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J. Peter St. Clair, DMD Blog

INTRO TO ADULT SLEEP

October 16, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 3:33 pm

Last week I discussed teenager sleep patterns and issues. This week we start a conversation about sleep for the majority of those reading this column.

My body has become accustomed to a certain amount of quality sleep. I have always had difficulty sleeping past a certain time in the morning, regardless of what time I go to bed. On the days when I stay up later than my normal bedtime, my amount of sleep hours is less and my quality of sleep tends to be lower. This has an impact on the way I feel the next day.

There are many reasons for poor quality sleep. Everything from a poor mattress, poor pillow, sleep position, medical issues, diet, alcohol consumption, work schedule, or a noisy bed partner can have an impact on the quality of sleep that we get. Although some people like myself can notice subtle changes in sleep quality, many others do not realize that some of the issues they have routinely can be caused by poor sleep quality.

Sleep plays a vital role in good health and well-being throughout our lives. The way you feel while you’re awake depends in part on what happens while you’re sleeping.

Sleep helps your brain work properly. Studies show that a good night’s sleep improves learning. Studies also show that sleep deficiency may cause you to have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change.

Sleep plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, stroke, sexual dysfunction, ADHD, obesity and depression.

Sleep issues can affect the young, the old and everyone in between. The many changes that take place in our bodies as we age can increase the risk of sleep disorders.

Sleep apnea is one of many sleep disorders. It is a serious, potentially life-threatening sleep disorder that affects approximately 18 million Americans. It comes from the Greek meaning of apnea which means “want of breath”. People with sleep apnea have episodes in which they stop breathing for 10 seconds or more during sleep.

People with sleep apnea usually do not remember waking up during the night. Some of the potential problems may include morning headaches, excessive daytime sleepiness, irritability and impaired mental or emotional functioning, excessive snoring, choking/gasping during sleep, insomnia, or awakening with a dry mouth or throat.

Have you been told that you snore? Do you often feel tired, fatigued, or sleepy during the daytime? Do you know if you stop breathing or has anyone witnessed you stop breathing while you are asleep? Do you have high blood pressure or are you on medication to control high blood pressure? Is your body mass index greater than 28? Are you a male with a neck circumference greater than 17 inches or a female greater 16 inches? (Note: anyone of any size can have sleep apnea)

If you answered yes to more than two of these questions, or if there is anything else in this column that makes you believe you may not be getting the quality of sleep you would like, please discuss these with your physician.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.stclairdmd.com.

TEEN SLEEP

October 12, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 12:48 pm

When we were all young children, most of us got plenty of sleep, and for that matter, we didn’t think much of it. Our parents told us it was time for bed and we went to bed. We slept until the morning at which time we were woken by our parent’s gentle touch.

As we progressed into our teenage years, our responsibilities increased. This typically led to staying up later and getting up earlier to be able to keep up with these added responsibilities. Today, it seems that getting enough good sleep is even more of a challenge for our teenagers.

One of the contributing factors of this teen sleep crisis is that parents are not as strict with setting rules for sleep as they were when their children were younger. It is not uncommon for teenagers to say to their parents they are going up to their room to do homework and then go to bed.

I recently asked my daughter (a freshman in college) what time she generally “packed it in” and settled down to fall asleep. She told me that after she finishes her homework she will lie in bed and watch something on her laptop until she feels sleepy. This trend is an antithesis to good sleep and one that must be discussed with every teenager by their parents.

Rules about electronics, which include cell phones, computers, games and the television, are especially crucial. In a study done by the National Sleep Foundation, it was determined that teens who have electronic devices on prior to going to sleep, get an average of 30 minutes less sleep. There are other studies that show that the quality of sleep is also greatly affected by this same practice.
Another, more obvious rule that parents must enforce, is the consumption of caffeine at night. Any form of caffeine should not be consumed after dinner. Studies indicate that caffeine in the system accounts for almost a full hour less of quality sleep. We, and our teenagers, cannot afford this deprivation of sleep.

