Dental India
News/Discussions in the web - The value of prevention


Mike Rethman says:  “. . . periodontitis's effects on the various systemic maladies are probably not enormous,
otherwise the relationship would have been obvious --and detected long ago. But for those occasional individuals who
periodontitis may affect systemically, the effects of your intervention may be enormous. But you will never know who you
helped because a problem prevented is a problem probably undetected -- and unappreciated.”

What strikes me the most in conversations about statistical correlation and our recommendations as therapists is: “What is
the motivation behind the recommendation or warning?” I feel we must first answer questions such as: Am I a Preventive
Therapist? Do I practice wholistically, in other words do I believe that the body, mind and spirit are connected? Do I
practice in a “wellness” vs. disease model of care?

I believe that the mouth is the SOURCE of health, how one takes care of it and how one chooses to utilize it (the food we
eat and the words we say). My approach with my clients is to find out where they are (clinical assessment) and where they
stand (behavioral assessment) on those very basic issues and then coach them toward healthier choices, not with scare
tactics, with a practical, common sense, step by step, approach. I see, on a case by case basis, clients that begin to
heal their oral disease, begin to reap the benefits of improved systemic health. Using current research to recommend
change is only a tool and is best used by asking clients if they are open to doing their own analysis. The only person we
have any control over changing is ourselves. Preventive therapists, are by our very nature, unappreciated. To be a teacher
of delayed gratification in a society of immediate gratification is a paradox, almost like swimming upstream without a
paddle. Most folks are aware of the cliché “An ounce of Prevention is worth a Pound of Cure”, they sometimes just find
themselves on the “cure” end of the equation. The research most beneficial to preventive therapy would be to measure the
VALUE of a problem prevented. Perhaps then, we can elevate our profession to the “appreciated” side of the fence. We are
all born and we will all die. The true question is: How do we choose to spend the time in between?!

Joan Kenney Fitzgerald

HI all, I like the idea of how we spend the time "in between."  Also, how much time  we spend "in-between" is another
potentially important outcome variable.

To elaborate in response to Joan's post:  No matter what the NNT (number needed to treat) is to observe a desired outcome,
one must weigh the cost (time, money, etc.) of one choice v. the other.  For example, living outside a cave increases
one's chance of being struck by a meteorite (a cost).  However, the likelihood of this happening is quite small, so most
make the choice to live above ground since the overall "cost" of living in a cave is pretty high.  The same sort of
"public health mindset" thinking applies to therapeutic decision-making.  We typically don't perform therapies that have
a one in a million chance of succeeding, because the cost-benefit scale in terms of perio doesn't tilt towards this
choice.  However, when it comes to screening air passengers and dead birds for H5N1 flu, we do -- because H5N1
flu is considered incredibly dangerous if it becomes easily passed between humans -- so we maintain viglience against such
needles in haystacks.

We all do these things in all choice-taking, it's just that most don't boil things down to the basics like this.

In the case of periodontitis and various systemic maladies, it appears that
1. the likelihood of periodontitis contributing to the others is not enormous, but quite real and far from rare;
2. hence, despite the fact that the NNT is (probably) not small, the costs of these systemic problems is so high
(compared with the costs of providing periodontal therapy), we recommend therapy at least partly on these bases
(as well as on its own "local health" merits).

For the heart attacks we prevent, the low birth weight babies that our care prevents we get little or no credit... just as
if 9/11 would have been prevented, no one would be getting credit for it.  This is because the VALUE of prevention is only
rarely recognized by the individual beneficiaries -- because these individuals didn't have to suffer the consequences of
the maladies we seek to help them prevent so they mostly can't fully (or at all) appreciate the path chosen.  Yet
epidemiologically, such effects are likely and often obvious.  So other than award committees like those in Sweden, few
notice.  Capeche?

As far as the mouth being the "SOURCE" of health, this is more of a metaphysical argument for which there is not much
other-than-empircal opinion.  I like how it sounds though... yet I'm not prepared to be so pedantic about most things --
unlike the NYTimes OpEd page when it comes to slamming Dubya. - Aloha, Mike Rethman

Joan, What a great post! Joan and I used to practice together and she gives 150 percent to her patients. Your
thinking about "health" goes far beyond what most teach in dental operatories and we could all learn a lot from you.

This week, I worked a temp day in a practice and I had a husband/wife periodontal exam to perform. Their chronic
periodontal infection was so bad that I could smell the infection through my mask. Joan, how would you approach
this particular couple and how would you begin to  educate them? Am looking for a new approach and I know you
are the one to recommend one! Anyone else have any ideas? I know that Sandy would start with microscopic
samples which is very powerful! - Lynne

You bet. I'd explain that they are infecting each other and that it is great that they are both in together so we
can treat the infection as a family problem. I'd also have any of their children come in too. When a hygienist gives
150% the patients feel it and are very responsive especially after they have seen the infection on a monitor through
the microscope -  Sandy Sheffler RDH

Thank you my friend and colleague! I too would begin with as many visual assessments for co-discovery as possible
including microscopic sample, a BANA test, Florida probe charting, stress indicator, etc. We would discuss
the cross transmission factor and the malodor and if they were willing to do whatever it takes to reduce their
scores. I would do a laser bacterial reduction and place them initially on the Oxyfresh Dental Success System
(ODDS)and hydromagnetic irrigator twice daily and have them work toward a reduction in scores in all of the screening
tests on their own. (I have been working with the ODDS for over 13 years now so it's easy for me to trust the
system will improve the baseline score of chronic putrefaction and infection. Other clinicians would require putting
the system to the test with their worst patients) If their stress scores are at the highest level, I would place them
on 3 ounces of Primorye Stress relief supplement daily. I would re-appoint them in 2-3 weeks and re-test. All
therapeutic treatments would begin AFTER they have the positive experience of what they can accomplish on their own.
Remember, the power is in the question and the only person you can change is yourself. We are too quick sometimes to
DO IT FOR THEM and they don't get the experience of self discovery. - Joan Kenney Fitzgerald