Mouth-Body Connection: How Dentists and Physicians Can Work Together

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Over the past 5 to 10 years, there has been fast-growing interest in possible links between mouth health and body health. The working relationship between diabetes and periodontitis may be the strongest of all the connections between the mouth and body. With us today is an expert on this topic, Dr. John Comisi. Dr. Comisi has been in private practice in Ithaca, New York, since 1983. He's a regular speaker on Viva Learning.com, was the founder of Dental Care with a Difference, president and CEO of Sleep Focus Solutions Incorporated, and an assistant professor at the Medical University of South Carolina, James B. Edwards College of Dental Medicine. Dr. Comisi, thanks so much for joining us again on Dental Talk. It's great to be with you again, Phil. Yeah, we really enjoyed your previous podcast and just letting our listeners know that you did an excellent one on sleep medicine. It was very, very interesting. And I encourage everybody to listen to that. It's about 15 minutes and it has great information about how dentists collaborate with the medical profession regarding treating patients with sleep disorders. This particular podcast is on the mouth-body connection and how dentists and physicians can work together. So it's another podcast about collaboration. My first question is, tell us briefly about the mouth-body connection and how can dentistry and medicine better work together? Well, thanks very much. That's a great question. One of the biggest challenges I think today is recognizing that periodontal disease is a ubiquitous problem. It's almost epidemic. uh in in our in our society and probably in our world uh an article in the journal dental research a few years back uh made the quote this quote available says now that we have re-established that periodontitis periodontitis is virtually ubiquitous it is not time to define levels of disease that may make more sense to focus on maybe from a perspective of public health perspective is going on. We seem to be in an era now that inflammation is becoming a buzzword that we're worried about. And what greater inflammation is there in the body than periodontitis? And periodontitis, of course, has been correlated and linked to so many different possible diseases. heart disease, respiratory problems, arthrosclerosis, diabetes, rheumatoid arthritis, even pregnancy complications have been associated with this inflammatory disease, all because of the bacteria of the mouth, pancreatic cancer. has recently been tied to P. ginger valis, which is one of the bugs that are found in the oral cavity. All kinds of arthrosclerotic vascular disease. And recently, just a few weeks ago, an article published in PLOS showed that there is a correlation between periodontal disease and... Alzheimer's and neurologic disorders. So we need to control this disease, which is controllable because the bacteria in the mouth are not found anywhere else in the body. And the body has no real effective defensive mechanism against this. So we need to control the inflammatory disease that's going on in the body. Yeah. And obviously. Dental floss does help. Oh, sorry. Just out of curiosity, a couple of questions before I get back onto this topic. One is when did the mouth-body connection become prevalent where this was the thought process in dental medicine? Yeah, it's been something that's been brewing for a number of years. And one of the organizations that I belong to, the American Association of Oral Systemic Health, formed about six or seven years ago. And they were one of the first groups to really bring that forward. in being a multidisciplinary organization, bringing medicine and nursing and dentistry and physical therapy together to try to understand how and why we need to work better together. But it's certainly something that's happened. It's becoming more and more obvious over the last decade in particular. If I remember correctly, back in about 2000 or so, Bob Jenko at University of Buffalo published one of the first papers regarding periodontal disease and heart disease being... to each other. So it's been quite a while now, but over the last decade or so, it's becoming more and more of an issue and more and more of a hot topic. So what areas of medicine collaborate the most with dentistry? Not as much as should. To really be their reality is that sometimes physicians forget that we actually... a window into the overall health of a pair of a patient looking at them from their medical history patients will see us more often than they will their primary care physicians because of their need to make sure that their dental health is well. Not that as many people see us as they should, but certainly for those people that do seek out health care, they usually see the dentist more often than the physician. But we have a responsibility of communicating with the physician when we start to recognize that something is out of balance. In my practice, my diabetic patients, we knew when they were off of their regimen or they weren't doing as well, simply because their periodontal disease was out of whack than usual. And once we control the perio and coordinate the therapy with their physicians, we often were able to get them more controlled again. So periodontitis and diabetes in particular is an area that we really need to be looking at more closely. In fact, the Academy of General Dentistry has formed a task force with the American Academy of Family Physicians and the American Association for Diabetic Educators to try to inform our various memberships on why and how we need to collaborate more closely together in the treatment of people with diabetes. And so what is being done to increase this collaboration? Well, the last several annual meetings of those three groups, lectures have been provided to try to get the ball started, get the ball rolling. The organizations have created a forms for communication between physicians and dentists and dentists and physicians so that this way we can inform each other of what's going on. We are also beginning to create some other forms of education via podcasts, et cetera, to just continue to bring that messaging out. The more that we talk to each other and talk about how we can reduce medical costs. Physicians and the government would love us to help to reduce their medical costs if we just help to improve the communication about the dentally related disease entities that can probably reduce the challenge to our medical system significantly if we just control oral health. Yeah, I mean, and of course, not to undermine the significance of diabetes and heart disease, but just the early detection of dysplastic tissue related to the early detection of oral cancer. I mean, like you mentioned, dentists see patients more than physicians do. I'm still wondering when it comes to oral cancer, are most dentists using devices, whether it's fluorescence or other devices, to look at the patient from the standpoint of screening of oral cancer? Is that something that's routine in every dental practice? It really should. And it's one of the things that we focused on in our practice a great deal simply because. I'm a cancer survivor myself, and I have a very high sensitivity to the potential of someone else developing any type of cancer. So screening orally is critical. I know that April is Oral Health Care Awareness Month, Oral Cancer Awareness Month. by golly why aren't we aware of it all year long i think that that's that's one of the issues so we as as dental professionals hygienists are are really on the forefront of trying to identify that insidious disease before it becomes more a manifest that as a white lesion that has grown into a more frank lesion if we can identify these potential challenges early on using visible fluorescence as a tool. It's not a diagnostic, but it's a tool to make us identify if something is just looking out of place and further evaluations with. So it's certainly one of the things that I'm very, very aware of and we have used in our offices since they were made available. Yeah, actually, there's another product or a new product that's out, or relatively new. It's actually a pair of goggles that you wear. I think it's called Goggles. I'm not absolutely sure. Yeah, I actually tested those in its trial thing. Oh, is that right? Yeah, they're nice devices. You still need to be able to use a fluorescent device of some type or another with them, but they really can help you. visualize things to a higher degree. So they're nice things to use. Yeah. So my last question in this podcast, and this has been great information, is what can dentists do in their practices to take part in this healthcare collaboration? Educate yourselves. No, understand the medications that the patients are taking because there may be something going on. Recognize the inflammation and how you can get your patients to control that inflammation. In a later podcast, we're going to talk about things that we can help our patients do. But one of the things I'll leave you with in this situation is how many of us tell our patients to clean their teeth? How many of us actually show them how to do it? Maybe if we teach in the way that the person is going to be able to understand rather than trying to tell them how to do it, maybe we'd have more success in controlling the inflammation of gum disease, periodontal disease, and dental caries as time goes by. And if we just take a wise eye and visualize what's going on in the mouth, it can help us help our physician colleagues help our patients. That's a great point, Dr. Comisi. Thank you so much for joining us for today's podcast. We appreciate your time. We know how valuable it is and your insights into this topic were absolutely invaluable and excellent. We appreciate it. It's an honor and privilege being with you. Thank you.