The More Complete "Complete Dentist"
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Because the health of Americans is reaching a crisis level, there is an opportunity, and need, for dentists to address more than just the mouth, but the whole system. Learn how you can treat systemic inflammation to improve patient care & your bottom line.
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The More Complete "Complete Dentist"
- 1. The More Complete ‘Complete Dentist’ The Dawson Academy’s Dental Institute for Systemic Health DeWitt C. Wilkerson DMD Director of Dental Medicine
- 2. “I believe dentists should be on the front lines fighting the health crisis that is destroying our nation.” MichaelRoizenM.D. Chief WellnessOfficer ClevelandClinicWellnessInstitute
- 3. Dental teams are the patient advocates for total wellness
- 4. Dental teams are the gatekeepers for systemic inflammation
- 5. In what areas can a dental team identify and help manage systemic inflammation?
- 6. Systemic Inflammation Sources Oral Pathogens Physical inactivity (Obesity) Inflammatory Diet Sleep Apnea Toxins & Smoking Stress
- 7. What is your clinical definition of a periodontal condition? a) pocketing greater than 3 mm b) pocketing greater than 3 mm with bleeding c) bleeding with or without pocketing Oral Pathogens
- 8. Do you think abscessed teeth have an“Oral-Systemic Connection”? a) yes b) no c) sometimes Oral Pathogens
- 9. Dental teams are the primary health care providers to put out the fire of oral initiated systemic inflammation
- 11. Bradley Bale M.D. inflammation The LINK between Oral &Vascular Disease
- 12. Systematic Diseases associated with Specific Oral Bacteria Systemic Diseases Associated with Specific Oral Bacteria Oral Bacteria Associated Systemic Diseases A.a. Aggregatibacter actinomycetemcomitans Major etiological agent Brain abcesses Infective endocarditis Stenotic coronary artery plaque Aneurysmal wall Aneurysmal thrombus tissues P.g. Porphyromonas gingivalis Major etiological agent Rheumatoid Arthritis Chronic kidney disease Multiple sclerosis Stenotic coronary artery plaque Aneurysmal wall Aneurysmal thrombus tissues Atheromatosis, Atherosclerosis Diabetes T.f. Tannerella forsythia Major etiological agent Myocardial infarction Stenotic coronary artery plaque Aneurysmal wall Aneurysmal thrombus tissues Diabetes T. d. Treponema denticola Major etiological agent Stenotic coronary artery plaque Aneurysmal wall Aneurysmal thrombus tissues Diabetes F.n. Fusobacterium nucleatum Preterm births Pre-eclampsia Colorectal cancer P.i. Prevotella intermedia Myocardial infarction E.c. Eikenella corrodens Respiratory diseases C.s. Capnocytophaga species (gingivalis, ochracea, sputigena) Diabetes Atheroma (plaque) Thrombus (blood clot)
- 13. Fusobacterium nucleatum(Fn) gram- Increases permeability of endothelium and bacteria enter the arterial wall Fardini, Molecular Microbiology 11/2011
- 14. PD Pathogens found in coronary plaque Gaetti-Jardin, Journal of Medical Microbiology 2009 • 44 pt. endarterectomies • 39 had PD; 36/39 plaques positive for PD pathogens • DNA: Pg, Aa, Tf, Pi, Pn • 2 or more found in 64% of the plaques • Suggests: PD pathogens in coronary plaque is not coincidental, they may contribute to the development of coronary plaque
- 15. PD Pathogens found in carotid atheroma Figuero, Journal of Periodontology 8/2011 • 42 carotid endarterectomies analyzing PD paths • 33/42 Pg+, 28/42 Aa+, 26/42 Tf+, 21/42 Fn+ ... ALL had at least one
- 16. Oral pathogens and acute heart attacks. Pessi, Circulation 2/2013 • 101 acute heart attack patients • Obstructing thrombi and arterial blood analyzed for PD pathogens • Bacterial DNA load 16x greater in thrombi than arterial blood • Oral viridans streptococci (Ex. Strep mutans) found in 78% of thrombi • PD pathogens found in 35% of thrombi
- 17. •30 patients had panoramic CT •50% showed periapical abscess •If pt’s thrombus was + for strep viridans DNA: they were 13 times more likely to have a periapical abscess Oral pathogens and acute heart attacks. Pessi, Circulation 2/2013
- 18. •Electron microscopy of 9 thrombi •Bacteria-like structures in all 9 Oral pathogens and acute heart attacks. Pessi, Circulation 2/2013
- 19. Conclusions: Dental infection and oral bacteria are associated with the development of acute coronary thrombosis--heart attack! Dental health and dental care should be one major element in preventing heart attacks! Oral pathogens and acute heart attacks. Pessi, Circulation 2/2013
- 20. Bradley Bale M.D. “All cardiovascular prevention programs must include an oral/systemic component.” “Dentistry is a Big Dog in the CV wellness arena!” &
- 22. Tom Nabors, DDS Think Local & Systemic Infection
- 23. Page 1 emphasizes the bacterial profile A “Positive” result indicates bacterial pathogens detected above threshold “Bacterial Risk” Risk of disease progression based on specific bacterial pathogens. “Pathogen Load Threshold” The concentration above which patients are generally at increased risk of attachment loss/disease progression (represented by the black lines) CLINICAL CONSIDERATIONS Page 2 emphasizes clinical considerations Options to reduce bacterial risk MyPerioPath® can be used to assess response to therapy Links to additional information at MyOralDNA.com The Future is now: Microbial & GeneticTesting
- 24. The Future is now: Microbial & GeneticTesting Systemic Inflammation Markers hs-CRP (C Reactive Protein) Lp-Pla2 (Plaque test) Hemoglobin A1-C (sugar) Heart Smart Screen silverstaff.com
- 25. Complete Examination: • Periodontal probing- Signs of any Inflammation? • Data Collection (testing)- Salivary Diagnostics • Diagnosis • Therapy Protocol Where do we start?
