The New Role of Your Dentist
By Kevin H. Norige, DMD T
he next time you go to the dentist, the fi rst question you may be asked is, “How is your health in general?” Over the last couple of decades, the role of your dentist has changed from
merely fi xing your teeth and gums to becoming a vital partner in assessing not only your oral health but also often as the fi rst observer of unhealthy changes involving your cardiovascular system, your lungs, and your brain: aptly named the oral-systemic connection. And due to the increased regularity that most people see their dentist compared to seeing their primary care physician, going to the dentist may be the best way to improve your overall wellness and decrease healthcare costs.
Since ancient times, even the most casual observer has been able to deduce whether an individual was well or ill based on their appearance or level of activity. Even the word vitality comes from the Latin “vita” meaning life or to live. As the art and science of healthcare evolved, our precision in determining an individual’s rela- tive health and wellness has improved. In medicine, we routinely are measured non-invasively for height, weight, heart rate, and blood pressure.
So too in dentistry, your dental professional uses relatively
non-invasive observations to determine the presence of health or the severity of disease. But now your dentist has an improved array of tests to not only gauge the relative severity of a disease process, but also to screen for the presence of disease and the potential that an individual will exhibit symptoms of disease.
And it all starts with questions, such as: • Where are the areas of your mouth that you avoid during biting and chewing?
• Where are the areas of your mouth that bleed when you brush your teeth or fl oss your gums?
• When do you have any discomfort or lack of mobility in your jaws or jaw muscles?
• When do you snore? Or have you been told you stop breathing when you sleep?
Following the questions, a physical evaluation is performed “looking” for signs of disease or dysfunction: including measurement of blood pressure, heart rate, oxygen saturation, temperature, high speed digital x-rays, digital photographs, and measurement of the gums using a little round ruler called a periodontal probe. Based on the answers to the preliminary questions and an evaluation of the data from the measurements, your dentist will now specifi cally use more sophisticated tests to diagnose and more effectively treat your dental disease or refer you to your physician for management of your medical disease.
When an individual presents with extensive cavities or has re- curring bouts of cavities, this usually indicates that the individual has a high level of cavity producing bacteria in their mouth being fed by a diet laced with sugar. A high cavity rate can also hint at potential metabolic issues including type 2 diabetes, insulin resistance, and obesity. Your dentist may request to have ordered: a fasting glucose tolerance test or a Hemoglobin A1c test to discover the root cause of the cavity disease, and then begin to restore the damage from the disease. Your dentist may also do a saliva test to measure the acidity of your mouth (pH) and even a saliva bacteria DNA test to determine which specifi c bacteria are causing the destruction.
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Similarly if an individual presents with gum
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disease, which is minimally indicated by ANY bleeding (or discharge) on measurement of your gums, your dentist can do a simple saliva test to determine what kind of and how much of certain known pathogenic (disease causing) bacte- ria are present. This information can help the dentist decide what best course of anti-bacterial treatment is indicated. However, as bad as the bacteria are, the major problem with destruc- tive gum disease (known as periodontitis) is the body’s protective immune response going into “destructive overdrive” resulting from chronic infl ammation. Scientists cite gum disease as the #1 source of chronic infl ammation in the body, with chronic infl ammation being the major cause
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