I recently went on a date that didn’t go very well. We met at the restaurant, and he seemed polite, but then he smiled. I was immediately taken aback to see a 3-4mm bridge of calculus extending from #22-27. I ended up spending most of the night staring at my date’s mysterious mouth. I couldn’t figure out if the gaps in his smile were due to missing teeth or if his teeth were spread so far apart because of advanced periodontal disease.
I was so focused on his lower arch, I never even looked at his upper arch. I honestly had a difficult time concentrating on anything he said because I spent the whole date wondering how soon he might lose those teeth, or if he might have a cardiac episode any minute. I had so many questions.
Was that bridge of calculus the only thing keeping his teeth in his mouth?
How did he get this way?
Was his dentist or hygienist (if he had one) unable to educate him on the oral-systemic connection and how periodontal disease can contribute to a variety of health problems?
Where was the disconnect?
If he had no dentist, did his physician ever look in his mouth? The disease was obvious.
What medical conditions did he have because of his periodontal condition?
Did he not see either a dentist or a physician?
Before the last question ran through my head, the date was over. I was not interested in continuing to date this man, but I was concerned for his health. But by the time I drummed up the courage to talk with him about his issue, we had parted. I missed my window even though I knew what I wanted to say to him. I feel guilty that I never talked with him any further about his oral health.
You might never feel bad about not discussing oral health with a date, but there are times in every hygienist’s career when we know we should have said more to a patient about their situation.
According to a study in the American Journal of Public Health, as many as 20 million Americans visit their dentist each year but not a physician. Also, an estimated 111 million see a physician each year, but not a dentist. I’ve always striven to understand how we can help more as dental professionals.
The first thing we can do is find out which physicians in our area are accepting new patients and create relationships with them. Ask your patients when their last physical exam and bloodwork was. When it comes to medical and dental histories, we function as detectives. As detectives, we need to ask the right questions to solve the mystery of what might be affecting our patients’ oral and systemic health. It’s our responsibility to share these risk factors and their causes with our patients so they have a greater understanding of the problem. When patients understand, they own their problem and feel in control, and they’re more inclined to accept recommended treatment.
To dental teams everywhere: We are the first line of defense for 20 million people! We are lifesavers! We are not just cleaners of teeth, chiselers of calculus, or mere drillers or fillers. You are an integral part of your patient’s healthcare team. And we need to be screening for more than perio disease, we should also screen for the following:
- Oral Cancer
- Blood Pressure
- Sleep Apnea
Oral Cancer Screening: Do both intra- and extra-oral exams. Make sure your patients know you are screening them for oral cancer and that it is part of the routine care you provide. This shows how comprehensive your care is, and creates value and importance for the appointment. There are 100 types of HPV and 40 of those types can cause oral cancer, so screenings are more important than ever. Always refer to an oral surgeon in case of any detection of abnormalities. Better to err on the side of safety than to find out you might have missed something.
Dermatology Screening: When screening for oral cancer make note of any skin abnormalities. Show the patient the area of concern and find out if they have annual skin screenings. I have found lesions on the tops of men’s heads who otherwise would have continued on with life not knowing they had skin cancer in a place they could not easily see. It is always better to have them get checked, even if you’re not sure. Even though this is not your area of expertise, trust your gut if something looks abnormal. If your patients do not have or know of a dermatologist to visit, keep the names and contact information for one or two so you can refer to them.
Blood Pressure Screening: With 50 percent of periodontal patients having undiagnosed hypertension, blood pressure screenings are imperative. It is best for the team to know what the guidelines are for hypertension and treatment. If a patient’s blood pressure is elevated, consider giving them a physician referral letter with their readings. Explain the consequences of untreated hypertension. If their blood pressure is above the threshold for treatment, consider calling their physician and scheduling an appointment for them. If dangerously high, call their physician for an immediate appointment, emergency room visit, or call 911.
Sleep Apnea: If you are not screening for Obstructive Sleep Apnea (OSA), consider doing so. OSA increases the risk of morbidity and mortality. Extraorally, look for a neck size of greater than 17” in men and greater than 16” in women, Class II Malocclusion, retrognathic profile, long face, and small nasal passages. Intraoral features may include macroglossia, a narrow high-vaulted palate, enlarged low-hanging uvula, enlarged tonsils and adenoids, bruxism, overjet, erosion associated with GERD, and edentulism.
Connect with physicians who treat OSA to establish a relationship for referrals if you are not comfortable treating OSA.
HbA1c Screening for Diabetes: Diabetes is a risk factor related to periodontal disease. Screening for Diabetes is lifesaving. Check with your state dental board to see if they deem it within the scope of practice in your state.
Teeth and gums aren’t our only concern. As I wrote earlier, we are the front line for 20 million patients who do not have a primary physician. We are an extremely important part of the healthcare team. The closer we work with the rest of the medical community, the healthier our patients will become. I have no doubt the referrals to physicians will come back to you when they see how comprehensive you are with your screenings.
It’s a big WIN for everyone!
ABOUT THE AUTHOR
Jodie Heimbach, RDH, BS, has been a clinical dental hygienist for 31 years and is the Clinical Calibration Coach at Productive Dentist Academy, guiding dental teams to become aligned with their standard of care. Heimbach is a past president of the New Jersey Dental Hygienists’ Association and is the recipient of the 2008 Sunstar/RDH Award of Distinction. She can be reached at firstname.lastname@example.org.