Holistic dentistry – whole body health

health sugarJames Goolnik explains how dental professionals can help patients to be systemically healthier.

At dental school we all learned a myriad of medical conditions that can impact oral health and how we can spot early signs in the mouth.

The reality is that in a busy practice, there is not enough time spent on prevention and education. We are in a privileged position of seeing our patients regularly – often when they are healthy, unlike our medical colleagues. Isn’t it time we started to take a more holistic approach to their total health?

We know that dental health and whole-body health have a significant overlap, and affect one another much more than was previously realised. Research already shows links between gum disease and many conditions such as diabetes, heart disease and blood pressure. Links between gum disease and some forms of dementia have also been found recently too. Often, we spot when our patents are pregnant by just looking in their mouths.

The biggest impact on our patient’s health is their diet. We know it takes as little as three months of a high-sugar or carbohydrate diet for teeth to decay.

Today, dental decay is the number one reason children aged five to nine years are admitted to hospital in England. Furthermore, the National Child Measurement Programme (2019) states that 20% of children are now obese by age 11.

We need to change these statistics. Dental caries is still one of the most prevalent non-communicable diseases affecting humankind globally and the dental team can start to make a bigger impact.

Gum disease

Eating added sugars will increase your body’s inflammation. We know that gum disease in diabetic patients is more aggressive, leading to faster breakdown of their gums and the bones around their teeth, eventually resulting in tooth loss.

We also know that the chronic inflammation in gum disease actually contributes to further diabetic complications. Someone with diabetes needs to clean their teeth more thoroughly and see their hygienist and dentist more regularly. This will not only prevent gum problems, but will also stop complications in the rest of their body.

More and more, patients can reduce and even completely stop their diabetic medication by changing their diet.

What to measure

Start with a baseline. We cannot move anything until we are able to measure it. In dentistry, we can measure bleeding scores and DMFs, but how about knowing if our patients are metabolically healthy?

When it comes to general health, there are five numbers our patients need to know:

  • Blood pressure
  • Glucose
  • Cholesterol
  • Waist to height ratio
  • BMI.

Any one of these numbers can indicate an increased risk for conditions such as heart disease and diabetes. With some simple, inexpensive equipment and less than five minutes we can help screen our patients to see who needs to make lifestyle changes or referral for specialist help.

Blood pressure check

Maintaining a healthy blood pressure is very important because the higher your blood pressure is the higher your chances of having health issues are.

Increased blood pressure places more strain on all of the key organs in your body. If left undetected and uncontrolled it increases the risk of conditions such as stroke and heart failure.

For as little as £30, you can get a basic machine to use in the surgery. We use an Omron M2 monitor on our patients.

Blood glucose level

Blood glucose levels vary throughout the day in relation to what we eat and our body’s ability to regulate this. Type 2 diabetes occurs when your body is unable to regulate blood sugar levels. Untreated type 2 diabetes increases the risks of heart disease, stroke, damage to vision, nerve function and impairs the body’s ability to heal.

We use a finger prick test that gives accurate results in under 90 seconds. If your patient can fast for eight hours prior to the test (they can have clear fluids, tea or coffee with no sugar) then this will give the most accurate result.

We also offer HbA1c finger prick tests using a A1Cnow reader that does not require patients to fast. This gives an overall picture of what your average blood sugar levels have been over a period of weeks/months. It is one of the main ways in which diabetes is diagnosed.

Total cholesterol and full lipids

Cholesterol is needed to build healthy cells, but too much of the wrong type of cholesterol can build up in the arteries, restricting blood flow and increasing the risk of heart problems and strokes.

We measure the total cholesterol, and the HDL (high-density lipoprotein), or ‘good’ cholesterol, to get the ratio to see if patients are in the healthy range. Also check triglyceride levels help measure their risk of developing heart and circulatory disease. Again, this is a finger prick test using the Cardiochek Plus Analyzer.

Waist to height ratio

Waist to height ratio is a simple measurement for assessment of lifestyle risk and the correct weight range. Although a relatively simple measure, it helps to build a complete picture of our patients’ health. You just need a tape measure and height measure. We use the Seca tools for this.

Body mass index

Body mass index (BMI) is a useful way of measuring whether patients are a healthy weight for their height. It takes into account natural variations in body shape, giving a healthy weight range for a particular height.

