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Inside Dentistry
April 2019
Volume 15, Issue 4

A Case for Rebranding, Part II

Closing the loop between dentistry and medicine

Robert H. Maccario, MBA

When addressing periodontal disease, to raise awareness that it is a true medical concern, not "just a dental problem," and minimize the stigma of being a "bad patient," the need to rebrand the condition as an oral systemic infection (OSI) becomes apparent. The utilization of rebranding has a proven track record in both the medical and dental professions. For example, incontinence has been rebranded as overactive bladder and "snoring" as obstructive sleep apnea. In addition to increasing treatment acceptance and improving the health of patients, rebranding also helps facilitate easy and necessary communication between dental and medical practices.

Setting the Stage

To build on two previous points from the first article in this series, which were that "the specific words that you choose to use in your patient communications matter" and that "a dentist who adopts a science-based approach to oral healthcare is no longer merely a ‘tooth doctor' but instead, a specialized healthcare provider focused on the oral cavity," applying proven fundamentals of communication is appropriate if dentistry is to motivate the healthcare buyer. There are three critical points of communication that a rebranding strategy can enhance, thereby improving patient care:

1. Context is Critical

Defining and speaking about gum disease as an OSI, which is a medical problem, can help lead patients to conclude that if left untreated, it will get worse and could infect other parts of the body. This shifts the burden and focus away from embarrassing personal attachments and raises its value beyond being "just a dental problem that happens to patients with poor hygiene habits." This context changes the mindset of the healthcare buyer and makes the communication process more comfortable.

Ask your patients if they are familiar with the oral-systemic connection. If they are not, then explain that infection leads to inflammation and that inflammation can contribute to the development of or exacerbate many disease states, such as diabetes, Alzheimer's disease, cardiovascular disease, and some cancers. Let them know that a significant portion of the US population has an OSI and that if theirs is left untreated, the infection could travel through the bloodstream and become a serious health problem as well as contribute to and aggravate other health conditions.

2. Communicate Clearly

A fundamental tenet of business communication states that if you confuse consumers, they won't buy. According to Janet Press, RDH, an international trainer on hygiene protocols and laser certification, "You cannot treat infection with prevention." Applying this simple and concise principle to patient care is extremely powerful because it can help overcome some of the obstacles associated with treatment acceptance and care delivery.

If initial treatment discussions with patients include both therapeutic therapies (ie, to treat infection) and home care instructions (ie, to prevent infection), the message can become confusing. Simplify the message by focusing only on the seriousness of the infection as a medical problem and the need for immediate care. At this point, adding home care instructions can not only confuse patients, but also contribute to one of their most significant obstacles to accepting care, which is thinking that having the condition is a result of their own fault.Patients' defense mechanisms can come into play, leading them to believe that simplistic solutions, such as "flossing better," will be sufficient. When managing a patient back to health, home care instructions will have the most impact after the body begins to heal itself.

Once treatment of the infection is under control, it is time to start sharing information about home care. This is a time when the words that you choose really matter. "How" you present home care is just as important as "when." Discussing home care is a communication process, not an interrogation process. Communication is a two-way street-interrogation is not. Try to make patients feel safe. Using a statement such as, "Let's talk about what you currently do for home care," is much less threatening than, "What are you doing for home care?" You will now be sharing information with and guiding motivated individuals who see themselves as "good" patients because they committed to treatment. And they will see you, the provider, as a great resource because you made it feel safe for them to get on the pathway to health.

The principle that you cannot treat infection with prevention also impacts the timing of treatment. Even the most clinically skilled hygienists will commonly express the sentiment that they don't have enough time. Oftentimes, this is because they are combining treatment for infection with home care instructions at every appointment, which is what is taught in some hygiene programs. During initial appointments, focus on the treatment and use all of the appointed time to get the infection under control. Only during future appointments, after the infection is under control, is it a wise time to introduce home care instructions. Now, patients can hear you. They recognize that the infection was not their fault and that they could not have regained their health without professional care.

3. Be There

People rarely frequent businesses that make them feel bad about themselves. A healthcare buyer's self-perception that he or she is a bad patient can contribute to cancellations or no-shows in a dental practice. Rebranding can also lower this barrier to treatment, maximizing your productivity and contributing to practice success.

Link Among Conditions

A deeper application of the rebranding step involves considering patients with other medical conditions. According to a January article in Dental Economics by Richard H. Nagelberg, DDS, "In 2017, the CDC reported that more than 100 million US adults were living with diabetes or prediabetes."Nagelberg presents staggering statistics and asks the golden question, "Given the fact that diabetes and periodontal disease are intimately linked, chronic, incurable conditions-each of which impacts the other-why aren't we talking about this every day?"

Although the scientific implications of OSIs have been evolving for many years, and more evidence is moving from "linked" to "causative" in regard to other diseases and ailments, all dental providers are still not fully aware of or able to communicate the oral-systemic connection to their patients. However, even if a practice has yet to philosophically embrace this science or does not feel fully confident in discussing it with patients, there is a simple answer to moving ahead-one that helps the patient and compliments the practice's approach to care both now and in the future.

Closing the Loop

Currently, it is not uncommon for a patient with an OSI to ask questions that deal directly with the oral-systemic connection. For example, a patient may ask about diabetes and A1C testing parameters. The hygienist may not know the answer but can assure the patient that the doctor will be able to address his or her concerns.

It works the same for the doctor if he or she does not have all of the information to respond. In these situations, explain to the patient that you understand the question, but because it is a medical issue, you will discuss it with his or her primary care physician in order to give a more complete response.

The dentist can now coordinate with the medical practice to ascertain the best treatment approach for this patient, involving both doctors in the decision about which diagnostic tests are the most appropriate. This comfortably and appropriately closes the loop between your dental practice and the patient's medical practice.


With expectations accelerating, the public, the medical community, and the courts now expect dentists to be more than just "tooth doctors." An OSI is a true medical condition, and it needs the skill and attention of a specialized healthcare provider who is focused on the oral cavity.

About the Author

Robert H. Maccario, MBA, is the president of Dental Management Sciences, LLC, a business management firm for dental practices.

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