February 13, 2018
by Lorraine Gambacourt, RDH
It is said that awareness is the key to change. Awareness however, is simply not enough. We must take the new knowledge learned and actually do something with it! This requires effort, change, boldness, and a willingness to take consistent, persistent action in areas you may not have considered or applied before.
February is considered Heart Health Month nationwide. According to the latest statistics, cardiovascular disease (previously listed as second) is now the leading cause of death in Canada, as well as globally.1 This highly preventable disease is not only posing a strain on our health care system, but is decreasing the length and quality of lives of those we care about.
As dental health professionals we make a significant difference in the lives of those who put their trust in us. We are also exposed to numerous individuals on a daily basis who are at risk for a cardiovascular (CV) event. What if we could be even more impactful in our efforts? Although our clients’ response to our recommendations may be out of our control, the skills we acquire, the knowledge we share, the treatment we recommend, and how we empower our clients is in our control.
Earlier research suggested merely an association between periodontal disease and systemic disease, including heart health.2 A new ground-breaking, peer-reviewed study published in the prestigious Postgraduate Medical Journal (Bale BF, Doneen AL, Vigerust DJ) is the first to identify periodontal disease due to certain high-risk oral bacteria as a contributory, root cause of cardiovascular disease (CVD).3
In addition, a 2016 meta-analysis found those with periodontitis were more than twice as likely to suffer heart attacks, compared to people with healthy gums.4 However, with a causal relationship now existing between periodontal disease and CVD, it is recognized that optimal treatment and management can not only decrease the risk, but could be potentially lifesaving, by helping to prevent heart attacks and strokes.5
“This latest research totally changes the game, and should be a landmark paper that changes medicine and dentistry forever. When you have a condition that causes something, it demands that it be assessed and managed properly. This will also change the definition of periodontal disease. No longer can you define periodontal disease by clinical signs alone. The pathogens drive the risk with the arteries so the dentist has to objectively find out what pathogens are present and what that burden is. That demands DNA testing. You have to know the pathogens.” Dr. Bradley Bale, MD. Co-Author of the book, Beat The Heart Attack Gene and Co-founder of the BaleDoneen Method®.
Dr. Bale has been a family practice based physician for over 25 years, and was alarmed with the number of his patients who were having heart attacks and strokes, despite the standard of care. His focus became to keep the arteries healthy enough to prevent heart attack or stroke. Arterial disease is driven by inflammation. While there are a myriad of conditions that can cause inflammation in the arteries, one of the most prevalent is periodontal disease caused by high risk pathogens. Although he helped his patients to manage modifiable risk factors such as weight, nicotine, stress, diet, sleep quality, cholesterol, etc. he discovered that 99% of the time the cause of unresolved inflammation in the arteries was coming from the mouth. Dr. Bale and his partner Amy Doneen, DNP developed the BaleDoneen Method® for the prevention of heart attack, stroke and diabetes.
When a client harbours high and moderate risk pathogens such as Aa, Pg, Td, Tf, Fn, and Pm, they are at an increased risk of arterial disease, even in the absence of bleeding. Having additional risk factors increases the potential for deteriorating oral health, systemic disease, and the chance of a CV incident. When bleeding is present however, as I have heard Dr. Bale state, “it’s like the dam broke!”
“If there is blood in the sink, there is an open door for bacteria to spray throughout the body and cause inflammation as they do in the mouth- we need to close the door and kill the bugs” Dr. Charles Whitney, MD. – A nationally recognized educator in dentistry, writing and speaking to dental professionals about the impact they can have on a patient’s overall health.
Harmful bacteria can get out of balance from years of neglectful attention or poor technique in cleaning the mouth, teeth, and gums thoroughly as well as infrequent dental hygiene visits. Consider that at least 75% of our clients have bleeding on a daily basis, allowing harmful bacteria a direct pathway into the blood stream. Oral bacteremia has been well established as a very significant contributor to many systemic diseases including heart disease, stroke, diabetes, rheumatoid arthritis, Alzheimer’s, as well as a myriad of other diseases. Think about the number of your clients who spit blood in the sink 24/7, 7 days a week, 365 days a year for decades, thus increasing inflammation in the arteries and oral-systemic health risk. It is comparable to having an open wound that is constantly infected. Our clients must accept that bleeding is not normal, healthy, or hereditary!
