Dentistry and “The Third Wave”

by chaseccenter | Feb 3, 2011 | Philosophy of Science | 0 comments

I work in a world different from most dentists. Many of my patients are treated for a constellation of systemic issues including: Obstructive Sleep Apnea, Vertigo[1], Tinnitus[1][2], headaches[3], dysphagia[4], cervical dysfunction/pain, TMD’s, and a host of connected pathologies such a Rheumatic diseases[5] ,Bell’s palsy[6] and Multiple Sclerosis[7] to mention a few. Science and technology is supporting the dentist’s role increasingly being more authoritative for a greater range of care to these interconnected systemic health issues.

Interconnected to what? To our occlusion[8], to our head posture[9], to our cervical relationships, to our jaw positions, to our airway; indeed, all the way down to our feet. Biological testing will be knocking on our door as the medical world requests we test for various cancers, disease markers, and biometric data for medical referral. I lecture on these topics at the University of the Pacific Arthur A. Dugoni School of Dentistry and lecture locally, nationally, and internationally. The medical world and the public’s perception of dentistry is changing and we are entering the “third wave” as Danny Bobrow, MBA states in a recent article. [10] There are a number of dental researchers and academics that are saying the same thing. I like Mr. Bobrow’s essay as he is a lay person. Yes, even the people outside clinical settings are recognizing the trend.

The public has gone through the first wave where dentists were the ones to get them out of pain.  This was the “Feel Well Dentistry”. Then a second wave developed more recently with patients getting care in improving their appearance as well as keeping them out of pain. This was the “Look Well Dentistry”.  The phrase “cosmetic dentist” was created.

Presently a third wave is underway. This third wave perceives dentists connecting to a patient’s comprehensive health and wellness. For many dentists, this was not known about or taught in their dental schools.  We are in transition as more physicians, dentists, and the public come to see the dentist as truly an oral physician. When dentists offer integrated care for diagnosis, treatment, and prevention to a multitude of systemic illnesses; then interdisiplinary and interconnected care will be afforded and “Be Well Dentistry” sought. Dentists will have to become comfortable in charging for their time and not just for procedures.

Currently training for such a wider scope of practice is difficult. Though membership is booming in various special topic areas; we as dentists do not yet have the academic support we need. Change is hard and progress slower than one would wish. I often ask patients, “How healthy do you want to be?” after treating their chief complaint(s). The question I pose to dentists is “How much health do you want to offer your patients?”

[1] EF Wright, Otologic Symptom Inprovement Through TMD Therapy, Quitessence Int. 2007, Oct. 38(9): e564-71

[2] A Bjorne, Assessment of temporomandibular and cervical spine disorders in tinnitus patients, Progress in Brain Reasearch, 2007: 166:215-9
[3] Ana Franco, Migraine is the Most Prevalent Primary Headache in Individuals with Temporomandibular Disorders, Journal of Orofacial Pain, Vol 24, 2010

[4] A Monaco, R Cattaneo, etal, Prevalence of atypical swallowing: a kinesiographic study, European Journal of Pediatric Dentistry, 2006 Dec 7(4): 187-91

[5] Edward Reiman, TMD Diagnosis and Treatment Handbook, Medical Scope Publishing Corp, 2005

[6] P Rosted, and Dr Woolley, Bell’s Palsy following acupuncture treatment–a case report, Acupuncture Medicine, 2007 June: 25(1-2): 47-8.

[7] Tammarie Heit, DDS, Neuromuscular Orthotics in the Treatment of Craniomandibular Dysfunction and the Effects on Patients with Multiple Sclerosis, Cranio, Vol 1 , January 2011

[8] Pereira Magalhaes, etal, Influence of Maloccluson on Masticatory Performance, Angle Orthodontics, Unincor, 2010

[9] PJ Strini, NA Machada, MC Gorreri, etal, Postural evaluation of patients with temporomandibular disorders under use of occlusal splints, Journal of applied Oral Science, 2009 Sep-Oct 17(5): 539-43.

[10] Danny Bobrow MBA,; Are you ready for the next wave in dentistryDental, Products Report, November 2010

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