Understanding your Health Connections to your Gums and Teeth
by Sara De Nino Registered Dental Hygienist specializing in Holistic Oral Health Care.
In my experience, oral health care specialist’s best serve our patients by focusing our patients’ attention first on arresting periodontal disease.
Periodontal disease is strongly correlated with an array of chronic diseases. As Dr. David Tecosky, DMD, MAGD eloquently states, “more than 90% of systemic diseases reveal signs and symptoms in the mouth.
Most patients see their dentist on a regular basis more frequently than they do their physician. We are in a unique position to help our patients.”[i] I echo Tecosky’s perspective. As oral health care specialists we are on the vanguard of addressing our patients’ oral and overall wellness. Dentists and hygienists in our synergistic roles see patients’ inflammatory response first and up close.
I advance the view that oral healthcare specialists and all members of the dental team, best improve patient care by:
1) Seeking to achieve patient awareness of the factors that bear on periodontal disease and oral wellness through clinical assessment and education and,
2) Integrating nutritional assessment and planning for whole body health.
Foundational Awareness of Periodontal Disease
In my view patients’ achieving and maintaining oral wellness starts with their understanding of the fundamental importance of oral health to overall wellness. As the World Health Organization States: “[d]iet and nutrition affects oral health in many ways.
Nutrition, for example, influences cranio-facial development, oral cancer, and oral infectious diseases. Dental diseases related to diet include dental caries, developmental defects of enamel, and periodontal disease.”[ii] If patients have an “active awareness” of how periodontal disease, as an inflammatory condition, relates to overall wellness they are more likely to take tangible steps to enhance their oral and overall wellness.
Many diseases, especially chronic diseases, are rooted in the inflammatory process.[iii] “Manifestations of inflammation in the oral cavity very often correlate with systemic inflammatory processes.”[iv] In my opinion, based on what I have seen with my own patients, if more patients were actively aware that diseases of the gums and of the rest of the body are highly correlated, they would be more motivated to address the state of their gums.
If dental patients understood the systemic correlation between periodontal disease and other inflammatory diseases including arthritis, diabetes, and heart disease they would regard their visit to the dentist as far more important to their overall health than an obligatory quarterly or semi-annual tooth cleaning. As Gerlyn Beers says in the Say Ahh documentary:
“the total area of your gums is about the size of the palm of your hand….if you looked at the palm of your hand and you saw an open wound the size of the palm of your hand, would you just decide not to do anything about it…?”[v]
Oral healthcare specialists have the opportunity to activate patients’ awareness to the fact that their periodontal disease is an immune response burden on their bodies and possibly a bellwether of inflammatory conditions in the rest of their body.
Achieving Patient “Active Awareness”
Many patients may arrive for care with the expectation and wish that they simply receive a “teeth cleaning.” As we have discussed, accommodating these patients’ requests would ignore the fundamental importance of helping them understand the state and importance of their periodontal health. Fortunately we have many assessment tools at our disposal today. We are able to:
- conduct a full periodontal probing recording the bleeding, recession, furcation attachment levels, and mobility,
- employ intra oral imaging, a powerful tool for education and patient accountability to their oral health and,
- employ radiology/radiographic imaging
All of these are important steps. One of the most powerful tools I employ in treating my patients is microbiology. Microbiology is an inexpensive and highly effective motivational assessment tool for patients to improve their oral hygiene and assume greater responsibility for their oral health.
It is an excellent assessment tool for the practitioner. A phase contrast microscope (chair-side), helps inform treatment considerations and drive patient motivation. It helps me to educate our patients about the nature and intensity of their periodontal disease by allowing them to view the live aggressive micro-organisms in their samples (eg. spirochetes, amoeba, and trichomonads, and white blood cells).
Figure 1 Oral Amebeo Mag. 100x Figure 2. Oral Spirochettes 40x [vi]
In my experience showing patients their microbiology samples, is a vivid way of demonstrating to them the state of their oral health. Like the old adage, “a picture is worth a thousand words”, showing patients the microorganisms living in their own gum tissue, is worth a thousand encouragements to improve their oral hygiene habits.
