What is the Next Frontier in Dental Medicine?

So what is the next frontier shift in dental medicine?

I believe it is the utilization of our well established oral health model as a foundation to look more closely at the whole person with emphasis on complete health. That requires development of an expanded integrative dental medicine model of care. Complete dentists must routinely address critically important issues that are often ignored in our busy healthcare system.

Let's look at some examples of what complete dentists should be observing:

Dentists are in a unique position to observe systemic inflammation that may be reflected in periodontal inflammation, elevated blood sugar levels, pre-diabetes or even full-blown diabetes that exacerbates periodontal disease but is often ignored by patients.

Gastric reflux that visibly destroys tooth enamel but is also associated with a high risk for esophageal cancer, the fastest- growing cancer in the Western world.

Nasal allergies and upper airway restrictions that promote mouth breathing and improper tongue positioning. This leads to altered neutral zones that affect arch contours that, in turn, crowd the tongue into airway obstruction. Any alteration of the neutral zone can also affect craniofacial growth and development, altered dental occlusions, neuromuscular imbalance and potential TMD signs and symptoms.

Observable signs of airway obstruction can lead to disordered breathing that can affect sympathetic dysregulation with increased chronic stress hormone production such as cortisol. The effects of this harmful body-wide stress during waking hours or during sleep should be noticeable enough during a complete dental examination to alert the dentist to seek answers that may require collaboration with medical specialists. The solution may require a dental solution such as changes in arch form to allow proper positioning of the tongue.

Upper Airway Resistance Syndrome (UARS) and Obstructive Sleep Apnea (OSA) are major health risks experienced by millions of people of all ages. Visible signs may include dental occlusal wear, crowded dental arches, soft tissue obstruction in the throat and scalloping of the tongue. These disorders are commonly associated with gastric reflux. Other frequently occurring signs may include fatigue, poor sleep quality, snoring, attention deficit, morning headaches and sore muscles.

The opportunity for dental professionals to contribute to primary care assessment and intervention is extensive. This will require a shift for both dentists and physicians to appreciate the vital role of dentists, dental hygienists and team members to save not only smiles but to potentially save lives.

This new focus of care is defined by both understanding the nature and scope of oral-systemic connections and how best to treat these newly appreciated relationships between infection, inflammation, breathing, airway, TMD and dental occlusion.

Peter Dawson, DDS
Foreword, The Shift