We all start our days at different times. For the teenager, getting up to get ready for school can start pretty early. There is a “start school later” movement that recently received a powerful boost from the Centers of Disease Control and Prevention (CDC). The CDC report showed that teenage students have biologically different sleep patterns and needs than in other stages of life. Starting school a half hour later or more provides the teenager the opportunity to consistently get a better night’s rest.

For the teenager, managing homework and extracurricular activities is also definitely a barrier to sufficient sleep. We as parents must discuss this with our children to provide support with time management. If necessary, we must also not be afraid to discuss this with teachers and coaches if our teenager is struggling to get everything accomplished, thus affecting their sleep patterns.

As adults, many of us have our own routines that could use a revision to get more quality sleep. That is a subject for another time. As parents, it is our responsibility to guide our children to practice good habits. Discussing and enforcing better sleep habits is a gift that keeps on giving.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.stclairdmd.com.

THE GATEWAY

October 2, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 2:51 pm

The more we learn about the body through research and science, the more aware we become about the interconnectedness of all the systems. For example, we now know and continue to learn about the relationship of sleep and its effects on the rest of the body. Sleep breathing disorders, namely sleep apnea, is something that should be routinely screened for by physicians and dentists. While sleep apnea is not necessarily an “oral disorder”, it presents in ways that can be easily screened by a dentist. The key here is the practitioner thinking “outside the box” and treating each patient’s total-body health.

You may have heard the phrase “the mouth is the gateway to the rest of the body.” The mouth is connected to the rest of the body, and the only healthcare providers who spend time examining this area are your dental team. The days of the dentist being just the “tooth fixer” are gone.

The average physician spends seven minutes every two years with a patient. There may be a 5 second glance inside the mouth during those visits. If you see a dentist on a regular basis, we (dentists and hygienists) spend an hour twice a year concentrating on a very specific region of the body. There is a lot of information available within that tiny little space.

For example, everyone has heard of gum disease. While many see periodontal (gum) disease as a tooth or oral health problem, the fact is, it is a bacterial disease, and bacteria can travel throughout the body. About a dozen of the nearly 7,000 types of oral bacteria can wreak havoc on the body, not just the oral cavity.

In a study that looked at blood clots from acute heart attack and stroke patients, researchers found that oral bacteria in the clots were 16 times more concentrated than in the surrounding blood. I think it is safe to say that sometimes there is more going on than what we can see in the dental chair.

Some dentists recommend salivary testing, as they believe that it is a crucial part of diagnosing and reversing oral bacteria and inflammation. The salivary tests can show whether patients have abnormally high levels of the specific bacteria associated with heart disease, diabetes, and other total-body conditions. Diagnosis can then lead to treating the bacteria with a combination of antibiotics, antimicrobials and specific homecare techniques. In a perfect world, this information would be shared with the rest of the patient’s medical team to be able to provide comprehensive total-body care.

This is the same reason many dentists are now screening patients for sleep-disordered breathing. Sleep affects the functioning of the entire body. For a dentist, there is more to screening for sleep apnea than simply asking patients about snoring. Bruxing (grinding), clenching, gastric reflux, and TMJ issues are also signs of a possible sleep disorder. Some believe that many patients who grind or clench their teeth at night do so to open their constricted airway. In addition, experts feel that many children diagnosed with attention deficit disorders have airway problems that are contributing to, or causing the problem.

Nutrition is another area that should have more emphasis from dentists. While dentists often talk to patient about how sugar affects teeth, they should also be educating patients on how other foods, such as processed carbohydrates, cause body-wide inflammation.

This just touches on some of the systemic issues which can be screened for and make a huge difference in patient lives. There is a link between your mouth and the rest of your body.

KEEPING TEETH STRAIGHT

September 25, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 7:05 pm

You’ve spent spend thousands of dollars to straighten your teeth or your kid’s teeth with an orthodontist and the goal is to keep them that way. However, long-term compliance of retainers is an issue. Adults who have had braces tend to be better with retainer compliance. Here is the latest research and my thoughts on keeping your kid’s teeth straight.

