Tuesday, March 19, 2013
Many dental professionals are aware that the care they provide contributes to their patients’ overall health, and physician Charles Whitney, MD, strongly believes this knowledge can be used to help usher in a new era in our approach to health and medicine.
Dr. Whitney is a proponent of the concept of the Third Era of Medicine, which he described in an interview with Dentalcompare as, “a conceptualization of where we’ve come and where we need to go.” The First Era was when early humans realized they could intervene in their overall health, and the Second Era was the dawn of diagnostics and the model of being able to find an existing disease and react to it.
“Every practicing physician was basically brought up in the 2nd era which is a reactive model. Basically it's find the disease. Our identity as physicians is to find the disease and react to it there,” Dr. Whitney said.
Now we’re on the verge of a new era as we gain an understanding of the underlying causes of illness. Health care providers can become educators who help their patients find the intrinsic motivation to take the actions in their personal lives that can reduce and prevent the start of illnesses. Dr. Whitney believes this would be a true paradigm shift in how health care is approached and delivered, and provide a far greater impact than the political football of public health care reform, which he described as really being, “health care financing reform.”
Dawning of a new era
Moving to a Third Era approach to health care requires providers in all settings to look at things a bit differently, and Dr. Whitney said physicians are likely to be slow on the uptake while dental professionals are perfectly positioned to lead this change. This leadership comes from the fact that knowledge of the oral-systemic link is widespread in dentistry, but less familiar to most physicians. Educating patients about the connection between oral and overall health and using this to motivate them to practice better oral care at home is a Third Era approach, and one many dental professionals are already putting to work in their practices.
Unfortunately, physicians often are not interested in hearing about anything that goes on in the mouth because they are not trained in caring for that part of their patients, Dr. Whitney said. For him a light bulb came on as he learned about the growing body of evidence backing the connection between perio and numerous conditions in other parts of the body. With that in mind, he’s reaching out to the dental community to encourage dentists and hygienists to take a leadership role in the education of both patients and physicians.
“I recognized that in 7 years of medical school and residency, my education of everything in front of the tonsils in the mouth was one lecture in my first year of medical school,” he said. “There’s so many body diseases that we medical people take care of that are powerfully influenced by disease going on in the mouth. We physicians can't ignore that. We need to have the help of our dental colleagues. In my vision we need all health care professionals to not just take care of our niche, our body part—whether it's the mouth for dentists or the joints for chiropractors—we all need to treat our patients and that involves helping them to create health.”
Educating everyone
The way Dr. Whitney envisions it, the start of these changes moving forward will take place in the dental chair. Dentists and hygienists are already educating patients about the oral-systemic link, and as that movement grows, there will also be more dentists reaching out to physicians to collaborate on helping patients improve their overall health.
Education is the key and dental health professionals interested in getting involved can start by educating themselves about the oral-systemic link. Dr. Whitney said he’s been impressed by the way the American Academy for Oral Systemic Health has worked to promote this concept, and he also sees the American Association of Periodontists as a solid resource for evidence based information. On the medical side, he follows research performedd at the Cleveland Clinic, which he said is a leader in medical Third Era thinking.
“There are all these different avenues that they can go with, but most importantly is just to get well versed in the oral-systemic connection,” Dr. Whitney said. “Then they can find the best ways to educate the patient to intrinsically motivate them. It's about educating the patient enough to open a discussion about their systemic health.”
For Third Era medicine to work, the patient needs to be motivated to take the actions necessary to care for his or her overall health, and this mix of education and motivation is one place hygienists are poised to shine. Dr. Whitney said whether a practice is looking to make oral-systemic health a key part of the way they brand the care they provide or just working to provide the best care for their patients, the hygienist is the person ready to provide the most positive interactions with patients.
“By treating the periodontal inflammation and infection, and then educating the patient, hygienists can get their patients to buy in.,” he said. “I've talked to a lot of hygienists and they want to do more, they want to make an impact. This is a great way that they can be a leader. The dentist just has to support it.”
For practices that do want to make oral-systemic health a bigger part of the care they provide, Dr. Whitney recommends a range of approaches that begin building a bridge between the medical and the dental environments. These approaches can include health screenings such as blood pressure tests during regular check-up appointments, providing wellness information to patients, offering health coaching for patients to help patients with conditions such as diabetes make the lifestyle changes that will help their physical and periodontal health, or even using diagnostic screening tests such as those created by OralDNA Labs to provide a more targeted, medical approach to periodontal treatment.
Creating a Dental-Medical Link
While there seems to be some momentum within the dental industry to focus attention on the connections between oral and overall health, that message has not made inroads with physicians. Dr. Whitney does not see this as a small hurdle, calling the puzzle of how to connect physicians and dentists into one health network, “the trillion dollar question.”
“99% of physicians don't have a clue how important oral health is to systemic health, therefore they don't see the need. Physicians are not going to be starting the conversation,” He said. “Part of what I'm trying to do is initiate this conversation.”
Physician education on this issue needs to come from all sides, and Dr. Whitney said dental professionals can work on two fronts by educating their patients who will then carry the message to their physicians and also connecting directly with local physicians when appropriate. This can be as simple as providing patients with a flyer they can give to their doctor explaining what you’re treating and the connection to a medical issue.
“It's initiating the discussion. If the dentist understands the value and the need and wants to keep it simple, let the hygienist take the role of educating the patient, put together some information they can give to the patient and initiate the discussion. It doesn't have to be work intensive,” Dr. Whitney said.
The message might not take hold right away, but it’s one that will eventually resonate with physicians. As they hear more about the oral-systemic link on a regular basis, the knowledge will take hold, and when they see results with their patients, they will become fully engaged, said Dr. Whitney who sees these results with his own patients.
“When I have my patients simply do a better job of taking care of their mouth and getting to their hygienist to do a cleaning, I see inflammatory markers drop significantly.”
The eventual result of more professionals in both the dental and the medical fields understanding the implications of the oral-systemic link will be a more connected health care system focused on helping patients find the motivation to care for and improve their health. Dr. Whitney looks forward to the time when referrals to a dentist are seen as the same thing as a referral to an endocrinologist, a cardiologist or any other specialist.
“The education part is the critical component. We need to educate the health professionals on the need for linking these two specialties,” he said. “It’s imperative that physicians learn about the mouth. It's imperative that dentists learn about the system. We don't have to be experts in those areas, but we're all out there to take care of our patients and not our body part.”
From there everyone providing health care services can start working in concert, and the focus can shift from diagnosing and treating existing disease, to motivating patients to care for their health in order to prevent those conditions from ever taking hold.
“The third era is all about empowering our intrinsically motivated patients to create personal health.”