In October, I attended the University of Maryland’s Innovations in the Prevention and Treatment of Early Childhood Caries Conference: an intensive and very interesting update on the status of caries, the disease, and its various treatments.
A few things became quite clear: measuring oral health is difficult. Treating dental disease is challenging, labor intensive and extremely expensive. The currently accepted surgical approach to caries fails often and regularly and has a questionable return on investment: for example, the relapse rate of 52 to 79% after 24 months for children treated in the OR. Sobering statistics.
At one point during the conference, my notes morphed into a mind map. I placed CARIES at the center and filled the bubbles to the left of CARIES with the inherent qualities of teeth and the disease that destroys them. On the right side of the map I focused on the embarrassing statistics related to this PREVENTABLE disease.
What are we missing?
For one thing, the prevention we do in our clinics is based on a teach and tell model that fails to honor the ability of our patients to manage themselves. At the conference I learned about promising research projects focusing on filling that gap with Motivational Interviewing to help people change, video games to help teens change their health behaviors, saliva tests being developed in Japan to identify pathogens, the promises of xylitol.
What remains is: our current approach with caries prevents us from seeing the bigger picture: an oral microbiome out of balance from a 21st century diet loaded with sugars and fermentable carbohydrates, (malnutrition?) and compounded by the lack of oral hygiene facilities everywhere.
What is a dentist’s work?
It is hard to be a dentist. It is physically demanding and the work seemingly never ending. But there is more to the stress of being a dentist. In my search for authenticity and integrity, I have struggled with reconciling my construct of a successful dentist with the statistics relating to caries. It seems to me that I worked very hard to make very little difference. I would imagine that you, like me, also struggle with this dilemma, especially if you have a decade or 2 of practice behind your belt. This tension ate away at me, especially when I heard remarks on the cost of care or comments on how financially rewarding it must be to be a dentist. Somehow, I was never completely satisfied with my replies to these comments highlighting the fact that dentists are highly qualified health professionals.
What can we do to fill those gray areas on the diagram?
On September 12, 2014, FDI World Dental Federation launched its Data Hub for Global Oral Health a first of its kind online database collating oral health data from various international sources – including World Health Organization (WHO), Niigata University, Malmö University, World Bank and Globocan
The FDI Data Hub is an easy-to-use, one-stop-shop for global oral health data. It provides FDI members and policy makers with the tools to support and promote advocacy for the dental profession. As recognized by the United Nations, oral diseases pose a major health burden for many countries, share common risk factors and can benefit from common responses to non-communicable diseases (NCDs). Therefore, the FDI Data Hub includes the use of NCD risk factors together with oral health indicators. Click Data Hub for Global Oral Health to learn more.
A new book on the oral-systemic connection has just been published: “The Oral-Systemic Health Connection: a guide to patient care” – edited by Michael Glick, DMD.
It is a collection of 13 chapters on different topics ranging from “Causation, Association, and Oral Health-Systemic Disease Connections” to “Oral Manifestations of Systemic Diseases” and “The Traveling Oral Microbiome”. These chapters were written (some co-authored) by 19 different university professors in fields ranging from Periodontics to Oral Medicine.
I was pleasantly surprised by how easy the book was to read. While it had copious references and detailed scientific descriptions, it is written in a way that wet gloved dental professionals can easily understand. This is because of the many conclusions, summary boxes, color pictures, Figures, and other pages like “Clinical Considerations- What you can take back to your practice” interspersed throughout the book.
Upon completion of the book, I felt like I had been updated on the different facets of the science behind the O-S connection.
Here are a few outtakes from the book:
- “The notion that infections in the oral cavity may influence oral health is not a novel idea. More than 2,000 years ago, Hippocrates was credited with curing arthritis by extracting presumably infected teeth.” (Glick, preface)
- “Moving forward, oral health care providers should have a role in preventing and treating non communicable and communicable disease in an effort to reduce their associated morbidity and mortality,” (Greenberg, Chapter 1)
- “This concept is supported by the fact that currently there is no scientific evidence that identifies any particular bacteria as a cause of periodontitis.” (Borgnakke, Chapter 4)
- Oral conditions can significantly influence or be influenced by events locally and systemically.”(Freire and Van Dyke, Chapter 5)
- The target of periodontal therapy, whether it be control of the biofilm, and/or control of the local inflammation, should be to control systemic inflammation associated with chronic systemic diseases.”(Freire and Van Dyke, Chapter 5)
As you can see by my above quotes, I found the first 5 chapters to be the most interesting. The remaining chapters were on the O-S connection in diabetes, the cardiovascular system, obesity, pneumonia, pregnancy, immunocompromised patients, osteoporosis, and the oral manifestations of systemic diseases. The last 8 chapters addressed the clinical considerations of these maladies and how you can address them in your dental practice.
