Looking back on the history of our profession, from the eyes of our patients, dentistry has not always been painted in the best light. The past generations of patients have all had a similar view; dental appointments hurt, take unnecessary time out of the day, and cost too much money. Even worse, historically, a large percentage of the population was raised to never see the importance of seeking out proper oral health care. Presently, the profession of dentistry has never been so poised to capture the attention of the masses, and through partnership with our physician counterparts, be seen as such a crucial element benefiting the future of health and wellness.
In just over a century, dentistry has gone from the G.V. Black era of caries management to the periodontal pathogens are the root environmental cause (not just a risk factor) in vascular disease, and multiple, patient-centric pathways for biofilm management for the treatment and prevention of oral AND systemic disease. As members of the dental profession, we have been educated, trained, and inundated in the importance of the care that we provide to the health and well-being our patients. With the curse of our knowledge and level of understanding, we may not be well able to see how or why the rest of the world still holds us in the light of unnecessary, unimportant, or the worst recently popular term: “non-essential”.
In a world where healthcare costs are rising faster than inflation and the cost of gas, the profession of Dentistry holds the keys to reducing overall healthcare spending, improving average healthspan, and “filling the cavity” in our current system of healthcare. This amazing and bright potential future becoming a reality only requires one, simple step; the education of our medical professional counterparts in the importance and understanding of how the oral health care that we provide is an absolute cornerstone of an individual patient’s overall health and wellness. True, this may be no simple task. Mass media and Pop cultural references have gone a long way towards placing the dental profession on a much lower pedestal than the medical profession, in the eyes of our patients. This is why it is so important that the medical profession be seen as the group that lifts us all up to the same level. If every physician, PA, nurse, medical technician, and so many others referred every patient for a comprehensive oral health evaluation by a properly educated and trained dental team, two important things would happen. First, our patients will start to see the care that we provide, supported and backed by their physician, as needed and necessary for their health; not as optional or cosmetic. Second, and most importantly, the rate of chronic disease and negative health effects associated with aging will start to decrease, resulting in a healthier general population and a significant decrease in healthcare related costs. This is the triple-win foundation required to build the future of healthcare; physicians win, dentists win, and most importantly, patients win!
The first thing that anyone reading this article can do to support this bright future, is start communicating with your patients’ primary care physicians, just as a dental specialty care provider communicates back to the general dentist. After every examination, send the patient’s physician an updated comprehensive correspondence in medical standard SOAP format. Highlight any findings or correlations to the patient’s medical history, current medications, and risk factors for future systemic health concerns. Be sure to also request the reciprocal records from the primary care physician, including any updated systemic inflammatory blood panels, microbe/antigen test results, and/or genetic testing that could affect oral health or dental treatment. It is also imperative that we as dental professionals educate ourselves to a level of oral-systemic health understanding that places us as key partners to our physician counterparts on the over-all healthcare team. The American Academy for Oral Systemic Health (aaosh.org) provide the best and most comprehensive education and collaboration support for dental and medical professionals.
Once communication has been established, we can support our our medical professional counterparts to better support our patients by providing them the tools they need to make a collaborative relationship simple. These can be created by you specifically for your practice, or you could use customizable templates available to AAOSH members.
For the medical team, Dr. Ellie Campbell DO, an integrative medical physician in Atlanta, GA, who has witnessed the successful improvement in the health of many of her patients, through collaborative relationships with her patient’s dental providers, has provided her approach to oral health within her practice and how she helps support dental care as a foundational piece of over-all health. This can be shared with your local collaborative physicians to help begin the collaborative relationship and set foundational standards for what information should be included in communication and joint patient care correspondence.
A Physician’s Treasure Trove: For Oral Health Awareness, Diagnosis, Treatment
Ellie Campbell DO
No healthcare treatment protocol or prevention program is complete without a dentist and hygienist on the team. EVERY primary care patient should know the name of their doctor and their dentist, and physicians and dentists should strive hard towards open communication and interdisciplinary collaboration. The American Academy for Oral Systemic Health provides the platform, education, and practice implementation support for medical-dental collaboration (aaosh.org).
It is critical to recognize the role of simple oral hygiene as a potentially LIFE-SAVING strategy. One recent study tracked 5,600 older adults for 17 years and reported that:
- The risk for death during the study period increased by 20 to 25 percent, for those who neglected nighttime tooth brushing, compared to those brushing every night
- Compared with daily flossing, never flossing increased mortality risk by 30 percent.
- Compared to those getting dental care two or more times a year, not seeing a dentist in the previous 12 months raised mortality risk by up to 50 percent!! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124861/
How can physicians improve patient outcomes by increasing awareness of oral health?
Step 1. Ask History Questions Relative To Oral Health.
Showing interest in oral health helps patients understand that you recognize a link and connection. Here are some examples:
- When was your last dental visit and tooth cleaning?
- Do you have bleeding, tender or sore teeth or gums?
- Has there been any shifting in your bite?
- Are you a mouth-breather?
- Do you have any foul taste/bad breath?
- Are there any swelling/lumps in mouth?
- Do you tongue or lips burn?
- Did you ever have orthodontic treatment (braces/clear aligners, or teeth removed for teeth straightening)
- Do you get frequent ulcers or fever blisters in your lips/mouth?
- Do you clench or grind your teeth?
- Do you have heat, cold or sweet sensitive teeth?
