What is your definition of oral health? Is there even a standard definition of oral health? One thing is clear; the definition of oral health is not solely the absence of pain. Pain is also not necessarily an indication of poor oral health.

It wasn’t until the year 2000 that oral health was brought to the forefront of the surgeon general’s report as a critical component to overall health. This was an important event, but unfortunately never amounted to much in terms of being incorporated into most healthcare policies. This has led to continued poor to non-existent cross-over coverage between medical and dental insurance. Lack of benefits are one of the top reasons people do not get regular preventative dental care.

In 2005 at the World Congress of Preventive Dentistry, participants from 43 countries made it clear that oral health is an integral part of general health and overall well-being. They even concluded that oral health is a basic human right.

More recently, the United Nations recognized oral disease as an integral part of other non-communicable diseases such as diabetes, cardiovascular disease, stroke, chronic respiratory diseases and cancer. This association with these other diseases was based on common social determinants such as socioeconomic status, diet, tobacco and alcohol use, and not on the basis of transmission. However, there is still no solid definition of what oral health really is.

According to a column in the Journal of the American Dental Association, the American Dental Association is working on a proposed definition of oral health. The authors of the column state, “A proposed definition is necessary to achieve a common understanding of the scope of oral health, to help understand the array of complex oral and systemic health issues facing dental and medical professions now and, in the future, and to provide a rationale to position oral health professionals as partners within primary health care.”

The authors go on to say that the definition of oral health needs to align with the current definition of dentistry. That definition currently states, “dentists are responsible not only for the evaluation, diagnosis, prevention and treatment of diseases and conditions of the oral cavity, the maxillofacial area and adjacent areas but also for assessing their impact on the human body.”

As new tests and knowledge in the area of oral health increases, the days of simply recording missing and decayed teeth and poking patients with instruments to chart periodontal (gum) issues may not be enough to best serve patients. What we can learn from things such as genetic testing and salivary diagnostics will change the way we interact with our medical colleagues and greatly benefit our patients.

In conclusion, the authors state, “As the definition of oral health evolves and likely will continue to evolve well into the future, no matter how oral health is defined, the message remains: Oral health is essential to an individual’s general health and quality of life.”

So, while the definition of oral health is refined, it is our individual responsibility to take care of ourselves. If we know that oral health is connected to the rest of the body and if we care enough to take care of our body, then regular professional preventative and maintenance, and having excellent home care, should be at the forefront of our self-care.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

No two dental practices are alike! Each takes on the characteristics of the practitioner and the supporting team. Every office/patient interaction is the key to how that office “feels” when you walk in the door.  Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back.  This approach is often reflected in the office’s treatment preferences as well.

I would hope that all dentists suggest what they feel to be the very best plan for any given patient…..and present any reasonable options. The differences between the treatment suggested by one dentist and that of another reflects that dentist’s preferences based on his or her experience. Thus, differing treatment plans do not necessarily reflect any deficiency in either dentist’s judgment.  

I presented a complex case situation to a group of 15 dentists this past week. Even among this group of like-minded dentists, there were many different opinions as to how to approach this patient’s care. Some dentists said they would not do anything, while others offered very sophisticated treatment plans.

It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances.  A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is helpful if the dentist takes the patient’s ability to pay into account. 

Think of treatment plans like various models of cars at dealerships.  All of the models are new, have warranties and will work well out of the lot.  The higher end models, however, have some advantages not found in the less expensive models.  Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it. 

Dental treatment plans are like that too.  Saving a badly damaged tooth with a root canal and a crown will preserve it for a long time, but it is a larger investment than the alternative extraction.  Replacing a missing tooth may be done with an implant or fixed bridge (not removable), or a removable partial denture. One is a larger investment than another. The implant, for example, provides a more natural solution, but requires a higher level of care. A dentist should be able to explain the advantages and disadvantages of the various options, and allow the patient to make the decision. 

All dentists who have graduated from an accredited dental school should be technically competent to perform any procedure that they personally feel comfortable with.  But it is important to remember that each one is an individual, and no two dentists can perform exactly the same technical procedure in exactly the same way. 

As a patient, you have no way to be able to judge the quality of the clinical treatment performed. Did it hurt? Does it look and feel good? Do I feel the investment was worth it? Those are the parameters most patients use to assess success. This starts with the trust in the dentist/patient relationship.

Over the years, I have developed a deep respect for those who practice dentistry. Many of my colleagues have impressed me with their technical abilities, and others with their communication skills. There are many great provider options for patients to choose from.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

A while back, The Boston Globe ran an article entitled “Advice for all ages: Don’t skip the dentist.” It started with, “A team of researchers from London and the University of Connecticut announced that aggressive treatment of gum disease can improve the function of blood vessel walls in the body, potentially reducing the risk of heart attacks.” 

