Dental disease—dental or medical

Townsend Letter for Doctors and Patients, June, 2005 by Andrea H. Brockman

There is nothing that people hate as much as going to the dentist. "It's nothing personal," they used to tell me. The baggage people carried with them about their real or perceived dental experiences could keep all the psychiatrists and psychologists in the world busy for the rest of their lives.

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My experience of being in the dental profession for 30 years had more of its share of biting moments than teeth marks on my operating hands. Not only did I have to deal with a wide-awake patient's anxieties about invasive procedures in a personally protected and very private space, but I had to experience their aversion to paying for treatment they would for the most part, prefer not to have. Pulling teeth was easier. In my opinion, when it comes to dealing with people, dentistry could very well be the most taxing of any profession.

As if Dentistry Wasn't Bad Enough!

Whether it is visions of Sir Lawrence Olivier in Marathon Man drilling into a live tooth without anesthesia, Steve Martin as the sadistic dentist in Little Shop of Horrors, or a murdering Corbin Bernson in the farcical horror flick, The Dentist, the results of such marketing have left indelible marks on millions of would-be patients. Dentists all over the world have always been faced with counteracting such damaging slants to the profession. Children's dentists have invested in many distractions to make the experience a positive one early on and adults have found fish tanks, headphones and virtual movies an adjunct to the valium and nitrous oxide. In recent years, however, with the advent of Cosmetic Dentistry, dentists have been able to position themselves much more favorably by appealing to vanity. Veneers, porcelain crowns, tooth whitening and invisible braces have kept more dentists in business than restorations for decayed teeth. The artistry may have quite possibly surpassed durability and functionality in order of importance for the consumer. Even the healthy practice of teeth cleaning is more tempting if the end result promises a brighter smile. The reality, however, is that dentistry needs to be recognized for its importance to overall health and must establish itself as a profession that is well respected and totally integrated into the entire health care community.

The Separation of Medicine and Dentistry

There is a group of health conscious Holistic or Biological Dentists who have filled in the void left by the medical profession over 150 years ago. Physician specialists, once known as Medical Dentists could no longer compete financially with the less trained craftsmen dentists performing dentistry on the masses. Eventually a split of dentistry from medicine resulted. That had the unfortunate consequence of the physicians ceasing to be taught in detail about the mouth, diminishing the dental relevance to health and relegating all repairs to the craftsmen dentists. The dentist, not being able to practice medicine, could only treat the teeth and related structures in isolation and not minister to the affected overall health of the patient. It's almost as if the mouth was not even considered to be connected to the same body that shared the skeleton, circulatory, nervous, or lymphatic systems. So what if the mouth is at the entrance to the respiratory and digestive tracts or in such close proximity to the brain, spinal nerves and master glands. What's the big deal that the sinuses sit on top of infected roots of teeth, or the muscles that control chewing, swallowing and facial expressions are used relentlessly? And is there any significance that each tooth sits on a different acupuncture meridian?

Dental Infections: A Systemic Health Problem?

Now add the jaw bones, whose complex functions are not fully understood by even the dental profession. These bones are subject to trauma and infections arising from unhealthy teeth, gums, sinuses, implants, surgical procedures and anesthesia injections. What other bone in the body also shares itself with the outside world? What other bone has as many procedures performed on it? What other bone shares joints and 32 neurological structures? And what other bone can have osteomyelitis and deteriorating joints and not be covered by dental or medical insurance? This very bone, which is not addressed by the medical profession because of dentistry's turf claim, is probably the one area of the body that can be easily viewed as a gauge to a person's overall health. The deterioration of the jawbone from periodontal disease is really a systemic problem and a proven risk factor for heart attack and stroke. Upon visual inspection, chronic inflammation is easily detected in gums and buildup of calculus on the teeth is more readily observed than calcium plaques in the arteries. Why aren't more doctors and dentists getting together over this disease?

For years, dentists have been premedicating patients with Mitral Valve Prolapse to prevent a bacterial endocarditis arising from the pathogenic bacteria in the plaque that could enter the bloodstream during a dental procedure. Surgeons recognize the risk of operating when an infection is present and take the proper precautions. Over 70% of the adult population is in one stage of periodontal disease but few safety measures are taken when the bacterial plaque is inevitably disturbed each time one flosses and brushes their own teeth. Are they at any less of a risk for pathogens entering the bloodstream and traveling throughout the body?