Why you need to care about oral health [PODCAST]

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“Guess what? The mouth is attached to the rest of the body. And though dentistry and medicine are typically separated from the very beginning of professional training, they are irrevocably linked for patients and have an impact on each other. Here’s some foundational knowledge that will help set the stage for discussing the connection between overall health and oral health: Our mouths are teeming with bacteria – mostly the good, harmless kind – and when an appropriate hygiene routine is followed, that bacteria is kept in perfect balance to keep our teeth strong and gums healthy. When that bacterial balance is thrown off track, the results can be disastrous. Yes, cavities are one consequence, but so are yeast infections and periodontal disease—i.e., inflammation of the gums and loss of the bony levels around teeth. A quick scan through any wellness magazine and medical journal will tell you that inflammation is bad news. Researchers continue to connect it to some of the worst chronic diseases physicians see in their offices today. Our mouths are a gateway into not only our respiratory system and digestive tract, but also our bloodstreams (there are a lot of surface-level blood vessels right there), so patients’ periodontal inflammation can be a harbinger of other health issues in their bodies.”

Cindy Roark is a dentist and health care executive.

She shares her story and discusses her KevinMD article, “The connection between oral health and overall health.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Cindy Roark. She is a dentist and a health care executive, and her KevinMD article, which we’ll talk about today, is titled “The connection between oral health and overall health.” Cindy, welcome to the show.

Cindy Roark: Thank you, Kevin. I’ll give you a little bit about my background. I am senior vice president and chief clinical officer of Sage Dental, and we’re primarily in Florida and Georgia, so the southeastern United States at this point, and growing. My background actually was clinical care for many, many years, and I probably never believed I would end up in an executive role, but that’s what happens when you go through this field. There are some fascinating things that I can share with you today, a little bit about the intersection between overall health and oral health.

Kevin Pho: Yeah, so before we get into that, we don’t have very many dentists on the show. We don’t get a lot of that dental perspective on our shows. So just in general, how is the health care landscape facing the dentist today? What are your comments on that in general?

Cindy Roark: Well, I mean, it’s very interesting if you think about it. In response to an overall look at medicine, dentistry, I think, for many years has been a little bit behind, right? We weren’t part of the HITECH Act, so that meant all the dentists in the country did not migrate to electronic health records at the same time. We didn’t have funds available to move into digital X-rays at the same time. And so if you really look at it, at this point we’re playing catch-up, right? There are these amazing AI things out there that can be used, but when you have a group that did not have digital for many, many years, it takes some time for us to catch up. So for me, I look at it and I think everything we want to do, we want it to be scientific and reproducible, and until we start utilizing these tools, we’re going to remain behind.

Kevin Pho: So in the next year or so, what would you say are some of the biggest trends that one would see walking into the dentist’s office?

Cindy Roark: Oh, well, I’ll tell you, in the dentist’s office, from a dentist’s perspective, you’re going to see the penetration of AI to help annotate X-rays. And if you think about it from medicine, Kevin, every CT scan, every MRI, all those things are run through an AI engine of some sort, right? And we have the capability, you know, the bandwidth, the technology’s there. And so what I’m seeing right now is that really take off, because if you think about it, in other areas of medicine, people typically aren’t their own radiologists. You have radiology review, then you decide what you’re going to do, and dentists have to do that dual role. So I love seeing technology that can kind of outsource, and, you know, what you decide to do is certainly up to you, but you need to have a single version of truth: What is decay? What is an open margin? You have to have that one version of the truth. So I see AI really penetrating not only the dental schools but dental practices pretty rapidly, because I think what we owe patients is that consistency. You know, we don’t want them going to 10 dentists and getting 10 different treatment plans. That’s not reproducible.

Kevin Pho: All right, so now let’s talk about your KevinMD article. It explores that intersection between oral health and overall health. Now, for those of you who get a chance to read your article, just walk my audience through it. Share the story of why you decided to write it.

Cindy Roark: Sure. I wrote it because I think quite often we’re in silos, right? And people will think, “Oh, dentistry is important. You’ve got to brush your teeth.” But you don’t really think about it. Guess what? Your mouth, my mouth, number one, they’re the dirtiest places in the human body, and they’re attached to everything else. It’s attached to the rest of the body. So that would indicate to you that if things are bleeding or wrong in the mouth, your body has access to your bloodstream, and people don’t often think about that. Quite often I’ll have a patient who will, you know, think their teeth only bleed because we used a probe on them. If I can touch your skin anywhere, whether it’s gingiva or your arm, and I touched it and it bled, there’s a problem. But people don’t really look at the mouth that way.