I have seen more patients mobilized to take steps to address their oral wellness as a result of witnessing their microbiology than through any other method I have employed.
Finally biofilm samples placed on slides and gram-staining is a highly effective outsourced service that produces laboratory results on patients’ specific bacterial strains. Patients are often highly motivated by these oral microbiological reports because they are accustomed to receiving laboratory results from their physicians’ and considering how to improve their results. Such reports also provide data to share with other medical practitioners for the purposes of collaboration.[vii] .
In parallel with these assessment tools, oral healthcare specialists have the opportunity to enhance patients’ awareness of their oral health through education. Memory aids, for example, help patients to retain information. Twenty years ago a colleague of mine, introduced me to the word H.O.N.E.S.T. as an acronym used to list some of the factors that are associated with periodontal disease[viii]. It is an educational tool I have used and expanded ever since to help educate my patients:
H refers to hygiene treatment, hormones, host and heredity
O refers to occlusion, over the counter and medication, oral hygiene, and obesity
N refers to nutrition (including nutritional deficiency)
E refers to exercise
S refers to stress, sleep, smoking, systemic diseases, saliva, stage of life
T refers to transmissibility
Discussing these factors with patients increases their oral wellness I.Q. and empowers them to make better treatment choices in support of their overall health. Having this conversation with patients also helps construct a relationship platform that will be the foundation for working with the patient on their future care.
The most important education area I focus on with my patients is nutrition. Over the past 20 years, I have found nutrition to be the factor that bears most directly on periodontal disease and the incidence of other inflammatory conditions. I have observed a high correlation between healthy diets and healthy mouths. Several studies have reported the association between nutrition and periodontal status on the periodontal therapeutic outcomes.[ix] That is why I believe that nutritional education, built on a foundation of patients’ active awareness of the oral wellness connection, is so vital to our work as oral healthcare specialists.
Stay tuned next month for the Nutrition Connections to oral hygiene and your health!
[i] Tecosky, David as cited in Russo, Jacqueline, “Enhancing Periodontal Outcomes Through Nutritional Support.” http://aaosh.org/enhancing-periodontal-outcomes-nutritional-support/.
[iii] Hasturk H, et al, “Resolving E1 Regulates Inflammation at the Cellular and Tissue Level and Restores Tissue Homeostasis in Vivo,” J of Immunol, 2007; 179: 7021-7029.
[iv] Loos, Bruno G; Craandijk Jeroen; Hoek, Frans J, Paulien M.E.; Van Dillen, Wertheim, Van Der Velden, Ubele. “Elevation of Systemic Markers Related to Cardiovascular Diseases in the Peripheral Blood of Periodontitis Patients.”
Journal of Periodontology, October 2000, Vol. 71, No. 10, Pages 1528-1534.
[v] Beers, Geraldine, Oral Systemic Educator, Say Ahh: A Film About Fighting The World’s Largest Cavity: The One in Our Healthcare System.
[vi] Ellen, Richard P, and Galimanas, Vaia B, “Spirochetes at the forefront of periodontal infections,” Periodontology 2000, v38, Issue 1, pp 13-32, June 2005.
[vii] One of the least invasive but effective systems for the treatment of periodontal infection is the use of a dedicated antibiotic rinse for a short period of time to decrease pathogens and create a balanced biofilm. See Bosy A.; Pearson G; Legere S. “Using an antibiotic rinse system: an adjunct in the treatment of periodontal disease.” Oral Hygiene May 2013 and “Laser treatment of periodontal infection also leads to significant improvement and patient comfort,” Southward Ken, Bosy Anne, General Dentistry, July 2013, p. 41-44.
[ix] “Sugar–mediated ligand–receptor interaction in Immune System, Rudd, Pauline M; Wormold, Mark R; Dwek, Raymond A, Trends in Biotechnology, v22, Issue 10, pp 524-530 October 2004.