The concept is nothing new. We have known for years of the mouth-body connection with health. However, the key to the statement above is “aggressive treatment of gum disease”.

What does aggressive treatment of gum disease mean? Basically, it means that instead of watching and waiting for resolution of gum problems on their own, whatever treatment is needed to achieve gum health should be performed.

Periodontal (gum) disease is a silent disease; it does not hurt. Over 75% of the population has some form of periodontal disease. Whether you have early stages of the disease or advanced periodontal involvement, you have periodontal disease. And, it is something that has to be controlled over your lifetime. It is not curable.

Any form of this disease is potentially affecting your overall systemic health. The goal is to become periodontally healthy. Whether that involves having professional hygiene maintenance more frequently, or more aggressive treatment, elimination of chronic inflammation is the objective.

It is easy for patients, and even dentists, to watch and wait as opposed to taking action. “Aggressive treatment of gum disease” means that if the disease is identified, it needs to be addressed. Let’s get it right out in the open – Once you have periodontal disease, and even after it is treated, it will always return unless you follow a strict regimen of home care and professional care…….for your entire life.

Even the smallest amount of inflammation in your mouth is gum disease. Periodontal disease is a chronic inflammatory process. As the article states, “Chronic inflammation anywhere, makes the body release nasty chemicals called cytokines that have been linked to diabetes and heart disease.” It goes on to say, “Cytokines can also trigger inflammation in artery walls, raise blood pressure, worsen cholesterol levels, and increase blood clotting, which can lead to potentially fatal heart attacks.” This also includes strokes. “Pregnancy complications, too, have been linked to gum disease, perhaps because chronic inflammation leads to high levels of a hormone-like substance called prostaglandin E-2, which can induce labor.”

No one wants to hear that they need treatment for something. It is even harder to accept treat for something that doesn’t hurt or seem to not be harming anything.

The fact of the matter is, periodontal disease is a disease. Diseases need to be treated or they will affect and possibly even shorten your life. Periodontal disease is no exception. And remember, “aggressive treatment” does not mean watch and wait to see if it goes away. It won’t go away on its own – I promise.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

We all have people we look up to, whether in our personal or professional life.  One of those people in my professional life is the late Dr. LD Pankey. Dr. Pankey was a true visionary. There is an advanced dental education institute named after him in Florida, where dentists learn from his influential teachings.

One of my favorite quotes from him he wrote in 1981, 8 years before his death. It is interesting to read some of the things he wrote, because it shows how little things have changed, and how well he understood people and his profession. I would like to share a few paragraphs from this piece:

“Another important element, then, in the future of dentistry is determining the answer to the question: why don’t more people with needs go to the dentist? In-depth studies on consumer attitudes have turned up a host of reasons, but one surpasses all the rest. Most people who fail to seek dental care fail because they don’t perceive their need. More astounding than that is the fact that the majority of people who do go to the dentist don’t perceive the need either!

If the public is ever to be enlightened about the importance of dental health, who will have to do the enlightening? I’ve never found anyone else I could depend on to do it. I had to build the one-to-one relationships with my patients that were needed to make my practice- and thus the future of dentistry- prosper and grow.

People with dental needs are out there, all right, but even when they do perceive their need, they must be assured there’s someone available who will identify with what they’re feeling and devote themselves to helping them to be healthy, happy and whole.”

Dr. Pankey asks who will enlighten the public about how good dental health is better for your overall health? His answer is the same today as it was when this piece was written. The dentist (and dental team), who is dedicated to taking the time to listen and build a relationship with the patient, is the only one who has the best interest of the patient.

The insurance industry is trying to turn dentistry into a commodity, where a “cleaning”, a filling, a crown, or a denture is the same anywhere. It’s just “stuff” that’s done to fix problems. The insurance company’s main interest is profitability – period. Does it make sense that an insurance company should be able dictate who you can see as a provider?

The business of dentistry has reacted to these things as well. One example are the commercials on TV for a corporate dental facility that only does dental implants. The ads target the large sector of the population who think removal of teeth and replacement with dental implants fixes them for life. This is far from the truth. While there are patients who truly benefit from these types of procedures, many others have healthy teeth removed because it seems like the easier thing to do.

You have to be the one to decide how important your health is. In 1981 there were no connections between oral health and systemic health. Today we know that a healthy mouth is so important to a healthy body. If your health is a priority, you should seek regular dental care with a professional team who has your best interest at heart.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com