By John Kempton
This is what we know; most of dentistry is now aware that there is a systemic connection between oral pathogens and many chronic systemic diseases. Many dental practices tell their patients this relationship exists and in fact show them nice charts and graphs to make the point. In the end, very few dental teams have implemented new clinical practices that have a systemic impact on chronic disease outcomes while at the same time getting superior outcomes managing periodontal disease.
John Maxwell makes the observation, “when we continue to do what we have always done, we continue to get the results we always have gotten”. A standard of care shift in periodontal maintenance and management is available … NOW… with systemic ramifications that engage the dental team in patient primary care with improved wellness outcomes at every level.
Quite simply, we identify and treat high-risk pathogens in high-risk patients to mitigate the influence of many systemic chronic diseases.
Of the 800 or more bacteria in the oral biome, eleven have been positively identified as with being associated with or directly linked to a chronic disease other than periodontitis. These pathogens have the same effect on distant systemic sites as they do intraorally. They create intra-cellular damage and cell death as well as cause a cascade of unwanted inflammatory markers like cytokines.
These high-risk pathogens are not generally released by tooth brushing, but are always released into the blood stream by invasive dental procedures like SRP, extractions, and endodontic therapy. Once in the system by virtue of a bacteremia, they have the potential to exist as ‘dormant persister cells’, and to translocate to a susceptible site at any undetermined time.
It has been found that there is a 50% increase in cardiovascular events in the first 4 weeks after SRP, with a return to normal after six months. This evidence is significant within the 95% confidence level we use to establish research credibility. A simple saliva test will identify all or any pathogens at potentially threatening concentrations.
It is important to identify the high-risk patient for two reasons,  to minimize the potential for an adverse systemic event due to oral pathogens, and  to be responsible for some level of antibiotic stewardship. Younger and uncompromised immune systems are mostly well suited to handle high-risk pathogens in a bacteremia.
A medical history is key to locating patients who are at risk; that review includes some of the following factors;
Age 45 to 50 with a genetic background of parent having heart disease, stroke, diabetes, or periodontal disease. A genetic test would be absolutely conclusive when all parties agree.
Age 45 to 50 and patient is a smoker, diabetic, has cancer, or history of heart attack or stroke
Age 45 to 50 and patient carries a currant burden of inflammatory disease. Has two or more of the following; high blood pressure, rheumatoid arthritis, COPD, chronic bowl or kidney disorder, sleep disorder, high stress, and/or no exercise.
Any pregnant female
All or any of the above high-risk patients that would present with several sites of bleeding on probing, including the patient who has committed to good homecare practice and regular recall still with bleeding on probing.
Dental practice transformation…
The dental team that incorporates new clinical practices to treat high-risk pathogens in high-risk patients experiences transformation in a number of ways. Those changes will be apparent in the clinical team, the patients served, and the community at large. A summary of what to expect can be described in the following bullet points;
Patients experience the team’s care for their well being on a new level. The conversations go beyond teeth and a dental treatment plans… to physical wellness and health. Treatment plan case acceptance goes up across the board.
Dental team members feel fulfilled on a new level, satisfaction for contributing to patient care changes job perspective and enthusiasm.
Periodontal disease outcomes change immediately, success is easier to accomplish and predict.
The value of the practice in the eyes of the community elevates to a new level.
Collaboration with the medical community generates respect and mutual collegial conversations in behalf of patient wellness.
The hygiene department revenues will increase … immediately.
Join the movement…
Simply mechanically root planning and scaling is not enough to mitigate high-risk pathogens in high-risk patients. It is also not enough to create an environment that enables oral soft and hard tissues to recover and become restored from the effect of these bacteria.
There is so much more… lets commit to a new standard of care; lets transition from doing dental hygiene to performing wellness therapy.
Graduate of Loma Linda University School of Dentistry in 1976 and been engaged in clinical dentistry for almost four decades. In addition to numerous post-graduate continuums in reconstructive dentistry, has completed Dawson Academy’s Dental Institute for Systemic Health, the medical Bale/Doneen preceptorship for cardio-vascular health, and is a member of AAOSH. As a certified professional coach and a consultant promoting leadership development within dentistry, Dr. Kempton is engaged at every level helping dentists and dental teams achieve… and become more.