Studies show and should not be surprising, that the average patient compliance decreases dramatically the longer a patient is out of treatment. Retainer use is abysmal at five years following treatment.

There are basically three methods used to retain teeth after braces: a clear, vacuum-formed retainer (typically referred to as an Essix retainer), a hard, pink, plastic retainer with a wire in the front (typically referred to as a Hawley-type retainer), and a bonded wire, which is splinted to the back of the teeth. Obviously, the bonded wire has the best compliance because nothing has to be “worn”, but it has its own issues – namely, it only keeps the front teeth straight and flossing compliance is poor because it can be difficult.

The most recent studies I have seen suggest using the clear, vacuum-formed retainers for a year or two and then moving into the Hawley-type retainer. The reasoning is that it is has been shown that kids are more compliant initially with the clear retainers because it is a relief to get rid of all the wires. However, after a while, those types of retainers lose their “memory” and are also difficult to keep clean. Return visits to the orthodontist for retainer checks also decrease as time goes on.

Another great system for long-term retention after orthodontics is a system developed by Invisalign called Vivera. Here’s how it works. You have impressions taken after orthodontics with your teeth in their ideal position. Invisalign creates a digital model of the teeth that stays on file. They send you (4) sets of retainers, which look like the Essix-type retainers, although they are made from the harder type Invisalign material. At the end of the first year you throw out the retainers you have been using and use the second set for another year. This provides excellent retention for four years.

Every year you change the retainers the new retainers feel a little tight because the teeth have moved slightly over that time. However, the “new” retainers were made from the original model, therefore the teeth are moved back to their starting position. After the four years you order another (4) sets of retainers made from that stored digital impression. Guaranteed retention provided there is good compliance. The cost of the (4) sets of Vivera retainers is about $600. That’s $150 per year to guarantee the teeth stay straight.

Of all the choices available, however, my preference is a bonded lower wire on the lower front teeth and a hard plastic custom-made nightguard for the upper. This keeps all the teeth straight and also provides protection of the teeth from grinding and clenching, which is a very common problem. This option also lasts the longest, which is the most cost effective.

DIETARY REMINDERS

September 11, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 4:21 pm

I’m sure you have heard the saying “You are what you eat”. This implies that a healthy balanced diet high in vitamins and nutrients and low in junk food is better for you and will help you maintain a healthy body and stave off illness.

Your diet provides your body with the fuel it needs to run at its optimum, so if you are filling your tank with a diet heavy in sugary and fatty foods instead of nutrient-rich vegetables and lean proteins, you’re doing yourself a disservice. A poor diet can lead to weight gain, high blood pressure, digestive problems, increased risk of illness, and can also affect the health of your teeth and gums.

When you eat anything, the bacteria that are already present in your mouth convert the sugar and starch in this food into acids, which attack the enamel on your teeth and can cause tooth decay. The more often you eat foods that contain sugars and starches, and the longer these remain in your mouth before brushing, the greater your risk for decay. That is why it is important to brush and floss after every meal, preferably about a half hour after the meal, to brush away any food particles that may be clinging to or in between your teeth.

Sugar and starch are not just in junk food. Sugar also lurks in things such as milk, yogurt, salad dressing, ketchup, and even some vegetables. Fruit juices, granola bars, and even “nutritional” bars can also be loaded with sugar.

Starchy foods such as bread, cereal, pasta and beans can also wreak havoc on your teeth and gums. Like sugar, starch can also be found in some unexpected places such as bananas, canned soup, prepared spaghetti sauce, potatoes, and some other vegetables like corn and peas.
It’s not just what you eat, it’s when and how frequently you eat. Limit the amount of sugary and starchy foods, especially between meals. Make sure to read nutritional labels so you know what you are consuming. After you do eat any of these things, wait about a half hour for your saliva to naturally neutralize your mouth and then brush with fluoridated toothpaste.

There are several factors other than sugar that can contribute to dental decay. Genetics play a role, in addition to other things such as home care, xerostomia (dry mouth), pH (acidity level), gum recession and age. Decay rates can change throughout life due to these factors. For those who are more prone to decay, a prescription fluoridated toothpaste should be an important consideration. This is something only your dentist can prescribe, so regular dental visits are essential.

