Things I Wish Were Different About Dentistry

It is time to change.  It is time to leave behind the limited image of the dentist as the senior member of the oral hygiene police with the dental hygienist as the loyal foot soldier in the war against plaque.  It is time to stop admonishing patients that if they do not floss their teeth will fall out.  It is time to get more serious about dentistry.

Helping people keep their teeth was a justifiable goal for dentistry 50 years ago.  Even a conservative interpretation of the available evidence that has emerged since the tooth-saving days of dentistry suggests that this myopic goal must change.  I wish dentistry would come to terms with the fact that it is no longer solely about saving teeth, it is about reducing inflammation.  I wish the overall focus of dentistry would change.

Medicine has long been focused on controlling inflammation to reduce the development and progression of many of the quality-of-life robbing chronic diseases of aging.  There is now undeniable evidence that the local inflammatory response to initiating periodontal biofilm spills into the circulatory system, contributing to the level of systemic inflammation.  Medicine is embracing the potential for periodontal therapy to result in therapeutically meaningful reductions in markers of systemic inflammation.  While there is no proof of a causative link between all oral and systemic diseases, there clearly is sufficient evidence to suggest that oral inflammation contributes to the systemic diseases that are driven by inflammation.  That is something we should be shouting to every patient that walks by our office, let alone to our existing patients.

When the host response is inadequate and/or dysregulated, which can be significantly influenced by genetic, acquired, or environmental factors as well as microbiological and other local factors, periodontitis onset and progression may occur.  In other words, the onset and progression of periodontal disease are patient-specific.  Not all patients respond to biofilm in the same way.  Rather than treating every patient in cookie-cutter fashion with a prophy, bitewings, and fluoride treatment, it seems prudent to diagnose and treat some patients more aggressively, simply to help those patients keep their teeth.  Diagnosing and treating patients aggressively can also have a positive impact on patients’ overall health due to the fact many of the risk factors for chronic inflammatory periodontal disease (CIPD) are also risk factors for systemic chronic diseases.

Patients that are tobacco users, over the ideal weight, have diabetes, post-menopausal women, patients with rheumatoid arthritis, and patients with respiratory diseases are among the patients in whom inflammation reduction is critical.  In these “priority” patients, using salivary diagnostics can better help the management of oral and systemic diseases.  Helping these patients achieve and maintain a preferred level of oral health can pay dividends to their oral and overall wellness.

That brings me to the second thing I wish would change in dentistry.  For too long we have sold patients on the need for a procedure.  “You probably would benefit from deep cleaning,” has rolled off many a dental professional’s tongues.  It is no surprise that patients resist ongoing periodontal therapy.  Many of us dental professionals have also heard the common refrain from patients, “How can I have problems, I had a deep cleaning already.”  The recommended procedure is not the endpoint, but rather, it is a step along the pathway to achieving the endpoint

CIPD is a chronic disease.  Successful management requires life-long attention, especially in “priority” patients.  I wish dentistry would focus more on selling patients on the need to achieve and maintain a preferred level of oral health rather than the procedure.  My patients realize that they are coming to see me so that I can determine if they have any oral inflammation, so I can develop and institute a plan which is intended to maximize the chance any current inflammation is resolved and then kept at bay.  My patients realize that doing so is an important part of their journey towards overall wellness.  They also realize that ongoing management at our office is critical.  We use the most definitive diagnostics available to help our patients better manage their health.  We owe them nothing less.

From this point forward, I am going to make sure that my hygienists no longer tell patients that they are in the tooth cleaning business.  I am even going to stop telling patients that I am in the tooth-saving business.  I am telling our patients that we can help them achieve wellness by managing the risk factors common to oral and systemic disease and by ensuring that we achieve the desired outcome for our patients in terms of biofilm management and inflammation reduction.  In our office, we are in the inflammation-reduction business. For additional insight, visit

Tim Donley DDS
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