to confidently offer this guarantee to my patients: "If you suffer a heart attack or stroke while under my care, I will refund fees you've paid in the past year." This is a powerful pact, with great potential financial risk, especially when you consider that I have a direct primary care practice that charges a monthly fee for a highly personalized level of care.

Physicians Can be Catalysts for Dental Patient Compliance

As a physician, I am now on a personal mission to urge my medical colleagues to update their patient history questionnaires to include the question, "Do you see blood in the sink when you brush or floss your teeth, or when you receive cleaning from your hygienist?" If the answer is yes, the physician should strongly suggest that the patient have the problem addressed by his or her dentist. If the patient does not have a regular dentist, the physician should provide a list of recommended dentists with experience in treating periodontal disease, which of course would include periodontists.

If the patient has a history of heart disease, the dentist referral is much more urgent because of the negative impact untreated periodontal disease can have on this potentially devastating systemic disease. In this case, the physician should instruct staff to make the dentist appointment on behalf of the patient before they leave the office. (Yes, it's really that important!)

In my practice, we go a step further. We don't wait for our patients to see blood in the sink. If a patient has no systemic symptoms, but has a family history of cardiovascular disease, diabetes, pre-term birth or even Alzheimer's disease, we consider diagnostic salivary testing from OralDNA labs, especially if the patient has elevated inflammatory markers. Causative oral bacteria that can be identified with this saliva testing are often associated with elevated blood inflammatory markers. I frequently see these blood markers plummet when the patient receives adequate periodontal treatment and homecare!

I now aggressively fight periodontal disease, because the same bacteria that cause gum inflammation and bleeding has been strongly associated with many systemic illnesses. As you already know, the more advanced the progression of periodontal disease, the harder it is to treat.

Dentists Can Significantly Impact a Patient's Overall Health

While physicians can help bridge the oral-systemic gap by asking their patients if they see blood in the sink when they brush or floss, dentists can do their part from the other side of the great oral-systemic divide, with great benefit to their patients and practices.

I believe every dental patient record should include the contact information for a primary care physician. For those who do not have a regular physician, be prepared to provide a list of physicians who understand the oral-systemic link.

In the event that a patient presents with even Grade I periodontal disease, check his or her records for a personal or family history of the many conditions linked. Ask young women if they've had infertility or pre-term labor.

Someone on your team should explain to the patient the connection between the periodontal disease you have diagnosed and the systemic illnesses in his or her history. Explain that periodontal disease can contribute to the development of systemic diseases and make many existing conditions more difficult to adequately treat. Tell patients you will be notifying their physician of your findings, recommended course of treatment, and updates as treatment progresses.

By contacting your patients' doctors regarding periodontal disease diagnoses, your patients might be more accepting of your treatment plan and more compliant with your hygienist's home hygiene recommendations.

Encourage doctors to ask patients during visits whether they've followed up for the treatment of their periodontal disease.

If the answer is no, the doctor should edify you by saying, "Periodontal disease is an inflammation-producing infection that can spread to other parts of your body. It is making it harder for me to treat your diabetes, high blood pressure, cardiovascular disease, arthritis, etc. It will place you at increased risk of events like a heart attack! I want you to make an appointment with your dentist right away."

We are all health professionals and should be treating the whole patient, not just our respective parts of the body. Collaboration between physicians and dental professionals is critical for the greater good of patients' health. I would not be able to provide my patients optimal care without my local network of trusted dental professionals. Together, we can maximize the prevention tenets of the third era of medicine, the era of empowering an intrinsically motivated individual to create health!

Author's Bio
Dr. Charles Whitney graduated from Jefferson Medical College in Philadelphia in 1990, and completed his family practice residency at the David Grant United States Air Force Medical Center. He is double board certified in Family Medicine and Sports Medicine. His experience includes seven years as an Air Force physician and seven years in the University of Pennsylvania health system before establishing his own direct primary care practice, Revolutionary Health Services, in 2004. Dr. Whitney is the former vice president of the American Academy of Private Physicians (, a nonprofit organization founded in 2003 for the purpose of supporting the growth of medical practices that provide personalized direct primary care. He is also a member of the American Academy for Oral Systemic Health (AAOSH). For more information, visit Follow Revolutionary Health Services on Facebook and Twitter.


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