Snack on healthier choices such as cheese, vegetables and fruit. These are better for you in general but still require you to cleanse your teeth following consumption. Try to limit your intake of soda and fruit juices and drink plenty of water. Water not only keeps you hydrated but helps with cleansing the mouth.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.stclairdmd.com.

WHO’S YOUR DENTIST?

September 5, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 4:30 pm

Dentistry has nine recognized specialties. They are listed below with a brief description. As you will notice, cosmetic dentistry is not one of them. Every general dentist does “cosmetic” work – unless they are putting silver fillings in front teeth. There are some general dentists who do more “cosmetic” work than others and some who even limit their practices to esthetic cases. However, a dentist cannot officially be designated as a “cosmetic dentist” or “cosmetic specialist.”

The nine recognized specialties in dentistry are:

Public Health Dentistry – this field of dentistry is involved in the assessment of dental health needs and improving the dental health of a specific population of patients.

Endodontics – this dentist, an endodontist, deals only with the inside of a tooth, the tooth pulp, and the tissues surrounding the tooth. They perform root canal treatments and other procedures only dealing with this specific area.

Oral and Maxillofacial Surgery – these dentists treat a wide spectrum of disease, injuries and defects in the head, neck, face and jaws. Oral surgeons remove teeth, treat oral cancers and other oral diseases, place dental implants and some treat temporomandibular joint (TMJ) problems.

Orthodontics – this area focuses on the straightening of teeth and modification of midface and lower jaw growth. This is the “braces” dentist.

Prosthodontics – this specialty deals with replacing missing or defective teeth using crowns, bridges, implants and removable appliances.

Pediatric Dentistry – specializes in treating dental diseases in children, adolescents and those with special needs.

Periodontics – the periodontist specializes in treating the supporting tissues of the teeth such as the gums and bone that surrounds teeth. Many periodontists also place dental implants.

Oral and Maxillofacial Pathology – this group specializes in the diagnosis of less common dental and head and neck diseases. They work closely with the surgeons.

Cosmetic dentistry isn’t just limited to super expensive fancy stuff. Orthodontics and whitening can give a really dramatic result without any “drilling.” Replacing stained fillings or replacing aging, dark silver fillings can lighten the color of your smile too. Also, most people don’t really think of dentures as “cosmetic dentistry”, but a well-made custom denture can make a huge cosmetic difference as well.

General dentists are allowed to perform procedures within any of the specialties, if they choose to. This includes dental implants, which is also not a recognized specialty.

There are some dentists who refer all specialized treatment out to specialists, and others who do much of it themselves. It really depends on the dentist’s interests and training. Specialists are often relied upon heavily due to their advanced training and focus on one specific discipline.

If you need any specialized care, have a conversation with your dentist about your options. Many patients like to stay within one office to be able to get the care done they need. However, there are times when a specialist’s care is in the best interest of the patient.

WHAT’S IN YOUR TOOTHPASTE?

August 28, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 2:31 pm

3319883455_36a83f092c_nIt is common for a patient to ask what kind of toothpaste they should use. The concept of toothpaste and mouth washes is pretty old – almost as old as the Egyptian toothbrush. In fact, the earliest known toothpaste was created by the Egyptians. It was said to contain rock salt, mint, dried iris flowers and 20 grains of pepper, all crushed and mixed together to form a powder. It wasn’t until the 18th Century that the next recorded version of toothpaste showed up. That recipe was interesting as well.

The 19th Century saw a lot of toothpaste innovations, although many of them would be repulsive compared to what we are used to today. Charcoal, for example, was popular. Most of the toothpastes of this time were powders that became a paste when introduced to saliva. A lot of these different toothpastes were designed to both clean teeth and give the user better breath.

