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How Do Dentistry and Medicine Collaborate in Oral Systemic Health?

IADR Satellite Symposium Sponsored by Johnson & Johnson and Johnson & Johnson Consumer & Personal Products Worldwide

On July 3, 2008, the International Association of Dental Research (IADR) met for its General Session in Toronto, Ontario, Canada. This annual meeting gathers research luminaries from around the globe to exchange cutting-edge ideas in dental research. One of the program’s highlights was a symposium sponsored by Johnson and Johnson Consumer & Personal Products Worldwide “How do Dentistry and Medicine Collaborate in Oral Systemic Health?”

Although a robust literature exists in oral/systemic diseases, this issue also encompasses dental education, clinical research, and how the dental profession fits into health sciences. This timely Symposium is a result of a 2007 Summit recommendation to communicate about this topic to physicians and other healthcare professionals. That Summit was also sponsored by Johnson & Johnson Consumer & Personal Products Worldwide. The Symposium began with Dr. Ira Lamster (View Figure), dean of the College of Dental Medicine, Columbia University, who also served as moderator for the session, providing an overview and pertinent observations on oral and systemic medicine. During his opening remarks, Dr Lamster outlined the history of associations, communication with other healthcare professionals and patients, and discussed the opportunities and barriers facing the profession, including the current and developing dental school curriculum and the question of a mandatory postgraduate year of training. Dr. Lamster noted that the aging population is well educated and seeks health for a lifetime. If they are to be treated through integrative medicine, then the dentist needs to understand the biologic dynamics of this growing population.

Dr. Lamster was followed by Dr. William Costerton, director of the Center for Biofilms in the School of Dentistry at the University of Southern California. Dr. Costerton presented on “Bacterial Biofilms: A Role in Oral/Systemic Disease.” Biofilms naturally shed planktonic cells, and performing root planing and scaling can dislodge bacteria, which enter into the circulatory system. While biofilms themselves usually do not cause disease symptoms, planktonic bacteria entering the circulation may. New laboratory techniques can track the components and development of the biofilms, and have demonstrated that bacteria from the mouth have been found in various parts of the body where they do not naturally occur, such as in utero surrounding a fetus or on a heart valve.

The implications for oral-systemic disease connections are significant. The good news, according to Dr. Costerton, is that there is a major international project looking into the population of bacteria on the human body. The Human Microbiome will be using laboratory techniques based on bacterial RNA and providing identification of the biofilm colonizers that will help illuminate the relationship between oral biofilm and systemic diseases.

Speaking next, Dr. Maurizio Trevisan, executive vice chancellor and CEO of the University of Nevada Health Sciences System, gave the physician’s perspective on the important topic of how physicians and dentists can interact in his presentation titled, “Oral and Cardiovascular Health: Should Physicians be Concerned About this Link?” He pointed to the fact that both periodontal disease and cardiovascular disease are very prevalent conditions: cardiovascular disease is the leading cause of death and disability and periodontal disease is the leading cause of tooth loss in the United States.

Dr. Trevisan outlined that studies show a consistent relationship between indices of oral health and various indicators of cardiovascular disease. He noted, however, that the amount of time it takes for observation in research can take, on average, 16.7 to 23.4 years before implementation. Physicians are concentrating on a whole host of treatments in the cardiovascular disease patient; among them are lifestyle changes (smoking, diet, exercise), antihypertensive medications, lipid-lowering drugs, and ACE inhibitors. The question, said Dr. Trevisan, is how does the physician work in treating periodontal disease among these therapeutic strategies? He encouraged practitioners not to lose sight of primary prevention and the lifetime build up of the disease that cannot be addressed by periodontal interventions only. The message from this physician was that periodontal disease is an important problem itself. The dental professional’s encounters with patients are important opportunities for prevention-focused efforts, with the added probability that taking care of the gums may benefit the heart and other parts of the body.

Rounding out the presenters, Dr Anthony Iacopino, dean and professor of restorative dentistry and director of the International Centre for Oral-Systemic Health at the University of Manitoba, brought the symposium full-circle, echoing Dr Lamster’s opening remarks about the role of professional education. Dr. Iacopino’s presentation, “Translation of Oral Systemic Science to Clinical Practice: The Final Frontier,” informed the audience about an impressive learning opportunity in the dental curriculum. The model is the current program at the University of Manitoba, where there is a program with transdisciplinary and interdisciplinary approaches to periodontal health and systemic disease. This program stems from the philosophy that a core team of dentist/dental hygienist, physician, nurse, nutritionist, and pharmacist provide multi-directional reinforcement of health/wellness in patient care.

Transdisplinary training in education reinforces the idea that these core groups must all be linked together for a truly successful treatment, with the health message coming from all components of the team. Primary care providers need to keep the oral conditions in mind at every visit, and there should be regular communication to the dentist from the primary care physician, and vice versa.

Other important components include public education, access to care, government and policy initiatives, and establishing strong advocacy messaging, Dr. Iacopino said. The insurance industry is also an important component and has been in the leadership of applying the oral-systemic research into care for their subscribers. He closed by reminding the audience that the field of oral-systemic health will lead to significant changes in education research and clinical practice.

CONCLUSION
We have reached a point in dentistry where action can be taken through collaborations between researchers, clinicians, academicians, and all sectors of dentistry to generate real-time solutions. This symposium was an important educational opportunity beginning with the causative factors and ending with opportunities to translate the scientific and clinical into models for preparation of the dental and medical workforce.

Left to right: Drs. Costerton, Iacopino, Trevisan, and Lamster at the Johnson and Johnson IADR General Session Satellite Symposium.