The Dentist’s Role in Nutritional Counseling
Offering a new approach to treatment of sleep-disordered breathing
John Nosti, DMD, FAGD, FACE, FICOI; Jennifer Nosti, RDH
For years, science has been uncovering more connections between oral health and the body. Yet as dental professionals, it seems so often we limit our scope of practice to only the mouth, even though we are increasingly aware that the body is an interconnected mechanism.
Dentists are among the first-line medical practitioners to recognize when a patient may have obstructive sleep apnea (OSA) or a sleep breathing disorder (SBD). In most states, even though the dentist is required to refer out for the “official” diagnosis, it is the dentist who first recognizes these problems/conditions. In many cases, oral appliances and CPAPs only treat symptoms of OSA/SBD. We are obliged to ask ourselves, “When appropriate, should we be moving beyond these ‘crutches’ to offer permanent solutions?”
For example, the first time we discuss the reality of periodontal disease with our patient can be uncomfortable. We are sensitive to our patients’ feelings and don’t want them to feel upset. However, we must make sure our patients are aware of their accountability moving forward for long-term success of periodontal treatment.
The same is true for nutrition and weight loss. “It can be uncomfortable to discuss a patient’s weight,” said obesity expert William Dietz, MD, PhD, director of the Sumner M. Redstone Global Center for Prevention and Wellness at the George Washington University, during a presentation held by the Institute for Medicine. “Many health care professionals were not taught how to open the conversation with patients comfortably regarding weight related health issues.” Even when we know weight loss may very well be the solution to their OSA or SBD, opening the dialogue may be challenging. Heart disease and periodontal disease go hand-in-hand. Obesity, heart disease, and OSA also go hand-in-hand. That is why it is unequivocally necessary in your practice to discuss this with your patients.
An easy way to bring up the topic is to create an intake form that allows the client to decide how and when to discuss his or her weight and takes the shame out of the conversation. The American Council on Exercise suggests some simple, non-confrontational questions to add to your sleep questionnaire, such as:
• Would you like your health professional to discuss your weight with you?
• What words are you comfortable with when referring to your weight?
According to the Centers for Disease Control and Prevention, a staggering 65% of adults in the United States are either overweight or obese. Overweight is considered to be a body mass index (BMI) of 25.0 to 29.9, whereas obese is anything over 30.0 BMI. There is a known correlation between being overweight and developing OSA. Experts also agree that a decrease of 10% body weight can lead to significant clinical improvement in OSA, which proves the importance of addressing weight when trying to manage OSA or SBD.
How do you add nutritional counseling to your practice once the patient has been identified through proper screenings?
1. Refine your health questionnaire to incorporate non-confrontational questions about weight in the sleep questionnaire sections.
2. Fine-tune your nutritional skills so you can personally guide your patients to better health. Many organizations and schools offer online advanced training and certifications.
3. Employ or refer to a dietician who can educate your patients in groups or on a one-on-one basis.
4. Provide a “turn key” nutritional system that will empower the patient to improve their nutritional health on their own terms.
Each of these recommendations can be implemented alone or in conjunction with another solution. There are patients who are eager to do things themselves once they are given direction, whereas others prefer a system that is provided for them. Implementing these methods will increase the success rate in your office by increasing the options you are able to provide to your patients.
One of the milestones in the health care industry was the introduction of smoking cessation programs available to all health care providers. Physicians and dentists worked nationally on this program and achieved great success. The same can hold true for nutritional programs in the dental office. A successful program not only achieves greater health benefits for your patients, but also improves profitability and residual income to the practice.
For any questions, or if you would like to receive a health questionnaire to use in your office, please visit www.JenniferNosti.com.
About the Authors
John Nosti, DMD, FAGD, FACE, FICOI, practices general dentistry with an emphasis on functional cosmetics, full-mouth rehabilitations, and TMJ dysfunction. He is the clinical director for The Clinical Mastery Series and has earned a weight management specialty certification from the American Council on Exercise. He is a committed member of and fellow to numerous dental organizations.
Jennifer Nosti, RDH, is a nutritional and wellness coach who helps private practices incorporate nutrition and wellness counseling into their framework. She graduated from the University of Medicine and Dentistry as a dental hygienist in 2006, and has since earned her certification in nutritional therapy.