As hygienists we know and can appreciate that changing daily habits can be challenging. This doesn’t mean that we give up, or stop trying to inspire change. Something has to shift. Something has to motivate a person to change. Often that motivation stems from a fear of loss and connecting on an emotional level. An example is showing your clients mobility in anterior teeth to motivate them to wear their NightGuard. It works!
Building relationships and earning trust is the first step. Then as you use the right assessment tools, and effective communications skills you will inspire lasting change that will that will help your client not only improve, but sustain better oral health and decreased oral-systemic health risk.
Consider these suggestions to engage with your client. It will increase their awareness, understanding and force them to take ownership of their disease.
At Parkway Dentistry, an integral part of our assessment and treatment is the recommendation of Biofilm DNA testing to screen for high risk oral pathogens. OraVital® Inc. is a company based in Toronto that providzes this type of testing and makes it available to dental and medical offices.
Once we know what the pathogens and burden is, the client is placed on a periodontal therapy program that includes an antibiotic rinse, to ensure that healing takes place, the bleeding stops, and the high risk pathogens are decreased to healthy levels. The client needs to know however, that this is not a magic bullet, and that they must be vigilant in their daily efforts. We must also be diligent in our efforts to educate, support and coach towards more effective techniques and tools. Our maintenance protocol may include three month periodontal maintenance, a daily antibacterial rinse, xylitol, and/or oral probiotics. We often do a brief nutritional assessment to help the client set small goals towards better nutritive choices.
Bridging the Gap Between Oral and Overall Health
Many contributing causes of heart disease are routinely evaluated by physicians. While I would assume and hope that physicians/medical providers are developing a better understanding of the connection between oral and overall health, is this concept being given the attention it deserves? In the past year, I was impressed that a few of my clients told me that their cardiologist recommended they visit their dentist/hygienist. Yet, if this link was well understood, I would expect that dental offices would be bombarded with calls or letters from medical providers to assess their mutual patients’ oral health.
“Periodontal Disease is a medical problem with a dental solution, so we have to drive collaboration between medicine and dentistry in order to keep the arteries well.”
Dr. Bradley Bale, MD
So how can we inspire medical health providers to play a more integral part in the overall health of our mutual clients/patients? Do they understand fully, that by addressing oral inflammation/infection and working more collaboratively with their patients’ dental health providers, that they can help reduce inflammation in the arteries, and reduce the risk of heart attacks and strokes?
There is much work to be done in this area. At our office, Parkway Dentistry, we have begun to take steps. We send a letter to inform physicians of HBP readings, and/or our mutual patient’s periodontal health, inviting them to partner with us in their care. We have also sent letters to all physicians in the area, informing them that we offer DNA testing and a treatment protocol to decrease high risk oral pathogens. Taking steps in this direction is a great way to provide added value and help your office/clinic stand out from the average.
There must be an understanding of the critical role of oral health and arterial wellness, and its relationship to prevention of heart attacks and strokes. The time is now for the integration of medicine and dentistry. Therefore, as a call to action, I invite all of you to play a part in this important mission. Do your due diligence; continue to implement best practices; raise your level of commitment. With knowledge comes great responsibility – once you understand something, you can’t ignore it. Let’s work together to help bridge this gap and change the direction of our profession from disease management, to one of prevention, overall wellness, management of health.
About the Author
Lorraine Gambacourt, RDH has been a practicing Dental Hygienist for 32 years, currently at Parkway Dentistry. She is a Speaker, and also a Clinical Coach with OraVital® Inc. Lorraine invites anyone to reach out to her with questions or more information about the topics discussed here. She is passionate about helping to implement protocols that promote health and reduce oral-systemic risk. lgambacourt@OraVital.com Brantford, Ontario