If you missed Part 1 of this series, you can find it at www.thetowncommon.com.

Painless Gum Disease Still Needs Attention

I ended last week with a statement that I have used numerous times before – just because it doesn’t hurt doesn’t mean there isn’t a problem. We keep learning more and more about the link between the mouth and the rest of the body. It is essential that dentists and physicians do a better job at co-managing patients, and learn more about the relationship between oral and systemic disease. It is clear that if you want to take better care of yourself, you need to take better care of your mouth. Familial history is very important. If you know of any family history of dental problems, you are at higher risk. Higher risk individuals need to be treated differently and may need a more aggressive preventive protocol to help ward off progression of disease. In addition, an otherwise healthy person who presents with a sudden increase in gum inflammation should possibly be evaluated by their physician to rule out any systemic causes if there is not a simple explanation for the change. The connection between oral health and systemic health is well-established and ever-evolving. One thing we know for certain, we are living longer but with more chronic diseases and medication than ever before. It is exciting that there are so many things on the horizon when it comes to detection, prevention, and treatment. Among the tools being researched to help determine the particular disease path that a person is on are salivary biomarkers. Although not routinely available yet, this precision approach to the prevention and treatment of periodontal disease accounts for variability in a person’s genes, environment, and lifestyle. Because it is more personalized to the individual, it results in more accurate treatment planning as well as improved outcomes for the patient. Considering the aging population, periodontal (gum) disease has the potential to become the most prevalent dental disease in the near future. It is more important than ever for dentists to take the time to develop and incorporate a comprehensive periodontal examination and treatment protocol for adults. As with most diseases, delaying the treatment of periodontal disease until the advanced stages results in treatment that is more expensive, more complex, and less predictable. Most early to moderate stage disease can be treated in a general dental office if the inflammation is easy to control and the patient doesn’t have numerous systemic issues. Otherwise, it may be in the patient’s best interest to be referred to a like-minded periodontist. When half of the US population is still affected with periodontal disease despite decades of research and treatments, something is still missing. That missing key is a more collaborative approach involving, dentists, periodontists and physicians. To be continued.

The connection between oral health and systemic health is well-established and ever-evolving. One thing we know for certain, we are living longer but with more chronic diseases and medication than ever before.

Gum Disease in an Aging Population

The latest statistics are alarming. Forty-seven percent of US adults who are age 30 or older – an estimated 64.7 million Americans – have either mild gum disease (8.7%), moderate gum disease (30%) or severe gum disease (8.5%). As the population ages, the prevalence rises with 70% of individuals over the age of 65 exhibiting some level of gum disease. And, since we are on statistics, by 2030, it is estimated that the number of people over 70 years of age will have doubled from 35 million to 71 million. So, as we age, our risk of developing disease increases. Interestingly, there is also a direct correlation between the regions of the US with the greatest concentration of gum disease and those that have a high incidence of cardiovascular disease and diabetes. Although a direct cause-and-effect link is still in the works of being established between gum disease (periodontitis) and other systemic diseases, inflammation is often a common denominator. And, it is always important to remember that the mouth is the gateway to the rest of the body. We used to think that if people didn’t brush their teeth well or didn’t visit a dentist often they would automatically get gum disease. However, there are patients who have poor home care who never develop gum disease, and there are also patients who have great home care and visit a dentist regularly and continue to experience breakdown from gum disease – albeit at a slower rate than they would if they had poor habits. We now know that managing gum disease and other chronic inflammatory diseases like cardiovascular disease, diabetes, respiratory disease and arthritis are more patient specific based on an individual’s “inflammatory mediators”. These are molecules released by immune cells and are largely responsible for individual responses to disease susceptibility and progression. This is why probiotics are likely to play a significant role in treatment of chronic inflammation in the future. As we wait for research development of different ways to combat chronic inflammation, it is without dispute that people should do all they can to minimize inflammation in the mouth. The mouth is very accessible and with proper training, coaching and monitoring, a healthy mouth is better for your whole body. Although some may say that the associations between gum and systemic diseases are statistical by nature, not causal, the data is fairly strong that there is a link between gum disease and cardiovascular disease – such as heart infarction and stroke. This supports diagnosing and treating oral infections, including lifelong professional maintenance and good home care. Remember – just because it doesn’t hurt doesn’t mean there isn’t a problem. More next week.

One of my dental hygienists recently informed me of a new series on the Investigation Discovery cable channel called “Deadly Dentists”. Apparently there are enough stories out there about dentists to make a series.

I looked the series up online and despite my pre-conceived notion about what the content would be, the first episode is about a dentist who is killed by his wife’s boyfriend. I’ll probably stick to watching the Bruins and hope I am never in an episode.

However, the title of the series did remind me about stories of people dying in the dental office and how important it is to be ready for medical emergencies. A couple years ago I remember a dentist who was charged in the death of a patient in Connecticut after 20 extractions and implants placed in the same visit. The patient was sedated by a method many dentists (general and specialists) use called conscious sedation. It is a very safe method of sedation that usually combines a couple of different oral medications. Since respiration can be affected with conscious sedation, it is vital to measure oxygen saturation and have the proper equipment and plan in place in case of an emergency.

Patient Warning Signs and the Responsibilities of a Dentist

It took a year for the charges to be filed against the dentist. Apparently, the Connecticut State Dental Commission initially found that the dentist was practicing within the standard of care and didn’t immediately revoke his license. The allegations now are that the dentist ignored warning signs of the patient and also ignored warnings from staff members to continue on with treatment.

Most people cannot fathom having 20 teeth pulled and implants placed all at one visit. However, it is a relatively common procedure and the service is growing. So, in case you were wondering whether the dentist was doing too much at one time, the answer is that it depends who you are doing it on.

“The commission also found that [the dentist] should not have attempted to perform so many procedures on [the patient] in one office visit given that her medical history included a heart attack six months before the visit, two strokes within the last two years and medication that could have affected her response to the sedation.”

Do we assume the dentist knew about all these circumstances that made this patient a high risk to treat? Let’s assume the patient divulged all necessary medical information. It is up to the dentist to decide whether to treat or refer to a specialist that can provide more options for sedation and monitoring of vitals. It is essential for the provider and the patient to go over medical history and concerns in detail. The best interest of the patient should be the forefront of that discussion.

This same dentist also allegedly violated care standards a year before when another patient under conscious sedation to have teeth extracted inhaled a piece of gauze that was intended to prevent things from going down the throat. The patient was rushed to the hospital and recovered.

Both of these situations are unfortunate. Many people were affected and one life was lost. While it is impossible to determine a definitive decision based on the information available, it will be important for the dentist to show proper planning and reaction to incidents.

Medical histories are very important. Make sure to report all information, including any medications and supplements. And, if you are a medically compromised person and need significant dental surgery, consider a specialist.