Inflammation and Oral Systemic Connection P3

Daniel Vinograd

Some of your patients are already at risk for developing diabetes.  They may be type II diabetics already, or they may be prediabetics.  I learned a couple of years ago from Dr. Bale that diabetes just didn’t happen.  He tells a story, and I’ll say this very quickly.  Dr. Bale tells a story prior to the Bale/Doneen method that went to the hospital, had a heart attack, recovered from the heart attack, came back home, and in describing his experience at the hospital as fine, but said, “Guess what?  While I was in the hospital, I was developing diabetes.”  It happens all the time, but what Dr. Bale will tell you that you don’t develop diabetes in the hospital.  This is a 10-20 year evolution.

Some of our patients are prediabetic or already diabetic.  If you know what to look at in your patients’ oral health, you can diagnose 73% accuracy prediabetes or diabetes looking at the right parameters by doing a good oral health exam.  We’ll explain what that is, probably 5 minutes to be that accurate.  One simple test at that, you as a health practitioner can accurately diagnose with a 92% accuracy prediabetes or diabetes.  This is incredible information.  It has now been published, and we need to know about it.

So, how about your patient’s attitude?  How will this change your practice?  Will I have time for this?  Will it help my practice?  Will it hurt my practice?  Let me show you that these studies have already been done.  Patients that have gone through this screening, in other words, medical screening in a dental setting both in the private dental world and in the educational institutions, patients’ attitudes when dentists get involved in general health is extremely positive.  We’ll discuss what patients said. We’ll discuss what the literature clearly says about the powerful positive impact of bringing this kind of information to practice.  It grows your practice, and it also grows your reputation as a health care provider in the entire community to our practice.  Very positive there.

The last slide that I will show you is don’t forget yourself because your lifetime risk is the same as everyone else.  All of us, as human beings, have a lifetime risk of developing coronary heart disease.  If you’re a male and you’re 40 years or older, your lifetime risk of developing coronary heart disease is almost 50%.  You have a 1 in 2 chance of developing some kind of coronary disease.  I will tell you this, though, that Dr. Bale will tell you that this is preventable if you know what to do and you are looking at the right things and you are in the right position.

If you are a female, you have about a 32% risk of developing coronary heart disease.  Just looking at that risk that should be motivating for all of us to determine what our level of risk is because risk factors are equivalent to greater risks.  Risk factors like diabetes don’t just occur suddenly.  They occur in younger individuals, and it’s only once we get into our 40s and 50s decades that these risk factors ultimately culminate into the event.  That’s what we want to prevent.

So, in this course, you’re going to learn from two experts that deal with heart attacks and strokes and diabetes on a daily basis.  You’re going to look at your own health and determine if you are at risk.  You’re going to look at the health of your spouse, the health of your children, the health of your parents, and the health of your whole extended family.  So, please come to this course for your own personal reasons.  Also, please come to the course to learn about how you can protect your friends that are your patients.

It’s been a great privilege for me to be a part of Dr. Bale and Ms. Doneen’s work, and I guarantee you that this will be the most important course that you have ever attended. So, thank you Dr. Bale for your work and nurse practitioner Doneen, and thank you also Crown Council for the wonderful work that you guys are doing.  Please consider adding this important work to the causes that you are so good at doing.  Thank you.

Dr. Bale:              Dr. Nabors, thanks.  Amy and I feel indebted to Dr. Nabors because we’ve been aware of the connection for a lot of years, working with our patients to maintain oral health, but we ran into Dr. Nabors because he was able to really objectify the bacterial burden with the testing he brought to the United States with the salivary diagnostics.  So, that move we were doing went on to a much more solid platform of objectivity for our work to prevent heart attacks.

I’m going to fly through the next four slides because I want to leave a full 15 minutes for Q&A and basically just say I’m very excited about the potential for more oral medicine specialists in this country.  We need them.  We deliver a two-day course for medical providers and dental health providers come to that, and they’ve always been pleased when it happens.  That’s why I come to San Antonio now.  We have medical providers that will be attending our two-day course coming up.  After they go through our course, then they’re much more aware of the oral systemic connection, and they need to partner oral medicine specialists.  I had a patient who needed to find an oral medicine specialist to partner with, and he lives in Phoenix, Arizona.  We found somebody who wants to leave where they’re working.  They’re celebrating, testing.  We need more fighters out there.

