The name of the game with periodontal disease is cleaning root surfaces below the gum line so that the body can heal itself. Unfortunately, scaling and root planing (SRP) becomes more challenging the deeper the probing depths. At 5 mm, we are only 40-50% effective and that rate goes down drastically every millimeter beyond that simply because SRP is a “blind procedure” and we can’t see what we are doing. However, even at 40-50% effectiveness, SRP is often effective enough for the body to regenerate and heal itself. If SRP is successful, the patient can move on to the maintenance phase of periodontal treatment, where quarterly hygiene appointments, along with good home care, can keep periodontal disease at bay for life.
Unfortunately, for those patients whose periodontal disease does not improve after SRP, then the next step is osseous (pocket reduction) surgery. While this has been the standard of care for many years, it is expensive, painful, and can result in “black triangles” between a patient’s teeth. These aren’t ideal outcomes but are the trade-offs made in order to stabilize a patient’s periodontal disease.
What if we could see below the gum line and remove 100% of the calculus build-up on the root surface? The effectiveness would dramatically improve, and the need for osseous surgery would decrease. Any patient would be happy to avoid surgery and save money! The great news is that is now possible with the OraVu® dental endoscope, which we have recently introduced into our practice, the first of its kind in Austin.
Endoscopes have been used in the medical field for many years, and a dental endoscope works on the same principles. A tiny camera attached to a probe is used in conjunction with SRP to enable our hygienist, Kathleen, to see deep into the gingival pocket without flap surgery thereby giving “sight” to an otherwise blind procedure. Kathleen can now visually see the calculus enabling her to completely clean the root surface. We are excited to be able to offer “Visual SRP” for patients.
Dental endoscopy can also be used as a diagnostic tool to see root fractures, subgingival caries, open margins, overhang restorations, and residual cement on implants.
We are excited to have the OraVu dental endoscope in our practice. Moving forward, all SRPs completed at Council Oak Perio will be “Visual SRPs.” We are grateful for advances in technology that enable less invasive and lower-cost treatment options for our patients.
The alarming headline aboveis one of the findings of a recent study published in the Journal of Clinical Periodontology1. The study adds to research establishing a strong link between periodontitis and COVID-19 complications including ICU admission, the need for ventilator use, and death. The global pandemic has so many people fearful, uncertain, and eager for competent medical advice. So, how do we interpret this information? Should we share this information with our patients? Lastly, how do we educate our patients about the risks without using fear tactics? Below are my thoughts on how to answer these questions.
First, to understand why there is such a strong link between periodontal disease and COVID-19we need to consider what we already know about periodontal disease and systemic health.The linkbetween periodontal disease and other chronic inflammatory conditions, such as diabetes, cardiovascular disease, respiratory disease, and rheumatoid arthritis is now well established. Because of the link to systemic health, those with periodontitis are also the patients most at risk for COVID-19 complications. A healthy individual may be asymptomatic or only experience mild COVID-19 symptoms. In contrast, a patient with underlying chronic health conditions can find themselves in the ICU in respiratory distress. Studies also propose that when a patient is on a ventilator, the bacteria causing periodontal disease can be aspirated into the lungs2, making it a contributing mechanism in the rapid respiratory decline of COVID-19 patients.
Examining the numbers can provide insight intowho would benefit from a discussion about this information. While 50% of the US adult population has some form of periodontal disease, 10% present with severe periodontitis. As you know, periodontitis is an infection damaging the soft tissue and bone that supports the teeth, which can eventually result in tooth loss. On the COVID-19 side of the equation, around 14% of COVID-19 patients require hospitalization and oxygen support, 5% will land in the ICU, and 2% will die. Considering the numbers, a significant portion of the population is at risk for COVID-19 complications in association with their periodontal disease. Since we don’t know who will contract the disease, we should discuss this issue with the majority of our patients, particularly those with systemic health issues.
