Dental Tribune USA

Dentistry: It really is the new medical specialty

By Dr Mark Duncan, USA
October 06, 2009

For years we have heard of the ever-growing connections between dentistry and medicine, with articles written in medical and dental journals as well as in scientific authorities such as Reader’s Digest or Ladies Home Journal. For decades dentists have looked at the increasing body of evidence that what we are doing in the mouth can affect the rest of the body.

Nearly a century ago, Dr Mayo said a person with a healthy mouth would live longer. And yet, the question still remains as to what we are doing for our patients.

In dental school I distinctly remember being told a monkey could be taught to do what we are doing, and I am sure you have been given a similar charge. My feeling is this was supposed to encourage us to learn to become doctors, but in the end, I fear we have fallen short. I think that even had we been able to grasp the depth of the connection between the mouth and the rest of the body, the application of that knowledge is something we simply were not ready for.

Fortunately, dentistry is a profession that demands an ongoing dedication to learning. We are not productive professionals if we spend our careers learning to do the exact same thing over and over. As with all of life, either we grow or we wither and die.

The mountain of evidence that supports the oral-systemic connection has seen incredible growth and advancement over the last few years — and it has seen that tremendous growth in a variety of fields in dentistry. There is no longer a question as to “if” the soft tissue in the mouth is connected to the rest of the body. We can easily find evidence of periodontal pathogens creating challenges in tissues throughout the body.

Periodontal pathogens can be found throughout the body from plaque in the aorta and arteries, to the gut and the lungs, to tissue in the brain. Periodontal disease is implicated in disease processes from cancer to Alzheimer’s to lung disease to pre-term low-birth-weight babies. The co-morbidity of periodontal disease is astronomical, and yet it is largely ignored in the traditional practice of dentistry.

However, the oral-systemic connection is not limited to just infections in the soft tissues of the mouth. The impact of the mouth extends to such monumental things as blood flow to the brain.

Just as with periodontal pathogens and the course of periodontal disease, the understanding of other supporting soft tissues in the head and neck has seen evolution. Throughout the history of occlusion in dentistry, we have moved to the next level with an increase in perspective.

About 100 years ago, we thought balanced occlusion was the answer. Then about 30 or 40 years later we realized the jaw joints had an impact.

From our new understanding of gnathology, we saw some improvement and also some things that were still lacking and worked from the other end first. We thought perhaps the jaw joints were paramount, and that created the ideas that have become the centric relation-based understanding most of us were educated with in dental school.

As with everything in life, to ignore a part of the system results in an incomplete mastery of the whole. As technology advanced to be able to evaluate the supporting soft tissues, we recognized there is a massive impact on the system as a whole in the muscles that support the head and neck.

With this new perspective, known as neuromuscular dentistry, some absolutely amazing things are happening. This brings into the field the critical understanding of the growth and development and protection of airways, along with the multitude of ways a dental condition can create myofacial pain and migraine-like pain.

What we can now see is the way a chronic pathologic bite can wreak havoc in the body as a whole. What we now know is why we don’t have room for that crown on the second molar, even though we know we removed 1.5 mm from the occlusal surface. What we understand is why a tooth that never hurt or had any symptoms starts to bother the patient after the failing restoration is replaced.

There are so many areas of dentistry that are exploding with new understanding and new technology, and we can help patients in ways that we never imagined possible before, and our patients are paying the price, whether in pain or periodontal infection. Quite simply, periodontal disease is the most pervasive infectious disease in adults, and it is preventable.

It is time to change that! I am fortunate to get the chance to be sharing these concepts in the new “Proactive Perio” course and in the Core Curriculum at the Las Vegas Institute. Join us as we make our profession a better caretaker for our patients!

About the author

Dr Mark Duncan is the clinical director at the Las Vegas Institute for Advanced Dental Studies (LVI). Teaching with LVI since 2002, Duncan has been recognized by the Oklahoma Dental Association with the Platinum Eagle Award for his dedication to continuing education and raising the bar for professional development and education. He lectures across the country on esthetics, technology and practice management topics.

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