- 26. ADA ClassificationADA Classification Type I Gingivitis • No loss of attachment • Bleeding on probing may be present Type II Early Periodontitis • Pocket depth or attachment loss: 3-4mm • Bleeding on probing may be present • Localized area of gingival recession • Possible grade I furcation involvement Type III Moderate Periodontitis • Pocket depths or attachment loss 4-6 mm • Bleeding on probing • Grade I or II furcation involvement • Class I mobility Type IV Advanced Periodontitis • Pocket depths or attachment loss >6 mm • Bleeding on probing • Grade II or III furcation involvement • Class II or III mobility Type V Refractory & Juvenile Periodontitis • Periodontitis not responding to conventional therapy or which recurs soon after treatment. • Juvenile forms of periodontitis. Diagnosis Therapy Protocol
- 27. Therapy modalities that will totally eradicate the causes of local and systemic inflammation What’s the therapy protocol?
- 28. What’s the therapy protocol? Root Planing & Curettage Antibiotics/AntimicrobialsAntibiotics/Antimicrobials Generic Name Brand Name chlorhexidine gluconate Peridex, Periogard clindamycin Cleocin doxycycline Periostat metronidazole Flagyl penicillin hydrogen peroxide PerioProtect Sustained ReleaseSustained Release Generic Name Brand Name chlorhexidine gluconate PerioChip doxycycline hyclate Atridox minocycline Arestin
- 29. Pathogen Testing www.oraldna.com Type II (early periodontitis) What’s the cause?
- 30. Iodine irrigation (5 minutes) Type II (early periodontitis) Therapies to eradicate infection
- 31. Daily irrigation (4 weeks) Viajet by Oratec Type II (early periodontitis) Therapies to eradicate infection
- 32. CLINICAL CONSIDERATIONS Page 2 emphasizes clinical considerations Options to reduce bacterial risk MyPerioPath® can be used to assess response to therapy Links to additional information at MyOralDNA.com ✓ Retest Higher Risk Cases Type II (early periodontitis) Therapies to eradicate infection
- 33. Higher Risk Cases Type II (early periodontitis) Therapies to eradicate infection AntibioticsAntibiotics Generic Name Brand Name clindamycin Cleocin doxycycline Periostat metronidazole Flagyl penicillin Sustained ReleaseSustained Release Generic Name Brand Name doxycycline hyclate Atridox minocycline Arestin
- 34. Type II (early periodontitis) Therapies to eradicate infection Maintenance Daily Irrigation Therasol, Oratec
- 35. Tommy Nabors DDS ©Thomas W. Nabors, DDS, FACD 4 12 mo. post-op 3 mm- 5 probe sites 4mm- DB site 0 bleeding ©Thomas W. Nabors, DDS, FACD 2 Infection with 10-12 mm pocket TYPE IVadvanced periodontitis(localized) ©Thomas W. Nabors, DDS, FACD 3 4 Months Post-Op Oral Pathogens
- 36. DeWitt Wilkerson DMD Oral Pathogens New Patient: Age 67 Quadruple Bypass- 2004 2 Stents - Spring 2013 Heart Attack- Fall 2013
- 37. DentalTeams are the Gatekeepers for Systemic Inflammation Oral Pathogens Physical inactivity (Obesity) Inflammatory Diet Sleep Apnea Toxins & Smoking Stress
- 38. Dental teams are the patient advocates for total wellness
- 39. Building a successful practice model around total wellness Stephanie Lodding RDH Elgin, Illinois $540,000 “Total Wellness” services 2013
- 40. Building a successful practice model around total wellness Tommy Nabors, DDS Nashville, Tennessee $1 million+ “Total Wellness” services 2013
- 41. How can you successfully implement these ideas?
- 42. Bradley Bale MD Amy Doneen PhD, RNP Tony Iacopino DMD Susan Maples DDS Steven Masley MD Tom Nabors DDS Tommy Nabors DDS Stephanie Lodding RDH David Seaman DC, MS DeWitt Wilkerson DMD Gy Yatros DDS Total Wellness Dental Practice Faculty
- 43. Total Wellness Dental Practice CURRICULUM SCHEDULE - NASHVILLE October 24-25 Oral Pathogens, Genetics & Systemic Inflammation: The Oral Connection to Systemic Disease November 14-15 Oral Health as an Essential Component of Cardiovascular Wellness Reviving and Thriving in the Business of Hygiene January 16-17 Building your Cradle-to-Grave Total Wellness Dental Practice Emerging Lifestyle Factors Enhance Cardiovascular Health February 13-14 Diet and Chronic Inflammation: Implications for Dental and Systemic Health The Importance of the“Periodontal-Systemic Connection”Throughout the Lifespan March 13-14 Evaluation, Diagnosis and Treatment of Sleep Disorders April 17-18 Facial Pain, Headaches & Splint Therapy
- 44. Total Wellness Dental Practice COURSE DETAILS Format: 6 weekend (Fri-Sat) sessions Tuition: $7,000 per dentist, $1,500 per hygienist or team members CE Credits: 84 Click here to learn more about this course.