To communicate this information to patients, I recommend making it part of a broader discussion of the association between periodontal disease and systemic health using the following talking points:
Periodontal disease is a chronic inflammatory condition that shares common risk factors with most chronic inflammatory diseases such as diabetes, cardiovascular disease, respiratory disease, and rheumatoid arthritis.
Studies have shown that those most at risk for COVID-19 complications are those with these same conditions.
The link between periodontal disease and other chronic inflammatory conditions adds another layer of risk for patients who are hospitalized with COVID-19.
Minimize your risk of COVID-19 complications by taking care of your mouth, including good home care and regular visits with your dentist and hygienist.
To help explain the link between periodontal disease and the rest of the body, our team has developed the chairside patient-education tool below. If you would like laminated copies to use with your patients, please contact us email@example.com.
My Dad and me. This picture was taken in 2011 when I was awarded the Richard G. Lazara Implant Fellowship Award, the largest monetary award given by the American Academy of Periodontology Foundation.
Asking someone why they chose their profession usually comes with a story that includes some discussion about their interests, an influential teacher, or an individual who introduced them to their vocation. In this article, I would like to share my story with you about how I came to be a periodontist. This story is just as much about my family as it is about my profession and begins before I was even born.
My grandfather was raised on a farm in southern Alberta, Canada. I don’t know why he chose to become a dentist, but he broke with the farming tradition and became the first dentist in my family. After completing dental school in Edmonton, he returned to a town close to home and worked in private practice from the 1950s to the 1980s.
One of the stories I love about my grandfather is how he was able to provide same-day dentistry. For example, crown preparation was often completed in the morning. He would then wax up the crown in the patient’s mouth, cast the crown over lunch, and finally deliver the crown at the end of the day. The goal today is still the same as in my grandfather’s time, just achieved with modern technology.
My father chose to follow in his father’s footsteps. I am the oldest of seven children, and I was born in Canada during the summer between college and dental school. At six weeks of age, my parents put me in a box (there were no car seats back then) and drove to Chicago so my dad could attend Northwestern Dental School. Periodontology was a fairly new specialty back then, and after dental school, my dad chose to complete a two-year residency. After his residency, he worked in Chicago for a couple of years before moving our family back to Canada to start his own practice.
Growing up, I loved being around my dad’s practice. As a teenager, I was allowed to watch my dad perform the occasional surgery. I liked what I saw, and so began my journey to dental school. After completing dental school at the University of Illinois at Chicago, I worked as a general dentist for two years in Canada. I realized during this time that I wanted to be a periodontist just like my dad. I soon returned to complete a three-year periodontal residency at the Medical College of Georgia.
My dad and I love to talk “shop” as it is referred to in our family. I also have a brother who is a general dentist. Put the three of us into a room together and we can keep each other entertained for hours exchanging dental stories and ideas. During these discussions, I often get animated and excited. There is so much I love about being a periodontist!
I feel so fortunate to be able to go to work each day and do something I love! My family’s deep connection to dentistry also deepens my love for my profession. In the future, I hope one of my children will choose to follow in my footsteps and find joy in their career as a dentist too.
In elementary school, testing identified me as “gifted,” a label that haunted me through middle and high school. I often struggled academically, particularly with writing, and I felt like a failure when I did not measure up to the “gifted” label pronounced upon me. After high school, I continued on to college, dental school, a GPR, specialty training, and finally an implant residency before I became a periodontist. Those years rack up to an impressive 13 years of schooling beyond high school. In hindsight, I can now see that my academic quest was in part fueled by my desire to prove that I could succeed academically in spite of feelings of failure and not measuring up that I had acquired as a teenager. Lurking just beneath the surface were beliefs about my own abilities such as self-doubt and fear that I had to overcome before I could truly succeed.