For most adults, an ideal BMI is in the 18.5 to 24.9 range. However, BMI isn’t appropriate for everyone. As we age, we tend to have more body fat and less muscle, so BMI may underestimate body fat in older people. Athletes and people with a lot of muscle may have a high BMI but actually not have much body fat. Pregnant women gain weight as a result of their developing baby. Certain ethnic groups, such as black or Asian, are at risk of certain health problems at a lower BMI than others.

That said, it is a good snapshot and most patients are aware of it. All you need is a set of digital scales; the NHS website has a good calculator you can use.

We know lots of people do not see their doctor regularly or are unaware of their key numbers, so why not offer a simple five-point health screening so that you can help your patients get to ‘know their numbers’?

Figure 1: The mouth is the gateway to better overall health

How can dental teams help?

Dental teams can help by screening our patients’ caries risk and delivering more prevention.

I can hear you saying ‘fluoride’ – whether in toothpaste, water or applied topically.  But the number one factor is diet – reduce your patients’ frequency and amount of sugar and carbohydrate intake, and caries stops.

We thought initially it was all about reducing frequency of sugar intake, but research shows the total amount of free sugars is more important.

There has been a recent proposal by the government to fluoridate the entire UK water supply. Currently, around 14% of the population of the United Kingdom receives fluoridated water (Mullen, 2005), but we still have a massive dental disease problem.

My personal concern is that parents/caregivers will then continue to feed their children sugar thinking ‘the fluoride will protect them’.

This, however, will not stop the growing diabetes problem in the UK.

Shouldn’t we spend the money on education and reducing the added sugars in our foods? The sugar tax, which was introduced in 2018 and applies to drinks that contain more than 8g of added sugar per 100ml, was a start. It has made manufacturers reformulate their products by reducing the sugar (in drinks by just over 20%) but maintaining the overall sweetness.

The manufacturers replaced the sugar with artificial sweeteners – which have been shown by research to not fill you up. They keep you hungry and consuming more.

We need to slowly wean the nation off ‘sweet’, especially as some children have dessert at every meal.

I would like to see the tax extended to cover milk-based drinks, smoothies and fruit juices.

Then, have the funds raised ringfenced for general health, where the money could tackle wider health issues, such as obesity and diabetes.

Help your patients be accountable

We need to do more than give out diet sheets, which are usually never discussed again. Telling someone to stop snacking and eat fewer sweets will not deliver lasting change. I propose to get them on the 14-day sugar challenge to reduce refined sugar and carbohydrates from their diet.

In as little as five days, they will experience a change in their taste, skin and energy levels. You are not only saving their teeth and gums but also improving their overall health. You can set up a private Whatsapp group to help support them though the journey. Post tips, recipes and share successes and help them overcome any hurdles. They can also join our supportive Facebook group – simply search ‘kick sugar community’.

The charity, Rewards Project, aims to get schools and nurseries sugar free by 2023. For the charity, we produced a cookbook – Kick Sugar – that dental care professionals can give to their patients to help with ideas for healthy recipes during the challenge. It helps educate them on what sugar does to their bodies.

School visits

School and nursery visits can be great fun, and enable dental teams to give back to the local community, forge relationships and attract new patients. The team loves getting out of the practice and teaching.

Get a whole generation to love seeing the dental team, teach them about teeth brushing and healthy eating. You can take toothbrushes, toothpaste, stickers, stationery, disclosing tablets, a toothbrush chart, and a large toothbrush and mouth.

The Rewards Project (www.rewardsproject.org) also has downloadable resources for your visits.

A complete toolkit

I talk to all my patients about diet and exercise and gently nudge them by giving them tips on snacking, different exercises or meditation apps.

We spot the signs of other disease by subtle changes in our patients’ mouths. In the majority of cases, these people are unaware of any problems and we refer them to the relevant specialists before it is too late.

Let us try and give added value to our patients. In return, they will value that appointment with you even more and you may even save a few lives, too. What do you need in your toolkit to help your patients get healthier?

Products used

A1Cnow – BHR Pharmaceuticals

Cardiochek Plus Analyzer – PTS Diagnostics

Omron M2 – Omron Healthcare

This article first appeared in Clinical Dentistry magazine. You can sign up for the magazine here. 

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