And I think you’re really seeing an evolution right now, and one of the things that I think brought it to the forefront, Kevin, would be COVID, right? Dentistry was shut down just like medicine was shut down, and so it gave us time to really look at data, look at NHANES studies and all these things. And what we found out as we went through that pandemic would be that if you have periodontitis, you’re actually three and a half times more likely to be admitted to the hospital, four and a half times more likely to need a ventilator, and nine times more likely to die. Why is that? It’s inflammation. It’s just like everything else in medicine; it all ties back to inflammation. So those are the things I think people pay attention to now more than they did in the past.

That’s just kind of a one-off example, but there are so many. If you think about it, the average human in the U.S. might take several medications. And so what does that mean, right? If I’m taking an antihistamine, a diuretic, a painkiller, antidepressants, which, you know, many people take, or decongestants, they decrease saliva. Well, what does saliva do? It’s protective for your mouth. So it means if these medications are turning off your protection, you’re probably likely to get more decay. You’re probably likely to move into the gum disease category, and then you start that whole inflammation cascade. So there are things where, if you get out in front of it and you use something as simple as a saliva replacement when you’re on these things, you can stop a whole lot of negative effects.

Kevin Pho: Now, tell us some of the common oral health or dental issues that may arise in a primary care office like the one I practice in.

Cindy Roark: Sure. I think elevated A1C levels. You see type 2 diabetes is really epidemic at this point, and that one for us is actually cyclical. You know, if MDs did nothing else but say, “High A1C, you need to see your dentist,” that alone would be helpful, because what happens with A1C is it increases the inflammation levels. So it’s a cyclical thing with that particular one. Number one, poor sugar control is going to increase that inflammation, and increased inflammation continues to affect your sugar control. So something as simple as diabetes, which quite often is dealt with in a regular medical care office, they need to be going to the dentist. It’ll help you, and it’ll help us, and it’ll help the patient, right? But you need to be doing it. I just don’t think that’s on people’s radar, by and large.

Kevin Pho: So if I’m in the exam room and I’m doing, say, a typical physical with a patient, tell me what kind of questions I should be asking my patients that may uncover an underlying dental issue that I need to be worried about, and say, “Hey, you need to see your dentist.”

Cindy Roark: Well, very simple. You know, anytime you’ve got blood work, you’re going to see the A1C level. So anytime you’re concerned about diabetes, you definitely want to get them into our hands. It’s that simple. You don’t even have to look in the mouth. We know there’s going to be an issue there, we know control is going to be an issue, and we know they’re going to have inflammation.

And here’s what’s interesting. You know, everything’s related, Kevin, and if you think about it, there’s all this inflammation related to diabetes, and then what happens when you suddenly have a situation where you allow the oral bacteria to kind of take over, right? P. gingivalis is the most common culprit in periodontal disease. And if people aren’t aware, if you’re in a different piece of medicine, periodontal disease then starts eating away the bone that holds the teeth in, right? So now you’ve got something taking that bone away, and it’s not coming back. P. gingivalis is actually the number one bacteria isolated in beta-amyloid plaques in Alzheimer’s. So I’m not standing here today saying that, you know, periodontal disease causes Alzheimer’s. I’m saying it makes it worse. So if you’ve got a situation where you’ve got a patient with possible dementia, possibly heading down that path, I mean, absolutely, those people need to be in their dentist’s office right then, right now, on a different regimen, because we know it’s going to make it worse. It will just continue to get worse.

Kevin Pho: Now, whenever I think about oral health, there’s a traditional connection with that and endocarditis. So tell us what the current thinking about that connection is.

Cindy Roark: So the current thinking on that: We used to premedicate everyone who had ever had rheumatic fever, any of these things. And so I think dentistry and the American Dental Association and the American Heart Association also have gone back and forth about whether they feel like we’re giving too many antibiotics, and that’s giving resistance, or whether we’re actually helping. That I wouldn’t comment on. What I would say is, with endocarditis, that inflamed heart lining, any time I have the ability in your mouth to provoke blood, right, it now has, again, access to your circulatory system. And what happens? It gets lodged on stroke and heart attack plaques that are forming. So again, it’s not causing those things; it’s making them worse. So if we know that we can do something to keep things from getting worse, then we probably should.