Our beliefs are feelings of certainty about what is true or not true. They are an accumulation of ideas from our parents, education, society, and life experience that are often subconscious and not fact-based. They are powerful in framing the way we see the world and how we view our own potential. If you were shy or had a speech impediment as a child then you may avoid public speaking as an adult because any thought of speaking to an audience produces feelings of anxiety and stress. Our beliefs may not only limit us mentally but can also affect us physically. For example, when we feel embarrassed blood rushes to our face; when we feel angry our blood pressure rises; and when we are happy our bodies produce “happy” hormones such as dopamine, serotonin, oxytocin, and endorphins. Limiting beliefs prevent us from reaching our full potential, but identifying them can be challenging.
Understanding the concept of limiting beliefs has allowed me to push myself, to literally get out of my own way, to push past the uncomfortable feelings and move forward. The 2018 U2 song “Get Out of Your Own Way” has become the perfect theme song for me, reminding me to continually look for warning signs of my own limiting beliefs. Limiting beliefs are often subconscious and can be lurking where you least expect them. For example, my early educational experiences led me to believe that I was a poor writer and that publishing an article was not a possibility for me. This month I am being featured as the cover article inDentaltownwhere I share my thoughts and ideas on robotics in dentistry. Seeing the article online and in print is a little surreal. I count it as one of my greatest accomplishments of 2020.
Getting past our limiting beliefs doesn’t just have to happen in the workplace either. Our 2020 team Christmas party was a socially distanced event held at Playland Skate Center in North Austin. With the entire rink to ourselves, I watched my wife Penny sail around the rink truly enjoying herself, doing something she had not done in close to a decade. When I asked her why she loved rollerblading so much she said it was because as a child she was the worst kid at the rink. She would not let go of the railing and would stress about even crossing the 1-yard gap where you enter the rink. She was too afraid to let go. As a college student, she was determined to learn. She pushed past the uncomfortable fear of falling, practiced, gradually added distance, and eventually, she learned how to rollerblade and ice -skate. One of our first dates was rollerblading along the lakefront in Chicago. Overcoming her fear of falling also taught her to apply the same approach in other areas of her life as well.
We are all glad to have put 2020 behind us. I hope you will challenge yourself this year to discover and tackle one of your own limiting beliefs. Doing so can bring joy, satisfaction, and success.
2020 has been a unique year, one that will remain stamped on our collective memories. The pandemic has brought with it challenges and blessings. As we wrap up the year, it is the blessings I wish to focus on.
Over the Thanksgiving break, I took up a challenge to post daily #GiveThanks posts on social media. This exercise was a wonderful way to share and receive positivity. Some of the blessings I posted about were my family and friends; audio books which enable me to listen to fascinating stories, learn new skills and expand my mind during my daily commute; my expansive spice collection which allows me to cook anything and everything from Thai, Creole, to Filipino and German; and smiles that brighten my day at work and at home. Being grateful and expressing thanks are effective ways to push back negativity. It is not possible to be hateful and grateful at the same time. Often it is the little things in life that bring us the most joy.
Service is another way to be blessed with positivity. Thanksgiving week I was blessed as I served alongside my 13-year old son, who is working on becoming an Eagle Scout, as he conducted a neighborhood food drive to benefit the Round Rock Area Serving Center. With the help of friends, Owen was able to reach all 850 homes in our neighborhood by placing a flier and collection bag on each front door. Having planted the “seeds” the Monday before Thanksgiving, we went back the Saturday after Thanksgiving to collect the “harvest”. We were unprepared for the generous response with almost 3,500 lbs. of food being donated and flooding our garage floor. Many neighbors expressed thanks for the opportunity to give. The pandemic has made it harder for us to give service yet we all need as much help and positivity as we can get during these challenging times.
In November, during an all-day team meeting, the Council Oak Perio team identified five key values that exemplify our team culture. One of our values is “Positive Energy”, which is expressed in the following statement:
Positivity is a decision we make out of respect to each other.
