Have you ever said to a client during their dental hygiene appointment, “oh there is just a little bit of bleeding”? Overall, giving the client the impression, this is expected, normal, or really not something to be overly concerned with. ⠀
Throughout my career I have seen communication strategies of active inflammation evolve, and now more than ever this is the foundation of client centered care, and oral health education. We are detectives with a purpose to identify active infections in a client’s mouth along with ensuring our clients are well informed of their current condition and what must take place to work towards overall health.
Informing clients of their current oral health status is the cornerstone to each and every interaction we have. With an on-going goal to use appropriate language that aids in client understanding, as well as eliminating misleading words such as “just a little bleeding”. We need to recognize the power a statement like this has on changing a client’s perspective on their current oral health status. An informed client is a motivated client, and this all leads to improved oral health.
We have a larger purpose
Currently 206 people in Canada die every day from heart attack and stroke1. This is the leading cause of death and we need to be doing more.
At this point in dentistry we are well read and experienced with the oral systemic link. This trending and life-saving area of research has been analyzing the association between oral health and cardiovascular health and is moving towards strong facts to support a direct cause and effect relationship. The association and parameters of poor oral health and risk of cardiovascular diseases has been concluded in numerous types of studies, thus leading to the inclusion of periodontal disease in the group of potential conditions increasing the risk of cardiovascular disease2.
Recently, the American Heart Association Scientific Sessions presented additional research that further supports past research showing oral bacteria is associated with atherosclerosis3.
What is actually happening
If left untreated, inflammation in the oral cavity will lead to ulcerations in the epithelium tissues, allowing bacteria to travel a distance systemically. The bacteria present in the oral cavity triggers the inflammatory process causing the release of inflammatory mediators, also going directly into the bloodstream, all leading to deadly health issues such as cardiovascular disease.
Goldstep (2013), discussed how inflammation only becomes clinically detectable when the inflammatory response is prolonged, and this chronic inflammation is what leads to destruction of the tissues and bone4.
This is why addressing signs of inflammation at the earliest stage possible is key. If we can get our clients to understand improved oral health will not just save their teeth, but it will have a true impact on their general health, we could help save a life.
Our critical assessment
Assessing the state of active bleeding is one of most critical steps when completing an assessment, allowing dental professionals to determine classification of gingivitis and periodontitis. When there is bleeding on probing, or bleeding upon stimulus with an instrument or aid such as an interdental brush, this is a visual sign an active infection is present in the client’s mouth. Getting the client to see this and understand this is a top priority.
This means being able to communicate sites of active inflammation/bleeding with purpose and meaning is fundamental. Looking at the “why” and conducting a risk assessment to provide all critical information to the client will help work towards overall health. Even when there is “just a little bit of bleeding”, whether it’s generalized or localized, slight or profuse bleeding, it all matters. And our clients need to understand this.
What can be done
Let’s work toward getting our clients to understand if persistent bleeding and inflamed tissues are clinically detected, new adjuncts or treatment recommendations must be part of the treatment plan.
What might some of these adjuncts be? We are privileged to be working in a time where many tools are at our finger tips. Such as, ultrasonic scalers (piezoelectric and magnetostrictive), guided biofilm therapy with airflow, diode laser, non-antibiotic dose of doxycycline (Periostat), and interdental brushes. These adjuncts and aids have the capacity to contribute to a stable, and inflammation free mouth.
Another area we need to improve upon is the collaboration between medical and dental professionals. We see this continuing to strengthen as science recognizes that what happens in the mouth directly impacts the rest of the body, and vice versa. But more needs to be done.
Screening for both diseases more aggressively and more frequently in both the medical and dental field is required.
What can dental professionals be doing to help decrease the incidence of heart attack and stroke?
The future of dentistry must be aware of and start to look for opportunities to integrate the following into practice;
- Dental professionals need to be utilizing all tools to address oral inflammation and host inflammation (in-office adjuncts and home care regimens). The more risk factors one has the more aggressively we need to be combining in-office and home care treatments. There are numerous evidenced based treatment options to address inflammation and disrupt the microscopic biofilm.
- Both oral care providers and their clients need to make it a top priority to stabilize periodontal disease. “Just a little bit of bleeding” is not okay. We need to be continually asking ourselves are there signs of inflammation in the oral cavity, and what can be done to eliminate this.
- We need to look deeper into our client’s medical histories to identify the red flags and risk factors for cardiovascular disease and make the appropriate referrals to medical doctors. The collaboration between medical and dental needs to be streamlined to benefit the client and we cannot be working in silos. Very clear and welcomed communication is critical for both parties.
- Monitoring blood pressure in the dental office is a must, and needs to be taken more regularly at preventative, restorative, and surgical procedures.
- Take time with your extra oral assessments. Dental professionals are in the perfect situation to look at the skin, ears, nails and eyes as each could show signs of cardiovascular disease.
- Become a dental professional that is well educated on vascular inflammation and the oral systemic research that is constantly evolving.
In closing, we need to ask ourselves what’s our purpose and mission, can we improve our chair-side conversations? It’s an on-going goal in this industry to evolve and communicate to our clients in the most direct way, but with heart and empathy. If we ask the right questions and dig a little deeper to get the information needed while informing our clients in the most profound and meaningful way, we can ultimately save lives.
- Heart Research Institute. http://www.hricanada.org/about-heart-disease/facts-about-heart-disease
- Stefano Masi, Francesco D’Aiuto, John Deanfield, Cardiovascular prevention starts from your mouth, European Heart Journal, Volume 40, Issue 14, 07 April 2019, Pages 1146–1148, https://doi.org/10.1093/eurheartj/ehz060
- Bacteria in your spit might play a role in heart disease By American Heart Association News. https://www.heart.org/en/news/2019/11/19/bacteria-in-your-spit-might-play-a-role-in-heart-disease
- Fay Goldstep ( 2013) Periodontal Inflammation: Simplified https://www.oralhealthgroup.com/features/periodontal-inflammation-simplified/
About the Author
Lisa Hardill, RDH, BHADM, is a dental hygienist with experience in public health, independent and private practice, education, and sales within the industry. She is currently working with Oral Science as a Oral Health Consultant. Over the years, she has been involved in the dental hygiene field in numerous ways, including as a quality assurance peer assessor for the CDHO, as non-council member of the Registration Committee with the CDHO, Team Lead for Public Health Unit, and on the Board of Directors for Gift from the Heart.