Looking Beyond Pockets: Implementing What we Know about Patient Risk for Whole Body Consequences of Periodontal Disease

3 Hours CE
Course Participants: General dentists, dental hygienists and periodontists

Most dental practitioners have heard the message that we need to start looking at the whole patient and not just their pockets. For the vast majority of clinicians, we grew up learning the mechanical art of treatment of periodontal disease- end of story. Periodontal disease etiology has evolved dramatically over the last 50 years. Today, exploration surrounding the inflammatory process of periodontal disease and its link to systemic health pours through the research pipeline at exponential rates. Some evidence for periodontal-systemic links is strong for association, other evidence needs to be validated by large scale epidemiologic and intervention studies, and the exact mechanisms to explain causality are still cloudy. Yet, what we do know is that with periodontal disease, as with any other chronic infection in the body, prolonged and persistent inflammation will precipitate an impaired or exaggerated host response in certain susceptible individuals. In these patients, this is when the body finally turns on itself.

There is a large group of susceptible individuals for whom periodontal infection may act as an independent risk factor for systemic disease, including risk for pre-term delivery of low birth weight babies, arthrosclerosis, cardiovascular disease, stroke, nosocomial bacterial pneumonia, Chronic Obstructive Pulmonary Disease, and challenges with metabolic control of diabetes. Medical professionals are starting to acknowledge that inflammation plays a much larger role in chronic diseases and many have come to recognize periodontal disease as an "exposure" for systemic disease states. Yet, there are many dental practitioners who do not recognize periodontitis as a gram negative infection with the potential for intravascular "seeding" of these microorganisms throughout the human body. As a result, they feel "out on a limb" talking about the mouth-to-body connection with patients. According to its' polls, the ADA estimates that roughly 80% of the US adult population strongly agrees that prevention of "gum disease" is an important step in maintaining overall health and close to 60% acknowledge there is a link between "gum disease" and other health problems. With a patient population primed with this level of awareness, dental practitioners need to step back from the technical aspects of dentistry to consider that they are the healthcare provider perfectly positioned to "connect the dots" in perio-systemic medicine.

The content of this presentation is anchored around the latest information from consensus opinions based on evidence based systematic reviews of perio-medico literature. Presentation of real life case studies offers practical suggestions on how to integrate appropriate evidence of periodontal-systemic links into everyday general practice environments.

Comprehensive Evaluation and Treatment Planning for Risk Related Chronic Periodontitis

4 hours CE
Course Participants: General dentists, dental hygienists and periodontists

There is a growing body of research that implicates a number of factors which predispose certain individuals to chronic periodontitis. Other research points to a possible association between periodontal disease and systemic consequences, often referred to as the periodontal-systemic link. Suffice it to say, science is closing in on the ability to identify individuals at risk for chronic periodontitis and possibly "leveling the playing field" for some at risk patients. New leading edge technologies allow us to prognosticate disease initiation in a population of patients who might be genetically predisposed. In addition, treatments that target the bacterial challenge and therapies that modulate the host response have stretched us professionally. For those hygienists who aspire to practice as periodontal therapists, understanding the complexities of these etiological cascades, how to accurately assess risk for periodontal disease, and design effective treatment plans, are essential. With the rising incidence of diabetes, recognition of the fact that poorly controlled diabetes is a known risk factor for chronic periodontitis, and suspicion of a bi-directional relationship between chronic periodontitis and insulin resistance, the periodontal therapist's role has become increasingly important. Given the fact that 75% of periodontitis cases have been deemed attributable to smoking, we can hardly ignore the importance of employing more progressive disease management strategies in smoking related cases of chronic periodontitis. Comprehensive understanding of risk stratification as it relates to long term case management of chronic periodontitis is fundamental to providing an expert level of care.

Realizing the Potential of the Emerging Dentist/Periodontal Therapist/Periodontist Collaborative Model of Care

7 Hours CE
Course Participants: General dentists, dental hygienists and periodontists

The goal of this presentation is to create the framework for a practice model that relies heavily on collaboration among dentists, periodontal therapists and periodontists in eliminating suboptimal clinical outcomes as a result of the fragmentation of periodontal care, and in increasing our ability to preserve patients' systemic wellness as it may relate to periodontal disease.

The presentation will focus on three key objectives:

• Provide a compelling enough vision for collaborative care that clinicians from all three stakeholder groups will be inspired to establish strong, "hot-synced" interrelationships that are essential in offering optimal periodontal care.
  
  
• Provide the "best evidence" on periodontal science to empower hygienist- periodontal therapists to identify periodontal disease in its earliest stages, integrate appropriate disease management strategies in these cases, and intercept cases that should be triaged for specialist care including cases of advanced loss of periodontal support, cases with underlying systemic conditions and patients who would benefit by periodontal plastic surgery.
  
  
• Provide recommendations on how to establish a forum for the continued education and sustained collaboration of dentists, periodontal therapists and periodontists in addition to building alliances with medical professionals which may hold promise for achieving a level of unprecedented health care for the public we serve.

Obesity and its Impact on Incidence of Chronic Periodontitis and Multiple Risk Factors Syndromes

4 Hours CE
Course Participants: Dental hygienists, general dentists, & periodontists

The growing epidemic of obesity and what is termed the "Sedentary Death Syndrome" in the US has raised significant health concerns. Recent research has found an association between obesity and periodontal disease. Other investigators point to a suspected link between oral health and multiple risk factor syndromes including coronary artery calcification, hypertension, hyperlipidemia, and diabetes. Even more disconcerting is the projected incidence of periodontal disease among youth as a result of the increased prevalence of abdominal obesity. Although the exact mechanism to explain this link is unclear at this time, what has become clear is that dental clinicians are the healthcare providers best positioned to be at the front-line in preventing and/or intervening to change this periodontal-systemic trend.

What is the Public's Perception of the Dental Hygienist, What Level of Care Does the Public Receive from a Dental Hygienist and What Level of Care Does the Public Really Value: Presentation of the 2004-05 Survey Results of a Consumer-Patient Population of 2,000

3-6 Hours CE

Course Participants: Clinicians, business administrators, industry representatives, representatives from government, academicians

In the fall of 2004, Casey Hein recruited approximately 300 students from 12 schools of dental hygiene throughout the United States to participate in collecting survey responses from a consumer group of approximately 2,000, the largest query of the public that the dental profession has ever attempted. The survey questionnaire was comprised of 16 well constructed questions designed to determine the public's perception of several key issues related to the profession of dental hygiene and an assessment of the level of care consumer-patients currently receive from dental hygienists compared to the level of care consumer-patients really value. Currently there are various levels of care being rendered within the dental hygiene profession ranging from assembly line prophylaxes and whitening procedures all the way to customized treatment plans for cases involving highly technical nonsurgical periodontics. As a result, US consumer-patients' perception of the dental hygiene profession is nondescript and very "fuzzy".

Barb Kunselman BSDH, MS and other faculty at Raymond Walters School of Dental Hygiene at the University of Cincinnati were diligent in assisting with review of the survey instrument, distribution of survey materials and compilation of data and its synthesis.

The research findings are expected to be finalized by April 2005. If the research corroborates these hypotheses, this may be evidence that we are not meeting the felt needs of the public we serve and that our failure as a profession to make a distinction between the different levels of expertise associated with various levels of care, i.e. prophy techs, conventional dental hygienists and periodontal therapists, may be negatively impacting the publics' perception of dental hygiene as a profession.