Anybody coming to the November 2nd course is going to leave that course being able to call themselves an oral medicine specialist, and medical providers who through another course will certainly need to collaborate around the country with you in the effort to maintain cardiovascular wellness.

So, we do need to rewrite the American Heart Association impact goals for the current decade.  Ideal cardiovascular health equals the absence of clinically manifested disease and optimal control of oral health.  So thanks again for being in on the call.  I’m excited about what you’re doing.  I appreciate all your help in preventing cardiovascular events in this country.  So, thank you.

Caller 1:               I have a few questions.  The first one is, how do you suggest that periodontal disease should be defined?  Please address active versus inactive periodontal disease, controlled versus uncontrolled.

Dr. Bale:              Dr. Nabors, do you want to take that?

Dr. Nabors:         Well, I would certainly love to, but I would say that those who are listening may think I’m biased.  So, Dr. Bale actually has case studies that show the relevance of what we’re trying to do together.  So, I would actually ask you Dr. Bale to answer that question.

Dr. Bale:              Yeah.  I think any definition of periodontal disease certainly has to include bacterial burden and certainly the bacteria we currently know that carries a huge risks such as the Porphyromonas gingivalis, Tannerella forsynthensis.  We know these periodontal Gram-negative bacteria can drive arterial inflammation, and they could do it in several ways.  Certainly, one of the ways that’s well-defined at this point is through the lipopolysaccharides that are created by these Gram-negative germs, and they stimulate toll-like receptor forms, toll-like receptor 2, which are critical drivers of the inflammation in our arteries.

In addition to that, several of these bacteria have been shown to increase the permeability of the inside lining of the artery, as you know, called the endothelium.  When you increase the permeability of the endothelium, you’re opening up the wall of the artery for injury.  So, I think any definition of periodontal disease has to address bacterial burden, and we do have excellent tests for that now.  The bacteria are clinical, and they could certainly be sub-clinical.  I do have a case I’ll be talking about in our course where he had subclinical periodontal disease in term of attachment loss and pocket depth.  You would give him a gold star, but the more sophisticated salivary test showed that he had a very significant bacterial burden, and he had arterial inflammation.  He’s a very high-risk patient not only for heart attack but also for ischemic stroke.  A critical part of getting his artery cooled off was addressing his periodontal bacterial burden.

Dr. Nabors:         May I add to that, too, Dr. Bale?  I think we certainly want to encourage any practitioner to follow the ADA guidelines as well in defining periodontal disease, especially on bleeding and pocket depth.  Unfortunately, we don’t have a perfect way of diagnosing periodontal disease.  We do have a classification system, not a diagnostic system.  The classification system must involve the ADA I, II, III, IV, V or the AAP classification.  Either one works.  Most of us use the ADA but bother are important.

What Dr. Bale is saying is that when you add the bacterial burden to it simply increases the level of risk, most for bone loss, and certainly, the level of risk for us that may be at risk for heart disease.

Caller 1:               What is the best way to teach this information to a patient who doesn’t feel or see any impact of periodontal disease?

Dr. Bale:              Now, let me take that.  We will be addressing that in a big way in our November 2nd course.  My partner, Amy Doneen, will spend a whole hour addressing how you communicate with patients the potential cardiovascular risk.  We have ways where we’re going to talk about how you can educate the patient.  We have an acronym or a method called EDRA, and the E stands for education.  So, we have great terminology, and Dr. Nabors has developed the terminology along with us that you will be able to utilize that the patient will understand.

For example, at the endothelium we’re talking about, the inside lining of the artery, you let them know that’s the tennis court, and how hot it is and permeable it is, is the most important thing you can know about your cardiovascular health.  We have ways of identifying subclinical plaque in the wall of the artery.  Actually, some of that testing will be available at the course for individuals.

If you want to find out about your own potential risk, whenever we’re addressing an audience that we’re teaching, we always let them know they’re the most important people in there, not the patients, because if they don’t take care of themselves they’re not going to be taking care of any patient.

So, a lot of people that come to our courses inadvertently find out, “Hey, you know, I got a little risk, but at least I found out before I had an event.”  We’re actually going to do two simulated visits as part of the course, as part of the CE we applied for.  We’re going to have a patient visiting a dental professional, a patient visiting a medical professional, and how you communicate to the patient and how the dental provider communicates with the medical provider and how the medical provider communicates with the dental provider.  All that communication.  Whoever has the communication, they’re right on the money.  If you don’t know how to educate, you don’t know how to communicate.  That’s your death.

