Integrative oral medicine: Dentistry's role in improving health outcomes

• Published in: Journal of esthetic and restorative dentistry 2023-07, Vol.35 (5), p.758-772
• Main Author: Thompson, Doug
• Format: Article
• Language: English
• Subjects: Apnea; Arteriosclerosis; Atherosclerosis; biofilm; Biofilms; cardiovascular health; Dental caries; Dental Caries - therapy; Dentistry; Dentists; Gum disease; Humans; Infections; Inflammation; Information processing; oral dysbiosis; Oral hygiene; Oral Medicine; Outcome Assessment, Health Care; Patients; periodontal disease; Periodontal diseases; Periodontal Diseases - therapy; periodontal medicine; Risk factors; Sleep apnea; Sleep Apnea Syndromes; Sleep disorders
• ISSN: 1496-4155; 1708-8240
• DOI: 10.1111/jerd.13083

Objective This article describes the importance of identifying inflammation‐inducing conditions in the dental office that are prevalent in the population and have significant systemic health risks for the patient. The role of the dental biofilm will be presented, as will the clinical protocols for treating an unhealthy biofilm. Methods for testing and maintaining a healthy biofilm are also presented. Clinical Considerations Periodontal disease, dental caries, and periapical infections are inflammation‐inducing diseases that can be identified in the dental office. Additionally, sleep apnea has been linked to chronic systemic inflammation. Dentists can identify risk factors and provide treatments that lower the risk of serious systemic outcomes, such as atherosclerosis, cardiac arrest, and stroke. Conclusions A thorough dental examination, including a comprehensive periodontal evaluation, can provide important information that can be used to improve or maintain a patient's systemic health. Treatments provided to improve oral health have been shown to improve systemic indicators of cardiovascular health. This is the basis of integrative oral medicine, a collaboration between the medical and dental providers, which can offer patients the best opportunity for improved health outcomes. Clinical Significance Periodontal disease, caries, periapical infections, and sleep apnea all have negative systemic health consequences for the patient (DiMatteo, Inside Dent, 2017, 13, 30; Nakano, Oral Microbiol Immunol, 2009, 24, 64; El Ouarti, BMC Oral Health, 2021, 21, 124; Lamberg, Steve). Periodontal disease, caries, and root end infections influence the health of the oral biofilm. If the biofilm becomes pathogenic the host inflammatory response can be stimulated, resulting in a cascade of inflammatory processes that damage the supporting structures of the teeth and harm the patient's overall health. A thorough dental exam that includes a comprehensive periodontal evaluation will identify patients with active inflammation or oral conditions that contribute to chronic inflammation. Dentists can integrate this information into treatment strategies that reduce the inflammatory burden and assist in better overall health outcomes.