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
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
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
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!