The negatives of the book for me were the price ($118.00) and no mention of how important it is to understand the dynamics of how people change their health behaviors and how dental professionals can learn how to facilitate this.
This book review was first published in www.SpiritOfCaring.com and is reprinted here with Lynn Carlisle’s permission.
To read more about the book visit Amazon Books The Oral-Systemic Health Connection: a Guide to Patient Care
Too few oral health care providers are seeing children under the age of 3. The University of North Carolina at Chapel Hill and the developers of the Baby Oral Health Program have created a couple of very helpful videos for dental health care providers to boost confidence and competence in delivering preventive oral health services for young children. Click here to watch the bOHP Provider Training Videos. While you are on the bOHP site, go to PROVIDER REGISTRATION on the top right of the screen and register as a provider. Registration is free.
THE CANARY SYSTEM HAS SUPERIOR EFFICACY IN DETECTING PROXIMAL CARIES COMPARED TO CONVENTIONAL METHODS
Led by Professor B.T. Amaechi, researchers from the University of Texas Health Science Center at San Antonio recently presented their findings that The Canary System® has superior diagnostic efficacy in detecting proximal caries compared to conventional methods including bitewing radiographs.
The findings were presented July 2-5, 2014, in Greifswald, Germany, at the 61st ORCA Congress (European Organization for Caries Research), and were published this month in Caries Research. The researchers concluded that The Canary System had greater sensitivity (0.933) compared to visual detection (0.733) using the International Caries Detection and Assessment System (ICDAS) II and bitewing radiography (0.267). When examining early lesions specifically, the highest negative and predictive values among all methods were for The Canary System at 89.2% and 88.9%, respectively. They concluded that The Canary System can be a valuable method for proximal caries lesions diagnosis.
This independent study along with the over 60 peer-reviewed publications, 14 case reports and 2 Health Canada approved clinical trials validates The Canary System as an accurate, repeatable, and safe device for the detection and monitoring of caries on all tooth surfaces, around the margins of restorations and beneath the intact surfaces of opaque sealants. The Canary System’s crystal structure diagnostics has become an essential diagnostic tool in dental practices in the US and Canada.
Our surroundings influence how we come together and how we come together in turn influences how we speak with one another. Knowing these fundamental facts, Dr. Ian McConnachie, Dr. Clive S. Friedman, Dr. Stephan Abrams and myself, Dr. Marielle Pariseau, launched a workshop this morning to facilitate a different kind of working conversation at the heart of ASM14, the Ontario Dental Association’s Annual Spring Meeting.
This workshop embodies a different way of learning that has the capacity to engage and empower our membership in dealing with the many concerns that have been identified with regards to the present and future of dentistry. It models an agile style of leadership that sees a leader in every chair in the room and it uses conversation as a core process around questions that invite all participants to make choices today to positively influence the future of dentistry.
We put a lot of thought in creating a space for this workshop that would give participants a new perspective, a sense of belonging, of connection with their inner wisdom and that of others around them. A space to inspire participants to move from knowing deep inside what to do, to talking about it, and to actually doing it.
The vision at the core of this process is
EMPOWERING ALL DENTISTS TO BE
LEADERS IN HEALTH
A spark was ignited this morning as a result of this workshop. As a participant, we invite you to keep the spark alive with your comments. The rules are the same as the ones we presented during the workshop:* Be mindful * Be willing to be influenced * Set aside your preconceived conclusions, your judgement * Comment from your heart * Engage your right brain: your left brain may be very smart, but without your right brain you can not see the whole picture
If you were not a participant this morning, May 9 2014, we welcome your comments too. However, if you find it difficult to express your inner wisdom in writing, we understand. This is normal. We learn to speak before we learn to write and this is WHY we created this workshop, to give dentists a chance to speak first. You may want to contact us to explore the possibilities of hosting a Shaping the Future of Dentistry workshop at the heart of your dental community.
Professor Andreas Mandelis, Co-Founder of Quantum Dental Technologies (QDT) and Co-Inventor of the core technology behind The Canary System, is the winner of the 2014 Killam Prize, one of Canada’s most prestigious scholarly awards. The Killam Prize recognises outstanding career achievement by scholars actively engaged in research.
