The Emerging Opportunity in Wellness Dentistry

FDI Presentation, September 23, 2006

By  Ken Southward D.D.S.

Dentists typically work in isolation from other health professionals because we are told that dental diseases have a unique cause – oral bacteria. At the same time, cardiovascular surgeons are working in isolation to fight a cholesterol disease, diabetic specialists are fighting an insulin disease and oncologists are dealing with cells multiplying incorrectly. Modern health care sees the body as individual parts with specific problems. It focuses on the differences between diseases.

To discover a link between dental disease and these other systemic diseases, we must focus on what is similar between them, not what is different. Recent research is discovering inflammation to be the similar factor in all these diseases. It is now commonly understood that periodontal breakdown is not caused by oral bacteria, but by the body’s own uncontrolled inflammatory response. Essentially, it is an autoimmune disease. Likewise, the beneficial effects of cholesterol lowering drugs on cardiovascular disease are not so much due to reducing cholesterol but controlling inflammation. The macular degeneration and neuropathies of diabetes are inflammatory in origin. Inflammation can also be a factor in cancer promotion and progression.

Coping with infectious diseases obligated the dental profession to raise the standard of care to include more comprehensive sterilization. Likewise, coping with inflammatory diseases will obligate us to again raise the standard of care to include ways to help our clients cope with this common factor in all degenerative diseases.  

What is causing this systemic inflammation? Oxidation is the process that causes steel to rust or an apple to turn brown when cut. Our bodies also oxidize and the process is recognized as aging. This oxidation is caused by free radicals. They are molecules, often oxygen, that have an electron missing, which makes them very unstable. They will steal an electron from wherever they can to gain stability. This process can damage proteins, cell membranes and even the cell’s DNA. Free radicals are produced within our own cells as a natural by-product of energy production. Fortunately, our bodies also produce antioxidants to harmlessly donate electrons to neutralize these oxidizing free radicals. When oxidation equals antioxidation, everybody is happy and healthy.

We are also bombarded with free radicals from outside the body. These are things like plaque on your teeth, cigarette smoking, air pollution, radiation, too much sun and refined carbohydrates that stimulate excessive insulin. One cigarette alone generates 20 million free radicals. To combat this, we rely on sources of antioxidants from outside the body. These are found in brightly colored fruits and vegetables and high quality nutritional supplements. Once again, when the oxidation/antioxidation equation is equal, everything is well.

What happens to the equation when the oxidation side, that is the sum of inside and outside sources of free radicals, is greater than the antioxidant side or the sum of inside and outside antioxidants? This difference or imbalance creates oxidative stress. To defend itself against oxidative stress, the alarms go off and the body marshals its defensive inflammatory response. The more the oxidation excess, the more inflammation is necessary to help the antioxidants balance the equation. In an acute situation, like a sliver in your finger or plaque on your teeth, once you eliminate the oxidizing sliver or plaque, the equation is re-balanced and inflammation disappears. In a chronic situation, like never cleaning your teeth, long term smoking, obesity or air pollution, the body can’t shut down the inflammation response because the irritant is always there. Eventually, the body’s antioxidant defenses are exhausted and damage occurs either in the area of local trauma or systemically at the point of genetic weakness. Examples are the pockets of periodontal disease, the inflamed blood vessels of cardiovascular disease and the free radical damaged DNA of cancer.

To achieve health, we must continually find ways to balance the health equation. Traditionally, dentists have focused all our efforts on reducing one free radical generator, plaque on the teeth. Now we understand that there are so many more free radical generators. Some are controllable like smoking while air pollution is not as easily managed. The greatest gains will come from reducing as many sources of free radicals from outside the body as possible while increasing antioxidants in our diet. Supplementing one’s nutrition with potent multivitamins, minerals and newly discovered antioxidants will play an increasingly critical role

Dentistry is in a particularly favorable position to show leadership in this area because we see people of all ages who come to us by choice rather than on an emergency basis. They are relatively healthy so they still have time to make choices and learn to accept responsibility for their own health.

Why is today different than any other time in history? We are rapidly leaving the industrial world behind and moving to a knowledge era. While the assembly line was the force that powered the industrial economy, the network will power the knowledge era. Massive computing power and the internet will facilitate world-wide networks of people sharing philosophical and economic interests. Wellness oriented dentists can be part of our emerging network, if they choose.

            The glue that connects a network is a common cause. In dentistry’s case, that is the health of our clients. Draw a chart and put this objective on the top level. On the level below the health of our clients, place your dental team members who are committed to supporting your client’s efforts. The third level down is the dentist committed to supporting the team members so they can better support the clients. This model is known as servant leadership. You will note that it is just the opposite organizational style to the industrial model, which puts the leader on the top and rarely mentions the patient at the bottom. Knowledge era networks will add other levels as dentist leaders emerge to support other dentists. This kind of network leverage will catapult wellness leaders to the highest levels of compensation. Essentially, leaders will ‘net’work, while others ‘just’ work.

In summary, I have presented four concepts which I believe will change not only dentistry, but overall health as well. First is inflammation being the common link between all lifestyle diseases. Second is the health equation in which we must balance oxidation with antioxidation to avoid inflammation. Third is the concept of servant leadership where supporting our client’s health is the ultimate goal. Fourth is the unprecedented opportunity offered by knowledge era networks.

I invite the leaders amongst you to join me in this wellness mission to elevate the standards of care in dentistry to include supporting our clients and patients in understanding and coping with inflammation. I have created four web pages to support you.

www.dentalhealth.ca/China/FDIchinese.htm  to read this presentation in Chinese

www.dentalhealth.ca/China/stores.htm to support dentists practicing in China

http://www.dentalhealth.ca/China/FDIenglish.htm to read this presentation in English

www.dentalwellnessnetwork.com to support dentists practicing in the rest of the world

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I look forward to further discussion via e-mail at drken@dentalhealth.ca and the emergence of new leaders in wellness for our profession. Our influence will ripple far beyond dentistry if we shift our focus to wellness instead of limiting ourselves to the repair of dental disease.

Thank you.