By Dr. Keith Libou, Chief Clinical Officer
There has been a lot of discussion lately regarding the relationship between gum (periodontal) disease and a number of serious medical conditions. Some of the conditions that may be connected to gum disease include Type II Diabetes, heart attacks, strokes, rheumatoid arthritis, COPD, kidney disease, pre-term low birth weight babies, and others.
As research on these relationships progresses, the importance of improving (and maintaining) your oral health is also becoming clearer. However, while much of the discussion is related to the diagnosis and treatment of oral problems, the important role dentists can play in recognizing the presence of certain medical conditions cannot be understated. So think of your dental visit as an opportunity to have your overall health checked out for certain medical conditions.
For instance, dentists are on the front-line in recognizing patients with high blood pressure. This is not only key in understanding a patient’s overall health, but also enables dentists to provide care safely and avoid medical complications during or after treatment! Dentists frequently use local anesthetics that contain epinephrine, which they might otherwise avoid if they know a patient has high blood pressure. The reason for this is that the epinephrine in the local anesthetics could cause an increase in a patient’s blood pressure during treatment, which could be very dangerous for patients with untreated or undiagnosed high blood pressure.
High blood pressure can also be a symptom of obstructive sleep apnea (OSA), which is a potentially life threatening condition where people stop breathing while they sleep due to a small or blocked airway at the back of their throat. Recognizing the presence of high blood pressure, when combined with other potential risk factors for sleep apnea, could be a critical finding by dentists which may indicate that a referral to a sleep medicine physician is necessary.
Oral cancer has been in the news recently, mostly because of the increase in oral cancers associated with human papilloma virus (HPV). Oral cancers often have a high mortality rate, primarily because they are often diagnosed at an advanced stage where treatment may not be as effective. Like other cancers, early detection of oral cancer is vital and improves potential treatment outcomes after a diagnosis. This is the reason why, during your visit, the dentist, is peeling back your lips, pulling your tongue out of your mouth with a piece of gauze, looking at the back of your throat, and feeling under your jaw and all around your neck. The dentist is looking for oral cancers that often are not easily identified until they have progressed further. This is another extremely important reason to make sure you are routinely visiting your dentist!
Another critical health problem that dentists can help identify is undiagnosed Type II Diabetes. Most dentists are trained to recognize the risk factors for Type II Diabetes. The presence of undiagnosed diabetes not only poses a major health problem to patients, but can also have a significant impact on dental treatment decisions. For example, patients with untreated Type II Diabetes may have delayed wound healing, and this could be a major issue to recognize to avoid post-operative infections and complications.
To support the ability of dentists to identify the diabetic (or pre-diabetic) status of patients who have risk factors for Type II Diabetes, Delta Dental submitted a code request to the American Dental Association’s Code Committee for creation of a new procedure code for dentists to perform in-office HbA1c testing (the new code will be effective January 1, 2018). This test analyzes the three month average of a patient’s blood sugar level, and it is a reliable indicator of a patient’s diabetic status. If a dentist performs the HbA1c test in the dental office and a patient is identified as having an HbA1c result in the pre-diabetic or diabetic range, the dentist would refer the patient to their physician for evaluation. This information is a critical consideration in the dental treatment recommendations that are made in coordination with a patient’s physician.
Millions of patients who see their dentist regularly do not receive routine medical care. Regardless of whether you fall into that category, know that your dentist’s ability to provide safe, effective dental care while also recognizing potentially serious medical conditions earlier is a critical part of helping you lead your most healthy life.