It wasn’t until the 1900s that toothpastes evolved into what we know now. Colgate, and many other toothpaste companies, worked to design toothpastes that tasted better while cleaning the teeth and not causing gums to bleed. Many ingredients now show up in toothpastes, with fluoride being one of the most common. There are a wide variety of “herbal” toothpastes as well, which don’t contain any fluoride. The variety of toothpastes available is designed to fit the needs and wants of every type of person out there. This high level of choice is the modern age’s primary contribution to toothpastes.

So, where does toothpaste go from here? Research continues to develop different ingredients that will benefit different problems. One of those ingredients I recently came across is green tea.

The oral health benefits of green tea are getting increasing attention in scientific literature, and now the authors of a new study suggest that it should be added to dentifrices as an active ingredient for managing periodontal disease.

The study authors, who are associated with various medical institutes in India, reported that it is a beneficial adjunct to nonsurgical periodontal (gum) therapy. “Green tea is known to possess anti-inflammatory, antibacterial, and antioxidant activities,” the authors wrote. “Antioxidants have a protective effect on periodontal tissues by reducing the oxidative stress in periodontal tissues.”

The study compared the effectiveness of great tea vs. triclosan. If you remember, triclosan, an antimicrobial which used to be found in some toothpastes, came under scrutiny for its overall safety. It is also found in some hand soaps, skin cleansers and detergents and has been shown to help with gum inflammation. “On comparison with fluoride-triclosan dentifrice, green tea showed greater reduction of gingival inflammation and improved periodontal parameters,” the authors wrote. “This can be attributed to the antibacterial, anti-inflammatory, and antioxidant properties of green tea.”

These results showed enhanced outcomes with the use of green tea dentifrice as an adjunct to routine professional periodontal care during the active and healing phases. Long-term clinical trials should be conducted to validate the results of this pilot study, the group added.

The great thing about green tea is that it is a natural product. Something to watch.

DO YOU PRE-MED?

August 21, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 1:39 pm

For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. For those with these certain heart conditions, this was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. IE is an infection of the heart’s inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.

In 2007, the AHA’s revised guidelines were published in its scientific journal, Circulation, and there was good news: the AHA recommended that most of these patients no longer needed short-term antibiotics as a preventive measure before their dental treatment. This saved a lot of patients from taking antibiotics prior to dental appointments. However, those with replacement joints were still required to take the medication prior to dental visits.
These revised guidelines back in 2007 were based on a growing body of scientific evidence that showed the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks included adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria. Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection.

More recently The American Dental Association (ADA) finally weighed in on the controversy about prophylactic antibiotics prior to dental visits for those who have had artificial joint replacement:

“In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, the clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.”

While the ADA’s statement is not an outright cancellation of all prophylactic antibiotics, it is reassuring to know that we (dentists and patients) have more flexibility, and are able to make these decisions without having to always hunt down the orthopedic surgeon. People who have had previous complications with infected joints or have compromised immune systems may still be required to pre-medicate.

For those patients who have been swallowing all those pills prior to your dental appointments, I would suggest having a discussion about this with your dentist. Patients with artificial joints have become accustomed to pre-medicating and I can understand if there is hesitation about stopping this routine. Have the conversation with your dentist and decide what makes sense for your specific situation.

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DID YOU HEAR SOMETHING?

August 14, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 2:46 pm

It is not uncommon for me to get a strange look when I ask a patient about snoring. After an explanation about some of the reasons I include this on my medical history form, the patient will often say, “Well, I don’t snore but my spouse does. In fact, we sleep in separate bedrooms.”

Asking a patient about snoring is really asking, “Have you been told you snore?” Snoring can be a huge nuisance to the bed partner and is actually very detrimental to both people. For those without a bed partner, snoring can be assessed with apps such as Snore Lab, which measures snoring levels throughout the night.
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Snoring is a sign of a restricted airway, which means that there is a possible depletion of air getting into the lungs and thus the brain. You spend approximately one third of your life sleeping, which means if you live to 90 years old, you may have spent 30 years sleeping. Oxygen depletion during sleep has both short-term and long-term consequences. I have read multiple studies which suggest a reduction of oxygen to the body can take 6-10 years off of your life. Sleep is one of the most mysterious states of being – we don’t know a lot about what is going on during sleep without it being recorded. Wouldn’t you want to know if your body wasn’t being oxygenated properly?