Dr. Nabors:         May I add something to those wonderful comments, and that is our own Steve Anderson will be there as well.  At the end of programs, Steve is going to talk to us about implementation and how we can discuss this in terms our patients can understand.  So, we’re really looking forward to him being there.

I would also like to add that if I understand the question and that is sometimes our patient may be reluctant to do a test, we certainly understand that because testing is very routine in the world of general medicine and not as routine in our world, but Dr. Bale and Ms. Doneen are going to present some unique cases wherein they not only use serum risk factors where they were looking at specific markers that indicate risk.  They also discover from using the salivary test.  Sometimes, it’s actually the bacterial burden that tips them off.  Is that not right Dr. Bale?

Sometimes, there’s cases where the salivary test actually help to find what you’re treatment is going to be, right?

Dr. Bale:              Absolutely.  The patient I saw yesterday that flew in from Phoenix to see me has got a periodontal issue, and we discovered it.  That’s why I had to find a dentist quickly, an oral medicine specialist in the Phoenix, Arizona area, and we were able to do that.  He flew back yesterday, and he’s probably calling the office right now to make an appointment.

Caller 1:             I have a question about that.  May I ask if you may talk a little bit about where the access is to doing the saliva test.  My members want to know if that’s available to them, and can you talk about that?

Steve:                   I’ll weigh in on that.  Dr. Nabors pioneered one of the earliest salivary tests today in the brand Oral DNA, and you can go on the internet, just search for Oral DNA.  The supply’s ordered through Henry Schneid.  The supplies, you take the salivary sample, send in your oral DNA, and then the results are provided online.  So, Dr. Nabors has been very closely involved with Oral DNA for several years, founded it and developed the whole system.  I believe, Dr. Nabors, that would be considered the standard but not the most-widely used salivary diagnostic test?

Dr. Nabors:         Yes, that is correct, and thank you Steve for doing that.  Please be aware, too, that everything is HIPAA compliant.  The laboratory’s completely [1:00:36], and Steve said they’re very easy to get and start doing that.

If you have questions, you can e-mail me at [email protected]. Even though I’m not associated directly on day-to-day basis, I’m certainly very interested in learning how you can add value to the dental experience.

Steve:                   If I could just weigh in on how you raise patient awareness.  I’ll just give this one quick tip that I would say to the vast majority in the Crown Council.  For years, we passed a hurdle when you diagnosed periodontal disease in a new patient, you would simply ask, “How long have you had this infection?”  The response from the patient will always be, “What infection?”  When you show them, they commonly respond to this, “It doesn’t hurt.”  Your response to that is, I’m always amazed, “An infection this serious doesn’t hurt until it’s too late.”  Then, the next step in that, where medicine and dentistry come together, is to ask the patient who they know that heart disease or has high cholesterol, high blood sugar.

Of course, everyone know someone that has one or more of those conditions.  The response to that is periodontal disease is similar to those except they don’t hurt until it’s too late.  That’s why when we see the signs of it, we get very concerned, and want to get it treated before it’s too late.  Most people can relate to that because they’re very familiar with the other conditions.  When you frame it in that way, it makes more sense.  That’s a short answer to an obviously more-involved way of presenting things, but for those that may not be familiar with that, that’s a quick introduction and quick review.

Listen, Dr. Bales, Dr. Nabors.  Thank you again for sharing.  You accomplished the near impossible.  I asked the two of you to cram two days into one hour.  I appreciate you completing the task and making everyone aware of the resources that are available in your course that you’ll do November 2 in Las Vegas.  If you would like to know more, it is definitely a direction that dentistry is going rapidly.  We appreciate your pioneering work in educating all of us in how to take care your practice in that direction to better serve our patients.  So, thank you again for being with us today, and thanks for all the Crown Council members for being here in our webinar today.  We wish you a great day.

Thank you!

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Dr. Daniel Vinograd, DDS |
10450 Friars Rd, San Diego, CA 92120 |
Phone: 619-630-7174    •    Dr. Vinograd, DDS, is a Dentist in San Diego, CA, offering services as a periodontist, and providing teeth whitening, dental crowns, invisalign, implants, lumineers, dentures, root canals, holistic, family and cosmetic dentistry.

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