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Hot Topic - Treating the Whole Patient Is Standard of Care

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I’ve been practicing and promoting integrated oralsystemic dentistry for decades, and I’m dismayed
that so many dentists continue to resist this patient-focused treatment approach. Why the hesitancy?

I believe it’s as simple as inertia—an attitude of, “We’re just fine as we are.”

I believe so strongly in the “holistic” comprehensive approach to dental care, and I’d like to offer just a few easy-to-implement strategies to get started. Because NOT offering these services to patients—who may not even know they exist—is denying your patients the enhanced outcomes that these advanced modalities provide.

• In light of the widely accepted association between ,periodontal disease and so many systemic problems,

offer comprehensive periodontal services. Don’t simply be a prophy mill. Keep up with the literature to stay informed about these links. One of the most significant is the contribution of periodontal disease to the total amount of inflammation present in the body. Every area of inflammation, whether it’s an ingrown toenail or periodontitis, contributes to the total amount of inflammatory burden, which is a significant risk factor for cardiovascular disease. Incidentally, the oral contribution for periodontal disease is huge…not insignificant.

• Unrelated to the presence of periodontal disease, we know that a wide range of specific oral bacteria directly affect general health. For example, Fusobacterium nucleatum has been shown to be directly causative to atherosclerosis. Therefore, you have to be doing salivary testing to identify which bacteria are operating in patients’ mouths, and subsequently manage and control them.

• There are 12 classic risk factors for periodontal disease. Heredity, stress, hormonal disturbances, smoking, and diabetes are among them. You need to identify the risk factors in each of your patients and manage them as best you can. There are some that you can manage, and some you can’t. But managing any of these risk factors is another extremely underappreciated
service in integrated treatment.

I don’t advocate implementing all the new bells and whistles that come along, but it is important to
keep current on technologies—from locally applied antibiotics to salivary diagnostics—that can move you closer to treating the whole patient.

In speaking with colleagues, I’ve found that there’s no lack of awareness of the links between oral health and general health. The challenge is synthesizing this knowledge into a comprehensive approach to dental care. It’s not difficult, it builds patient trust, and it can actually boost the bottom line.

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Richard Nagelberg, DDS, has been practicing comprehensive general dentistry in the suburbs of Philadelphia for more than 3 decades. He is an advisory board member, speaker, clinical consultant, blogger, and KOL for several companies and organizations. He lectures internationally on a variety of topics and is an evangelist for spreading the word about the impact dental professionals have beyond the oral cavity.

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