The Oral-Systemic Link
How it affects the relationship between dental professionals and patients.
The association between oral and systemic diseases is changing the future of patient relations. The entire dental team, patients, and other healthcare providers all need a full understanding of not only the dental and periodontal concerns of the patient, but of health problems that affect the patient’s entire . The best way to combat these problems is to open the lines of communication between all parties, and make sure that all necessary information is shared and understood by all. This can be done in a number of ways: by increasing the level of education in dental patients, increasing the level of customer service provided in dental offices, and increasing communication between dental teams and other healthcare providers. If everyone works together, there can be significant progress made in the connection between oral and systemic diseases.
The oral–systemic link has been noted and emphasized in many places. There are two emerging theories about the oral–systemic link. The bacteremia theory links oral infection and systemic disease. The inflammatory theory is more narrow and links oral infection with cardiovascular disease (CVD) and adverse pregnancy outcomes.1 Recent studies have shown that periodontal treatment may decrease overall systemic inflammation and improve endothelial function.2
There are two primary oral conditions that can have serious consequences for the whole : caries and periodontal disease.1 These conditions, along with others such as gingivitis, can have serious effects on the overall health of the and can affect conditions like CVD, diabetes, pulmonary disease, and stroke. Chronic infections, which can include periodontitis, may predispose someone to CVD, according to the Oral Infections and Vascular Disease Epidemiology Study.1 There are also certain species of oral microorganisms that may be risk factors for acute coronary syndrome.2 However, the three systemic conditions that seem to have the strongest link to oral issues are adverse pregnancy outcomes, cancers of the head and neck, (see additional content on www.dentalaegis.com/ida), and osteoporosis.3-5
A Change in Patient Relations
How can patients become aware of the oral–systemic risks that have already been embraced by the dental community? The best approach is for dentists and dental assistants to communicate openly with their patients at all times, and to encourage patients and other healthcare professionals to do the same. But how can the lines of communication be opened? While a dentist’s primary responsibility is to provide dental care for his or her patients, the dental office must be run like any other business, and focus first and foremost on customer service. It is imperative that the office builds a base of loyal customers, those that will come back to the office time and time again. Many of today’s leading dental practices are based on the concept of “Killer Customer Service.”8 For a dental practice to provide “Killer Customer Service,” it must make the patient feel like they are being treated well at all times. If a patient does not have to wait too long to see their dentist, he or she will be more open to hear what the entire dental team has to say. If the staff in the office truly listens to their patients instead of just pushing them through the system, then the patient will be more open to communication.
A patient must trust the dentist, dental assistant, hygienist, and other staff members if he or she is to be educated on any significant dental or medical issues. This trust and open communication is the most important first step in opening the door between dental and medical professionals to establish and work with the oral–systemic link.7 The dental team must emphasize the need for collaboration to the patient. This may include the dentist writing a letter to the patient’s regular physician or specialist to open the lines of communication and discuss any issues relevant to oral–systemic risks. It is also very important that the patient is fully educated as to his or her own oral conditions so that he or she can give the full report to a healthcare professional. In the same respect, the patient must inform his or her dental team of any medical conditions, any medication being taken, and the general status of his or her physical health. The dental assistant or hygienist should be able to work with the patient to develop a personalized care plan that takes all of these factors into account.
The most important thing to remember when linking oral and systemic diseases is that change must come from within the dental community first. As a dental assistant, you must be able to encourage your patients to reach out to their healthcare providers. Many healthcare providers are now beginning to recognize periodontal infection as a risk factor for the prevention of serious systemic conditions.7 Now it is up to the dental community to ensure that by collaborating and maintaining open lines of communication, the patient is always receiving the best possible care.
1. DePaola, D. A framework and context for moving forward. Proceedings and Consensus Opinion from the Global Oral and Systemic Health Summit. Special Supplement to Grand Rounds in Oral-Systemic Medicine. February 2007. Available at: www.grandrounds-digital.com/grandrounds/200702/?pg=65. Accessed October 4, 2010.
2. Hein C. Present evidence and future directions. Proceedings and Consensus Opinion from the Global Oral and Systemic Health Summit. Special Supplement to Grand Rounds in Oral-Systemic Medicine. February 2007. Available at: http://www.grandrounds-digital.com/grandrounds/200702/?pg=65. Accessed October 4, 2010.
3. Helping patients understand the importance of oral health before and during pregnancy. Grand Rounds in Oral-Systemic Medicine. Available at: www.thesystemiclink.com. Accessed October 4, 2010.
4. Oral complications of treatment for head and neck cancer: what you need to know. Grand Rounds in Oral-Systemic Medicine. Available at: www.thesystemiclink.com. Accessed October 4, 2010.
5. Template for dentist’s communication to a physician to increase medical providers’ awareness of the relationship between osteoporosis and oral bone loss. Grand Rounds in Oral-Systemic Medicine. Available at: www.thesystemiclink.com. Accessed October 4, 2010.
6. Template for dentist’s communication to a physician to increase medical providers’ awareness of the complications associated with treatment for head and neck cancer, and help them understand the importance of oral health for these patients. Grand Rounds in Oral-Systemic Medicine. Available at: www.thesystemiclink.com. Accessed October 4, 2010.
7. Hein C. The promise periodontal medicine may hold for systemic health. Triage. 2005;1:6-14.
8. Varallo M, Varallo V. Killer customer service: beyond satisfaction. A plan to develop life-long loyal patients. Dent Today. 2007;26(10):142-144.
About the Author
Michael T. Varallo, DMD, Private Practice, Ho Ho Kus, New Jersey