Editorial: Don’t Get Left Behind

by Janice Goodman

The FDIC has a new definition of the term “oral health”; it “includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex”.

Oh my. How do we interpret this?

The FDIC has subtly redefined oral health and the parameters of the field of dentistry by defining our treatments to be in relation to craniofacial structures and functions. This is a step forward in improving dentistry, reducing suffering and helping individuals to reach their best potentials in health and in quality of life.

I also think that it is a complex and foreign concept, which will take awhile for mainstream dentistry to grasp and to incorporate into daily practice.

The old adage goes that “form follows function”. Fixing the form is what the emphasis was on until now in dentistry. Today, it is the functions that must be considered paramount, including, the most essential one, airway, while treatment planning. One must put a great deal of thought and consideration as to why there is established disease of the craniofacial complex in order to restore and eliminate the problem. It also involves recognizing when dentistry can prevent dysfunction and channel or redirect growth or habits to improve health.

Drilling and filling decayed teeth without making an effort to eliminate the causes of the decay or fracture will be a treatment of the past. The treatment is inclusive of eliminating what caused the need for the restoration and repair of the teeth. Only with dealing with the mouth breathing, the dry mouth, poor diet, lack of hygiene, tongue tie or whatever the cause, will the individual be brought into stable oral health.

That is the best protocol to get a lasting and optimal cure and prevent recurring illness.

Oral Health = Overall Quality of Life and Total Health

This definition might sound very inclusive, but Dr. Ira Shapiro, chair of the TMD Alliance, points out that it has failed to specifically included maintaining a healthy airway during sleep and awake hours nor the importance of jaw posture and (body) posture.

TMD disorders had a 300 percent increase in medical costs in every field of medicine (Shim shake to al, 1998). We know most TMD conditions are largely secondary to a primary functional etiology. We also know that airway trumps all for survival and so it’s a good place to start looking in a differential diagnosis of complex facial pain.

According to Dr. Jamieson Spencer, it used to be estimated that 18 million Americans suffer from sleep apnea but we’re discovering that the diagnoses of depression, chronic fatigue, fibromyalgia, migraine, and other “syndromes” may really be symptoms of sleep apnea.

Only a physician can diagnose sleep disorders, but dentistry has a big responsibility in treatment.

Airway trumps all and if it is compromised, the body will accommodate and some of the conditions that dentistry treats are sequelae of such compromises, which have developed to allow for improved airways including jaw and body posture.

This new definition encourages the dentist to include the very youngest patients. “The workings of an infant’s mouth while feeding at the breast are different than the workings of an infant’s mouth while feeding off a bottle. In the end, the task of getting milk is accomplished no matter if you take the boob or the bottle but the PROCESS of milking the breast is important to the optimal formation of the jaw and face bones. The structure of the face bonded and established motor patterns of the face mm ends up affecting other processes, like breathing and swallowing, as well as the space available for tooth eruption” (Katy Bowman, Move Your DNA, pg. 47).

In September 2016, the American College of Advancement of Medicine (ACAM) and the American Academy of Physiological Medicine and Dentistry (AAPMD) came together for a weekend of collaboration. Invitations were sent to major stakeholders to be involved and contribute. Whether they knew it or not- they were setting the stage for understanding and utilizing this new definition of oral health. Several White Papers were formed to give guidance in areas that required collaboration. This included a white paper for general dentistry and one for orthodontics, which will be released soon.

The topics covered in the Tucson meeting were largely “outside the box” and included:

  • collaborative care topics to promote airway health, function and development
  • airway, sleep and metabolic disease
  • orthodontics, myofunctional therapy and restorative dentistry: an Airway Team Approach
  • upper airway resistance syndrome: the hidden problem to chronic inflammatory disease
  • identifying and treating airway problems prior to restorative dentistry
  • early intervention for prevention: treating airway disorders in children under age six
  • Invisilign and restorative dentistry: beautiful smiles with better airways
  • building the airway/sleep team: screening, diagnosis, record keeping, finances and more
  • CBCT: identifying and using the wealth of information
  • frenectomies: before, during and after- a philosophical approach to midline anomalies
  • physical therapist/dentist airway collaboration for better airway health
  • nutrition’s role in dentistry and for better sleep
  • ENT/dentist collaboration
  • physiological dentistry

The following month, the Canadian Chapter of the American Academy of Cranial Facial Pain put on a similar collaborative airway centered dentistry meeting in Vancouver.

The profession is in good hands, being guided to new paradigms by leaders and top clinicians from almost every highly established dentistry academy. Unfortunately, many of the academic facilities are slow to lead the way, but as the old guard changes, so too might the curriculum change.

What an exciting time for the profession of dentistry! It will take practitioners with vision to see outside the box and to change the shape of dentistry and health care to fulfill the new definition of oral health. Don’t get left behind. OH

About the Editor
Janice Goodman is the General Dentistry member of the Oral Health editorial board. She recently completed a Masters of Science in Oral Medicine and Orofacial Pain at USC and practices in downtown Toronto.