today GNYDM 2

By Kristine Colker, Managing Editor n TODAY from 3:15 to 4:15 p.m. in aisle 5000, room 3, Dr. Mark Dun- can will present “Dentistry’s Dirty Little Secrets: What Is It That We Don’t Know?” as part of the DTSC Symposia. Inhissession,hewillfocusonsome of the hidden connections between a healthyandpain-freepatientandwhat issues 80 percent of adult patients presentwith.Therearesomanyissues that patients suffer with that are den- tally related but are totally missed because they don’t know to talk to their dentist about them. Duncan talked to today about what to expect from his symposium. Dr. Duncan, you are presenting a DTSC Symposia session called “Dentistry’s Dirty Little Secrets … What Is It That We Don’t Know.” Would you give us a brief overview of your session? For sure! I will focus on the things that patients will present with that generally are not seen as our first concern. We have amazing training in dental school and can do some absolutely astounding things for our patients, but there are still some very troubling issues with dental care today. The most commonly occurring infectiousdiseaseontheplanetisper- iodontal disease with an incidence of more than 80 percent. We understand better and better how to address and manage – and even prevent and heal periodontal disease. We also can per- form genetic tests from their spit and see how susceptible our patients are. All the while there is another foundational issue that we are all but totally ignoring — and that is the way that the bite fits. To be clear, when I’m talking about the bite, I mean two different things at the same time. No question we need to have proper tooth-to-tooth gearing or micro-occlu- sion — but actually more importantly, we must provide proper jaw-to-jaw relationships, or macro-occlusion, that will allow the mandible to func- tion correctly. Providing our patients with the proper macro-occlusion is of para- mount importance. This is the rest of the foundation in that, like peri- odontal health, it is only when the jaws are functioning in a way that is comfortable for the entire system that we are not forced to deal with consequences of muscle discomfort and poor posture. Mydentalschooltraining,likeper- hapsalldentists,coveredalotofthese issues but was not clear in why they were important. Or perhaps I was not ready to understand the intricacies at such an early stage in my career. However, I was also trained that things like bruxism were idiopathic and totally untreatable. “Don’t know why it happens and we can’t do any- thing about it.” To my surprise, when I utilize balance in the entire system not only do I have an effect on brux- ism,butIcaneliminateitpredictably! The position of the lower jaw in space was treated as if it were an inviolate relationship and that we were forced to deal with whatever is happeningwhenthepatientpresents, or we refer them out for orthognathic surgery. The reality is there is a non- surgical modality that is not only more conservative and predictable and comfortable, but may well save the patient’s life! The lower jaw pos- ture is directly and inextricably con- nected to the airway, and we are pro- fessionally bound to help protect that for our patients. This is a new topic in mainstream dentistry; however, it is perhaps the most important aspect of our patients’ care! In your session, you talk about how so many issues patients suffer with are actually dental-related, yet these issues are constantly overlooked. Why do you think this is, and what do you think needs to change in the dental industry to make a difference in uncovering these issues? Dental schools are built with the pur- pose of creating dentists. In order to createdentists,theschoolsmusthave them ready to pass board exams. The reality of this process has two major impediments to routinely producing progressive dentists with respect to technological advances. To start, there is still only the same four years in which to train the students. There is vastly more material, but the same amount of time. Secondly, many of those exams are still holding on to very old concepts. While gold foil is no longer a part of the process, neither is a conservative adhesiveonlay.Neitherisbitediagno- sisbasedonmuscularcomfortinaddi- tion to tooth and bone relationships. As students, we do address signs and symptoms, but their attached meaning is often lost. Perhaps we are simply not quite ready as students. Perhaps we would be better served with a more contemporary system of exam and licensure. Perhaps both. It seems a lot of the issues go untreated just because patients don’t know to mention them. Are there any things clinicians can begin looking for or doing in order to help their patients communicate better and get help for some of their medical issues? We have trained our patients how to be patients and what to expect for years. We made it OK for them to allow their benefits manager at their insurance company to decide which treatment is the most cost-effective for them. Well, most cost-effective for the insurance company. But as dentists, we made it acceptable for our patients to allow their insurance plan’s benefit to determine which option to pursue. Dental insurance is much like a rebate and the amount of service ren- dered is generally not vastly different than the amount paid in premiums. The point or goal of these plans is not better health care, but rather a modest basement level of care as a benefit to employees and still allow for a profit for the insurance company. The most important thing we could do is step outside of the insurance benefits — starttalkingtopatientsaboutwhatwe see and what we can do to help them. Our patients have a huge variety of dental issues and concerns and therearesomanynewandinnovative approaches to delivering dental care today.However,weneedtoknowhow todiscussthoseinasafeenvironment with our patients. It continually amazes me how much patients will censor what they tell us and how tainted our perspec- tive is as a result. The biggest hurdle is getting them to tell us the whole story. For years, our focus has been on the teeth, things we can take X-rays of. If the X-rays show something bad we treat. If not, we don’t. We literally have become a profession that largely focuses on mechanical repair of the hard tissues. Our patients are so much more! Some of the most critical things to assess are not even in the mouth! With a thorough cranial nerve exam or adequate muscle palpation exam, we can tell so much about the state of affairs for our patients’ health. Our bodies are very intricately connected, and it is our responsibility to outline these and determine where there may be issues or consequences that our patients struggle with. For instance, if a patient were to somehow think to tell his or her dentist that he or she has lower back pain or numb fingertips, would we know how to respond to that? I know in my own career, I would have had to suppress a laugh if a patient had sug- gested to me he or she was walking funny or fingertips were numb and it was from their bite. Not the case any longer! As a pro- fession, we need to know how all the pieces interconnect. Learning those connectionsandbeingabletocommu- nicate them will be a huge thing for our patients. Imagine if there was no longerareasonforanyonetotakeImi- trex or other migraine medications … Do you have any specific examples of screenings that have led to saving a patient’s life? The easiest one to incorporate would be the Eppworth Sleepiness Index. Perhaps a bold statement, but medi- cine cannot treat sleep apnea as effectively without a dentist as it can with. We cannot make a legal diagno- sis of sleep apnea, but this is such a pervasive and serious problem that it is irresponsible to not screen for it. It is irresponsible for our profession to not make sleep dentistry a routine part of practice. It is more important to live than to have white teeth. We are lucky enough that we can help to support both! If an attendee is interested in going to your session, is there anything he or she should be aware of? Is your session aimed for specialists or is a more general topic? There is no reason why every dentist or dental health professional would not get something from the discus- sion. Of course, any interaction like this is a two-way street. It is not my mission to convert anyone — but rather to open eyes to what we have seen work time and time again. It is not what I was taught in dental school, but it happens that it works significantly better in my hands. I see the same from the thousands of dentists I have know who have taken a similar journey. The bottom line is ours is a very speakers18 Greater New York Dental Meeting — Nov. 26, 2012 Dr. Mark Duncan talks about ‘Dentistry’s Dirty Little Secrets’ ▲ ▲ About the speaker MarkDuncan,DDS,istheclinicaldirec- tor at the Las Vegas Institute for Ad- vancedDentalStudies.Heisafellowof theinstituteandstartedteachingthere in 2002. He has lectured on esthetics, occlusion, CAD/CAM technology and practice management internationally and serves as development consult- ant to several dental manufacturing companies.