And so, you know, I kind of joke, and I just think it’s really an education and referral thing. We typically are in such silos with medicine and dentistry that I think it isn’t topical. People don’t think about, “Oh my gosh, you know, this person’s got Alzheimer’s,” or “They’ve got diabetes. I need to get them into their dentist’s office.” People don’t really think about that. Or they have a history of endocarditis: definitely need to get them into the dental office. It just isn’t topical. They don’t think about it.

Kevin Pho: Now, one of the things that you mentioned when I was reading your article, that I really didn’t make that connection with, was when I prescribe a lot of medications, it certainly has an effect on the saliva production. So go into more detail in terms of what I can do to help prevent some of the dental complications of that. Is it as simple as going over the counter and getting some type of moisturizer? So give us more detail in terms of what we could recommend to our patients when we prescribe a lot of these common medications.

Cindy Roark: Right, any of them. I mean, again, I think probably the ones I see the most of would be antidepressants, just everywhere, and rightly so. It’s been a tough time for a lot of people. But anyway, diuretics on the cardiology side, they’re heavily prescribed. And so something as simple as telling them, when they go on it, “Just grab some Biotène at CVS or Walgreens.” Very simple. It’s $3, not expensive. And again, if you’re rinsing with that every day, you’re protecting yourself, and it’s that simple. It’s not even hard.

But quite often I’ll see somebody who’s reached a certain point in their life, and they’re like, “This is crazy. I’ve been to the dentist, you know, twice a year for 30 years, and now all of a sudden I have these things. You know, what’s going on?” And my reaction is typically, “Well, what new medications are you on? How long have you been on them?” And let’s go from there. So I think, obviously, we know in medicine prevention is key. We’d like to prevent it versus deal with it after, because I can’t regrow bone today, at least not well enough to do it, you know, on every patient that has perio. But for me, it’s just having the knowledge base as a doctor to say, “Hey, you know, I see you’re going through a tough time, Mrs. Jones. I’m going to put you on sertraline. You may want to pick up a bottle at CVS, because it’ll really help, you know, protect your teeth.”

Kevin Pho: We’re talking to Cindy Roark. She’s a dentist and health care executive, and her KevinMD article is titled “The connection between oral health and overall health.” Cindy, we have a platform here of primarily medical clinicians. So are there any misconceptions or misperceptions about the dental profession that you would like to clear up?

Cindy Roark: Probably just this big connection: Everything’s interrelated. I can remember back in dental school, and it’s interesting, because at the school that I went to, the dentists and the doctors took a few classes together, and then we sort of separated as we moved into the clinical phases. And I can definitely remember hearing somebody say, like, “You know, gingivitis, periodontitis, how hard can it be, right? It’s not even medicine.” And I would just say that if we have the ability to make things worse, well, these are the big ones, right? Diabetes and Alzheimer’s. And there’s even a link to ED, which is always interesting to me, because lots of times, and that’s a stereotype, but I’ll have a male in the chair, and I might get something where they’re just not really interested in hearing where it’s heading. And then I say, “There’s also a link with ED,” and they’re suddenly listening, right?

So I think for me, the misconception I see is that they’re not interrelated. Clearly, they are. It’s the intake. It’s the first, you know, step into the body. You know yourself, because you read these things, if you have an abscess in one of your upper teeth, it can travel to the brain. So again, you know, is it life and death every minute? No, it isn’t. But definitely, if we have the ability to bend the curve, to make some of these chronic diseases a little less virulent for people, then we probably should be doing that. That’s what I would clear up.

Kevin Pho: And my final question: Any take-home messages that you want to leave with the KevinMD audience?

Cindy Roark: Definitely. Just do your homework. Realize that you can do things outside of your own primary care system that will very much help. You know, for instance, you’ve got patients who have a type of cancer. They may be undergoing radiation therapy or chemotherapy. Both of those, depending on location, have the ability to really affect the parotid gland and the saliva. So again, it’s absolutely critical that they see a dentist before they start either of those two things. So I think that’s probably the biggie. We want to keep people healthy, and then you want to keep those that are not exactly healthy from getting worse.

Kevin Pho: Cindy, thank you so much for sharing your time and insight, and thanks again for being on the show.

Cindy Roark: Thank you, Kevin. I appreciate it.

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