The Transitioning Practice – Part 1
September 27, 2011
It has happened. The worst possible thing in the world you could ever imagine has happened to you. The dentist you have been seeing for the last 20 years has retired. What are you going to do?
Many people, including myself, get attached to their healthcare providers. When you build a relationship with your healthcare provider and the office staff, there is a level of comfort in knowing that when needed, there is a person/office you trust to take care of you. When that provider retires there is a sense of abandonment, obviously not intentional, and that feeling of – What do I do now?
In many cases, the staff members remain, which is not only important for the patients, but also for the new provider. Dental patients go to a particular office for many different reasons. Those reasons range from convenience, insurance coverage (which is not necessarily a good reason and a topic for its own column), they love their hygienist and the other staff, they believe they are getting the best of care, or they have just developed a sense of comfort with the office. I can tell you a fact that I have seen over and over again – no matter how good the dentist is, if patients have issues with the staff, they don’t stay. Staff members play as much of a role in patient retention as the dentist does, if not more. If the staff members leave with the retiring dentist, it can be that much more devastating for patients.
The fact that your dentist retired obviously means that you must have a new dentist, whether you stay with the office or you decide to go to a new office. Because of this, and especially if familiar faces remain, it is usually a good idea to give the incoming dentist a try. One thing is certain, regardless of whether you remain in the office or jump ship, things will be different.
Every dentist has their own unique personality, style of practice and philosophy of care. It is unrealistic to think that any one dentist will be the same as another. It is impossible for you as a patient to have any way to evaluate the clinical skills of any dentist……although most patients don’t even think about that. For patients, the first thing you will be looking for in your new dentist is whether or not your personality meshes with the new person.
Expect to hear new things. As I said, every dentist is different and has his/her own unique style of practice. It is up to the dentist to be able to communicate their philosophy of care with you. If they fail to do this it is their problem because you will not be staying.
In general, a retiring dentist has been in practice much longer than the new person coming in. Patients get used to the style of practice they have been in. You need to keep an open mind. I know we have been inundated recently with the notion that change is good. My philosophy is that change can be good.
It will be up to you to decide if this particular change is good for you or not. If you approach this change with an open mind, and your new provider communicates his/her philosophy well, it will give you the best opportunity to decide if it is right for you.
I will present a few more ideas on this topic next week.
The Silent Epidemic – Part 2
September 21, 2011
Last week we discussed the role and effect that diabetes has on oral health. It is not something that should be taken lightly. If you missed this column, please visit the website at the end of this column or e-mail me directly and I will send you a copy.
After reading last week’s column, it may seem frightening that there is no way out of the partnership of horrors between diabetes and severe gum disease. There are solutions. Just as poor oral health can compound a diabetic’s plight, proper oral health can come to the rescue.
Clinical studies confirm that treatment of gum disease reduces oral inflammation, which removes the factor that triggers the body’s inflammatory response which, in turn, plays a major role in compounding the effects of diabetes.
Dental treatments that fight gum infections also help improve control of blood sugar levels in diabetics.
If you are pre-diabetic, your dentist may actually be able to help prevent diabetes. If you already have diabetes, your dentist may be able to help you keep it under control, improve your quality of life and reduce the risk of premature death.
There’s even better news. It’s never too late to improve oral health care. Even if you already have severe gum disease or other dental problems, proper treatment can help stop it in its tracks. In many cases, dentists can even reverse the damage done to your teeth and gums as well as manage the metabolic elements of diabetes. And, if you haven’t yet developed any symptoms of diabetes-related oral health problems, your dentist can start a prevention program that will help you stay in control of your diabetes, maintain better health and enjoy a preferred quality of life.
Perhaps the best news is that this is something that doesn’t require exercise, taking a pill, giving yourself a shot of insulin, or sticking to a special diet. However, some or all of these things may be necessary to also help control diabetes. From an oral health perspective all you need to do is to start seeing your dentist and talking to him or her about your particular situation.
In the dental world there are going to be varying degrees of participation from dentists, depending on their knowledge or “philosophy” of care, when it comes to partnering with you to manage the oral health issues in regards to diabetes or pre-diabetes. Different dentists just practice differently. The best team approach is between the doctor, the patient and the dentist. If one of these team members does not participate, the battle cannot be won. Often times it is the patient who is not doing the things that he or she needs to do to properly manage the problem. If the dentist does not seem too concerned about your diabetes, you have the desire to have your oral health properly managed and are willing to do your part, find a new dentist.
The point is that this is a serious issue and if you, the patient, wants to take control of it, a team effort is needed.
The Silent Epidemic
September 8, 2011
With more than 24 million diabetics and 57 million pre-diabetics in the United States, nearly a quarter of the nation’s population has already been affected by this disease. The connections between dental health and diabetes have never been more critical.
As an indication of our general health, the rapidly rising rate of diabetes should be ringing alarm bells everywhere. The litany of health implications from diabetes is a long and grisly list. It is the sixth leading cause of death in the U.S. That is probably vastly understated because as many as 65% of deaths from diabetes are attributed to heart attack and stroke. People with diabetes have about twice the overall risk of death as those who don’t have the disease.
Complications from diabetes cuts years off productive lives and interfere with the quality of those lives through a host of debilitating health effects. Heart disease and stroke rates are as much as four times higher among diabetics. Nearly three-quarters of diabetics have high blood pressure. Each year, diabetes causes blindness in as many as 24,000 Americans. It is the leading cause of kidney failure, nervous system disease, amputations – the list goes on.
This isn’t meant to be a scare tactic. These are simply the facts and, yes, they are sobering. But if you have diabetes or are pre-diabetic, you may want to brace yourself. Because we are going to talk straight about oral health and diabetes, two diseases that can twist each other into a tight downward spiral of amplifying negative health effects. Unless they are halted by your physician and your dentist working in tandem as a health care team, together with your commitment to hold up your end of the bargain, these effects can continue to compound.
The facts about the connections between oral health and diabetes are even more alarming than those about diabetes alone. Here are just a few:
Diabetics are twice as likely to develop gum disease. This is especially true if your diabetes is not under control. The gum disease then worsens your diabetes through an automatic response that your uses to fight the infection.
People with gum disease are 270% more likely to suffer a heart attack than those with healthy gums.
People who have diabetes and sever gum disease have a premature death rate nearly eight times higher than those who do not have periodontal disease.
Those who have gum disease and diabetes together are more than three time likely to die of combined heart and kidney failure.
In people who have type 2 diabetes, gum disease is a predictor of end-stage kidney disease.
In people who have pre-diabetes – blood glucose levels that are higher than normal but not in the diabetic range – gum disease makes it more likely that they will become diabetic.
Once established in a person who has diabetes, the chronic infection that causes gum disease makes it more difficult to control diabetes, and increases damage and complications in blood vessel disease.
We will continue this discussion next week and talk about some things you can do to help this problem.
Room For Improvement
September 2, 2011
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.
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 that 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.