This holiday season I am grateful for my professional colleagues who have weathered the COVID storm with me. Your advice and support have been invaluable. I am grateful to our referring offices who have continued to trust us to care for their patients. I am grateful for my team who has a positive influence on each other and on me. I am grateful for the pandemic, it is helped me refocus and brought my team together. We are stronger now than ever.
Wishing you all a positive and happy holiday season.
Chronic diseases like heart disease, stroke, kidney disease, diabetes, and lung disease kill over 1 million Americans every year. Obesity was a contributing factor in over 520,000 American deaths. Rheumatoid arthritis affects 40 million Americans. Thirty million American men live with erectile dysfunction. Sixty-five million Americans have periodontal disease. Is there a link with all these conditions? Yes. The answer is chronic inflammation.
For the last 20 years, dentists have tried to demonstrate a causative link between periodontal disease and these chronic inflammatory diseases. This is another classic example of which came first: the chicken or the egg? While the answer to that question doesn’t really matter, there is no doubt that chronic inflammation is a significant issue in the healthcare world. We can do our part as dental professionals in addressing this issue by improving the evaluation and treatment of periodontal disease and educating patients on diet and lifestyle choices that can reduce their overall state of inflammation.
Earlier in my career, I viewed the health history questionnaire as an instrument to identify surgical risk. This was shortsighted. I now view the health history questionnaire as an opportunity to reinforce how important a patient’s health is to me. In order to accomplish this, I redesigned our health history questionnaire to facilitate a dialogue about health. For example, if an obese patient with diabetes is referred to our practice for an implant placement, I now have a discussion about how important diet and exercise are to their health. These conversations can be uncomfortable at first. We weren’t trained in dental school on how to have these conversations but they are so rewarding. As a result of health-based discussions with my patients, I have seen patients reduce the number of cigarettes they consume each day or quit smoking altogether. Others have now taken ownership of their diabetes and hypertension.
Patients who come to our practice seeking an implant are also motivated by a discussion about their health. As patients lose more teeth, masticatory function diminishes and patients have to look for foods that are easy to chew, like processed carbohydrates. By maintaining a greater number of teeth, patients are able to chew fresh fruits and vegetables and reduce their dependence on processed foods.
One of the challenges of having health-based discussions with our patients can be determining what type of diet we should recommend. Mounting research indicates that a diet rich in plant-based, whole foods can reduce chronic inflammation and improve long-term health 1 . Counseling patients to increase the amount of plant-based, whole foods in their diet while also decreasing their intake of sugar, processed foods and animal products will lead them in the right direction. Just like my patients, I too want to live a healthy, happy life. I also want to be authentic as I counsel my patients on their road to health. For these reasons, I personally converted to a plant-based, whole-food diet three years ago.
We all have patients in our practices who struggle with systemic health issues. As dental health professionals, we can do more than just treat their periodontal disease. We can also counsel our patients in their diet and lifestyle choices in order to address the source of chronic inflammation and help them move toward a healthier, happier life.
Recently, my youngest son, 7-year-old Zack, begged his mom to teach him how to solve a Rubik’s Cube. About two years ago, his older brother had learned to solve the cube. Elliott is now 10 but, as an 8-year-old with dyslexia, solving a Rubik’s Cube seemed unrealistic. He could not even read the instructions his mom printed out for him. To help, she showed him some instructional videos on YouTube and then left him to it. Elliott is a very determined soul. After about a month, along with a great deal of frustration, practice, and focus, Elliott was able to solve the cube. Two years later, Elliott now turns his 3x3x3 Rubik’s Cube like a pro and can easily solve it in less than two minutes.
Having watched his brother, Zack thought he could easily do the same. When it took more than 10 minutes over the winter break for Zack to learn the first algorithm, he quickly became frustrated and moved on to something else. In the process of trying to teach Zack, my wife got hooked. She didn’t think she had time to learn how to solve a Rubik’s Cube but was surprised to find that if she just memorized a set of algorithms it was very possible and a little addictive. Over the break, she could be found sneaking around with a Rubik’s Cube in her pocket so she could practice any chance she could.