From the University of Toronto’s Faculty of Applied Science and Engineering, Mandelis is a world leader in the field of diffusion-wave and photoacoustic sciences. Professor Mandelis’ groundbreaking research puts him at the intersection between the exciting fields of engineering and applied physics – a combination that attracted him because of its wide potential for applications. By blending these two research fields, Mandelis and his team are able to see small differences in the human body or manufacturing materials that have gone previously undetected.
Professor Mandelis’ discovery and development of the core technology behind The Canary System, PTR-LUM, uses energy conversion technology to analyze infrared and luminescence signatures in order to provide information on the condition of the tooth structure. Unlike fluorescence-based devices that reveal the presence of bacteria close to the tooth’s surface, The Canary System identifies abnormalities in the crystal structure of the tooth up to a depth of 5mm. It can also pinpoint cracks that are causing pain and sensitivity. No other caries detection device on the market has these capabilities.
“We go where no light has gone before”, said Mandelis. “With support and hard work from the entire QDT team, we did the research, founded QDT, and brought The Canary System to dental clinics.”
Please visit www.thecanarysystem.com for additional information.
“Fed Up” was a hot topic during the Sundance Film Festival this year. The movie exposes how the food industry replaced the fat content in “light” and “low fat” food items with sugar. Medical experts and powerful newsmakers also expose the relationship between the food industry and the US government.
One of the facts that caught my attention is the time frame during which the shift from fat to sugar began: in the late 70’s. In the early 80’s the benefits of water fluoridation reached a plateau. Dentists assumed at the time that the plateau indicated the limitations of water fluoridation. But knowing that the frequency of carbohydrates consumption leads to an increase in numbers of acidogenic bacteria, I am now thinking that the fluoride added to community water supplies was no longer able to cope with the new challenge. Today, while many parents consider cereals a healthy way to start the day, most breakfast cereals contain so much sugar, they should be labelled as dessert.
Another fact that shocked me was that the World Health Organization’s recommendation from 2002, that sugars should make up less than 10% of total energy intake per day was not only silenced by the food industry, but increased to 25%.
The film follows the lives of a group of obese children over the course of two years as they diet and exercise in an effort to become healthier. Some scenes are heart breaking. Interestingly though, there is not a single mention of the caries or early childhood caries epidemic. Nothing new here. Oral health is seldom included in total health. But what if dentists could reverse this state of things? Are dentists Fed Up enough of being left out of the health equation to do something about it? Are we ready to take a stand against sugar to finally connect the mouth to the rest of the body?
Fed Up opens in theatres across United States on May the 9th. An eye opener on what is making America so sick, caries not included. Dentists, see the movie, support the WHO’s recommendations regarding maximum daily sugar intake and embrace the FDI’s vision of oral health as the foundation to overall health.
Connecting with patients leads to better engagement. Engagement empowers patients and holds them accountable for their own health. Using Motivational Interviewing in the dental office helps in connecting / engaging our patients, helping us shift from a reactive, surgical approach to care to one of pro-active prevention. With ORAL HEALTH proposed as the foundation for overall health by the FDI VISION 2020 Task Force, let’s see dentists leading the way with this empowering approach to ORAL HEALTH.
According to a white paper released today by the World Dental Federation (FDI), oral diseases are among the most common diseases of humankind, yet they receive little attention in many countries with weak health care systems. Despite a high social and economic burden from oral diseases they are considered a neglected area of international health. World Oral Health Day provides an opportunity to increase awareness of the poor state of oral health in many places and offers an occasion to highlight realistic and cost- effective solutions for health care systems and individuals alike.
WHAT IS ORAL HEALTH?
Oral health is more than dental health. It includes healthy gums, hard and soft palate, linings of the mouth and throat, tongue, lips, salivary glands, chewing muscles, and upper and lower jaws. Good oral health enables us to speak, smile, kiss, breathe, whistle, smell, taste, drink, eat, bite, chew, swallow and express feelings. The oral cavity plays a central role for intake of basic nutrition and protection against microbial infections.
The World Health Organization (WHO) defines oral health as “a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing” .
WHAT IS THE CONNECTION BETWEEN ORAL HEALTH AND GENERAL HEALTH?
Oral health and general health have close linkages. On the one hand, oral health can be compromised by a number
of chronic and infectious diseases which show symptoms in the mouth. On the other hand, oral diseases can lead
to infection, inflammation, and other serious impacts on overall health. Thus, maintaining good oral health is crucial to sustain general health and vice versa.
Click ORAL HEALTH WORLD WIDE to access the full white paper.