- Does your jaw click or pop or not open/close properly?
- Do you have any loose or broken teeth?
- Do you have dentures/partial?
- Do you have any caps, crowns, or root canal teeth?
- Do you snore?
Step 2. Pay Closer Attention On Physical Exam: Lips, Tongue, Natural Teeth, Saliva, Repair Work, Soft Palate/Mallampati Score
Use a tool like the Oral Health assessment tool to keep track: https://siphidaho.org/comhealth/ship/KM05-Oral-Health-Asssessment-Tool-for-Primary-Care.pdf
- Ask patient to open mouth wide (use a penlight or otoscope if needed)
- Carefully inspect the surface of the tongue and the hard palate
- Examine the entire buccal area and the gingivolabial (gingivobuccal) sulcus
- Ask the patient to lift their tongue toward the roof of their mouth and inspect the floor of the mouth (use the tongue depressor if needed) Pay careful attention to the location of frenulum (not too anterior)
- Inspect the uvula, tonsils, palatal folds, and posterior pharyngeal wall. Note Mallampati score – https://www.unitypoint.org/peoria/filesimages/Services/ProctorEMSSMOs/82MallampatiScore.pdf
Step 3. Order Proper Labs With Intent To Screen For Inflammation
We order the “fire panel” from Quest/Cleveland Heart Labs that includes: hsCRP, MACR, Myeloperoxidase, LpPLA-2 activity, F-2isoprostane, ADMA and SDMA, and OxLDL.
If the patient reports bleeding gums, has any of these markers elevated without an obvious trigger, has had an atherosclerotic event, or is not in a relationship with an enlightened dentist, THEN I also perform salivary diagnostics (a spit test for inflammatory mouth bacteria). Multiple labs provide these tests to both medical and dental practitioners.
Have a SUPER low threshold for ordering a sleep study. OSA is the most under diagnosed medical condition with root causal relationships to diseases of every body system!
Step 4. Encourage Better Oral Home Care
Avoid potentially toxic oral health care products and only use products recommended by a biological or oral-systemic trained dentist. Often, these will be SLS, paraben and fluoride-free and may include xylitol or hydroxyapatite.
Floss is not as effective as “pressure washing” between the teeth using a Water Pik, or HydroFloss. Consider adding hydrogen peroxide, Argentyn 23, or a drop of grapefruit seed extract to the water.
If flossing, avoid the habit of snapping the floss up and down, which irritates your gums and does a poor job of cleaning. Rather saw the floss in an up and down, zigzag motion, with the floss contoured in a C-shape to wrap around the tooth.
Brush teeth and gums, cheeks, the roof of the mouth, and the vestibule (the area between the teeth, lips and cheeks). Use a tongue scraper – not a toothbrush – to clean the tongue.
Consider dental picks (such as G.U.M. Soft-Picks) to efficiently remove debris between teeth.
Avoid standard sugar or alcohol-based mouth wash. They are too harsh, can raise blood pressure, and kill the healthy bacteria, too.
Choose dental products that contain xylitol, a compound with both a pre-biotic and antimicrobial effect. Xylitol products, such as toothpaste, gum, and lozenges help prevent cavities! Infants and children who use xylitol regularly (4-6X/day) rarely get cavities. NOTE Xylitol is extremely toxic or even fatal to dogs, even in small amounts, so keep out of pet’s reach.
Go to bed with a clean mouth, after eating a plant based, high nutrient dense diet all day!
Step 5. Partner With Your Dental Provider And Set Mutual Goals To Take Your Oral Health To The Next Level Of Excellence.
Ask your dental provider to screen for periodontal and endodontic disease and create a care plan if high-risk oral bacteria are identified. An excellent oral evaluation should include:
- X-rays or CT to check for signs of endodontic (tooth root) disease—NOT JUST bite wings to screen for caries (cavities) If there is extensive repair work (crowns, fillings, root canals) your dental provider may recommend 3-D cone beam tomography [CBCT.] Some providers are suggesting screening CBCT if patients are at risk for cardiovascular disease, stroke or dementia.
- A periodontal exam to measure pocket depths. This painless exam uses a probe to measure how tightly the gum tissue is adhered to the tooth. A healthy pocket typically measures 1-3 millimeters and a depth of 4 mm or more or if there is “bleeding on probing” there is a concern for gum disease.
- Oral cancer screening
Interpretation or care plan for any abnormal periodontal pathogen testing:
- A dental sleep medicine evaluation
- A calendar for dental hygiene and tooth cleaning based on individual needs
If a high decay risk is detected, options should include a home care plan for remineralization which may include ozonated dental products, option to receive painless topical silver diamine fluoride, conventional non-mercury containing resin filling material.
If an infected root canal is detected, often the tooth will need to be removed. SOMETIMES other options exist, but almost always extraction is needed. Use StellaLife products before and after all dental procedures to reduce swelling and pain without the need for opioids or NSAIDS. (also good for dry mouth, canker sores, halitosis and more.) https://stellalife.com/products/stellalife-vega-oral-care-recovery-kit-16oz
Additional educational sources, including product recommendation support can be gained by attending the annual “Collaboration Cures” conference, supported by AAOSH. (https://www.aaosh.org/collaboration-cures-2022).
©Ellie Campbell DO 2021, 910 Haw Creek Rd, Cumming GA 30041