The Perio Perspective

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THE PERIO PERSPECTIVE
Winter 2019
The Basics

We don’t save many lives. This is a blessing, since it also means that we don’t have to live with the possibility of patients dying under our care. But nothing is more gratifying than knowing that someone is alive today because of you.

In previous newsletters we have discussed the growing evidence that treating periodontal disease reduces the risk for heart attacks and strokes, for preterm infants in pregnant mothers, and perhaps for Alzheimer Disease and cancer. So this is one way to save lives. But today’s topic is more basic and banal: the initial and periodic exam.

The incidence of oral cancer is increasing at a rate of 15% annually for the past 25 years. This is primarily due to the human papilloma virus (HPV), which is increasingly common in the oral cavity. The prevalence of HPV is elevated in men, African-Americans, cigarette or marijuana smokers, promiscuous people, and the 30-to-50 age group (Sonawane, K et al, Ann Intern Med 10/17/2017). As they age, these groups will experience the highest risk for oral cancer. The highly successful HPV national vaccination program will eventually solve this problem, but it has not been extended beyond the age of 26. So for the next few decades, early detection of suspicious lesions will save many lives. Therefore every initial and periodic examination should include an oral cancer examination. We all know this, but it can easily drop by the wayside.

Approximately one in six of our patients smoke, vape, or use smokeless tobacco. We hope that all our colleagues agree with us that these patients should be periodically (and non-judgmentally) reminded of the risks of their habits. We offer prescriptions for Chantix or NicoDerm to many cigarette smokers. Although the long-term success rate for smoking cessation is low (well below 50%), it is not zero, and everyone deserves a chance. For the lucky few who can quit smoking permanently, their risk for many forms of cancer and heart disease will drop to normal over the ensuing decade. Eventually their dental health will benefit as well. Like oral cancer exams, smoking cessation is easily neglected while we are focused on our procedures. But with ongoing, judicious coaching (not nagging), some smokers can be encouraged to cut down or quit. If they do, you may have saved their lives.

Do you take a blood pressure at the initial exam? Periodically? Prior to treatment? Never? One-third of American adults (71 million people) have hypertension. Half of them (36 million people) are not well-controlled, and one-third of those (12 million people) are not even aware that they have hypertension (Wall, H. et al, JAMA 312:1973, 11/19/2014). This means that, for an average-sized dental practice, 3 to 5 patients each day will have high blood pressure, and 1 to 3 of them will not know it. Leaving aside the medicolegal risk of treating them, a significant moral concern is that diagnosing and informing them gives them a chance to avoid a heart attack or stroke. We suggest using an automated BP cuff as a screening device at all initial visits and prior to any invasive or prolonged procedures, and at regular intervals as part of maintenance visits. High readings can be evaluated further with a traditional BP cuff and stethescope, and if they are confirmed, we strongly encourage follow-up with a physician. More lives saved.

These tasks seem peripheral to our primary agendas as dentists and hygienists. They are certainly not money-makers. But for some patients, they will prove to be the ultimate service we can provide.