Watching my family’s experience with a Rubik’s Cube has provided me with five insightful practice management lessons.
Lesson 1: The success of your practice is directly proportional to your team’s ability to solve problems.
With less than 15 turns, anyone can scramble a Rubik’s Cube. It takes no skill to create chaos. Meanwhile, there are few people who can solve a Rubik’s Cube. It is entirely possible to learn how to do so in under two minutes provided you have a good dose of determination along with the right training and practice. In the hands of an untrained, unwilling individual, that same cube will never get solved.
Every day in our dental practices we face issues large and small, whether it be streamlining the new patient-intake process or finishing the day on time. Solving each of these problems one by one is like learning each algorithm to solve a Rubik’s Cube. In his book Traction, Gino Wickman states: “Your ability to succeed is in direct proportion to your ability to solve your problems. The better you are at solving problems, the more successful you become.”
Think of your practice as a series of problems to be solved. The faster you and your team become at solving those problems, the sooner you will create order, predictability, and success in your practice.
Lesson 2: There are many ways to solve the same problem. Seek help when needed!
The original 3x3x3 Rubik’s Cube has 43 quintillion combinations. To put things into perspective, that’s 43 with 18 zeros after it. This means that, if you had as many standard sized Rubik’s Cubes as there are permutations, you could cover the Earth’s surface 275 times. The good news is that print and video instructions are readily available if you want to learn how to solve the cube.
Likewise, there are many ways to manage a dental practice. If we consider each detail in the process from patient intake to the new patient exam, through to treatment and follow-up care, there could be as many different solutions as there are permutations of a Rubik’s Cube. Instead of floundering on your own, seek help when needed. Get involved in a Spear study club, find a mentor or enlist the help of a practice consultant. There is no reason to do it the hard way. Others have gone before you and there are many resources available to help you succeed.
Lesson 3: Thou shalt know thy destination.
The end goal of solving a Rubik’s Cube is very clear: solve each side with each side being a single color. If this goal was unclear, one could spend a lifetime mindlessly spinning the cube and endlessly creating new permutations.
For our teams, it’s critical that we communicate our vision clearly and concisely so that they know where we are headed. Without that vision, our daily work can become as unsatisfying as spinning a Rubik’s Cube without ever solving it. It is human nature to want to grow, learn and achieve. Give your team the opportunity to do so!
Lesson 4: A Growth, Can-do Mindset is Essential.
Watching Elliott, Zack and my wife Penny learn how to solve a Rubik’s Cube revealed very different mindsets. Despite his dyslexia, Elliott believed that he could learn to solve a Rubik’s Cube and had enough grit and determination to do so. Zack, on the other hand, quickly gave up once the problem appeared to be too hard and required too much effort.
We are all capable of far more than we give ourselves credit for but we have to be prepared to do the hard work that produces growth.
Lesson 5: Take risks when necessary.
The way my wife is learning to solve a Rubik’s Cube is to first solve one side of the cube, along with the adjacent edges of that side, then systematically solving the middle layer. As she moves the edge pieces into position for the middle layer, there is a temporary “scrambling” of the first side before returning the pieces back into position. To an observer, it may appear that she is taking a risk and creating “chaos,” but there is a plan in place and “order” is soon restored.
Likewise, in our practices and in our lives, it will be necessary to take risks in order to reach our goals. This will require us to feel uncomfortable and chaotic as we move the current way of doing things out of the way to bring in a new and better approach. The cost of not taking any risks is living with the status quo. This idea was expressed by John F. Kennedy who said, “There are risks and costs to action. But they are far less than the long-range risks of comfortable inaction.”
I challenge you to consider and apply these five lessons learned from the Rubik’s Cube as you grow and lead your dental practice. I wish you well on your journey!