A restricted airway can be caused by numerous different factors. Many times it is developmental and starts early in life. I will discuss this more in a future column. As we age, this risk for developing a restricted airway increases with things like gaining weight, muscle tone laxity, and even sleep position. Snoring is a fluttering of soft tissue in the back of throat due to there not being enough space for air to pass through. Not only does snoring have the potential to affect your brain and the way you feel on a day-to-day basis, it also disturbs the sleep of the person sleeping next to you….and in some cases, people in other rooms.

Snoring does not mean you have sleep apnea (a serious disorder measured by a sleep test,) but is a significant risk factor. If you do have sleep apnea, you need to know this so that it can be treated and you can live a better quality of life. If you don’t have sleep apnea and just snore, this can also be treated, and you may be able to make it back into your own bedroom.

Aside from snoring, if you have any of the following: familial history of sleep apnea, history of daytime drowsiness, history of clenching/grinding, history of TMJ disorder, history of mood disorders/depression, witnessed apnea events (gasping at night), large tongue with ridges on the sides, tooth wear, high blood pressure, gastric reflux, large neck (Males >17 / Females>16) – you should discuss this with your physician and/or your dentist.

There are different ways to treat snoring and/or sleep apnea including positional therapy (sometimes a wedge pillow strapped to your back so you can’t roll onto your back), a CPAP device (positive air pressure through the nose to keep the airway open), or a dental device (to keep the jaw and tongue from falling back).

Just like exercising and good eating habits are good for the body, quality sleep vital to good health. Just because you get 7-8 hours of sleep doesn’t mean it is good sleep. Don’t hesitate to talk with your doctors about your sleep issues…..and encourage the loud person sleeping next to you to do the same.

WORKING TOGETHER

August 7, 2017

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 8:01 pm

Dentists play a key role in screening patients for many disorders relative to nutrition and in providing appropriate referrals into the health care system. Although the importance of integrating diet and nutrition guidance into dental care has been advocated for decades by educators, it continues to be ignored except by a handful of prevention-oriented practitioners.

Many of the world’s most significant health problems are linked to poor dietary practices, including over-nutrition and under-nutrition. Nutrition plays a fundamental role in health, and dental professionals have the opportunity to be a critical link between discovery and wellness.

6188969028_ffe5b43d9f_m There is a great deal of evidence linking oral infections, including periodontal disease, nutrition and immunological response. We have clear evidence linking oral disease with adverse pregnancy outcomes, diabetes, cardiovascular disease and stroke. In addition, obesity, which is an epidemic facing our country, is significantly affecting the incidence of diabetes, cardiovascular disease and overall lifespan. We know there are direct connections between these problems and oral disease. What is the role of the dentist? Should the dentist just be a tooth fixer?

As the body of data linking systemic health conditions and oral infection grows, the expanding understanding of the gene-nutrient reaction may result in more profound discoveries. As of now, many dentists fail to fully appreciate that the scientific bridge between oral disease and systemic health is often mediated by diet and nutrition.

The beneficiary of this profound evidence should be you, the dental patient. It should not only be the responsibility of the physician or specialized nutritionist to incorporate this information into practice. The dentist should be playing a key role.

For the most part, the dentist is the only one who examines the mouth. It used to be that the dentist only looked at the teeth and only fixed problems when they arose. By now, most dentists screen for periodontal, or gum, problems as well as oral cancer. The trend is to address these problems earlier than ever before.

People tend to have ingrained in their head that the dentist just looks at the teeth and treatment should be the same as 25 years ago. The fact of the matter is, things change. As I have said in numerous previous columns, there are no two dentists who practice identically. Each individual’s philosophy of care comes from personal experience, review of literature and the type and amount of continuing education taken. One thing we all hope is that our health care provider, dentist or physician, has our best interest in mind. There is room for improvement in the communication between all health care providers.

As science continues and evidence grows, preventative care and treatment will change with the times. It is the responsibility of all health care providers to work towards a more integrated health care system.

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