North Texas Dentistry Special Issue 2016 | Page 42

SHAPING THE

O

FUTURE

ver the past few decades, dentistry has been
reshaped by a proliferation of transformative
changes, some of which have yielded dramatic
advances in oral health. When public health initiatives led to communities fluoridating the water
supply, the incidence of dental caries was cut in half. When
Brånemark’s innovative research enabled the osseointegration
of dental implants, a sea change in tooth replacement followed
that gave edentulous patients an esthetic, permanent answer to
tooth loss and its repercussive effects. Advanced digital technologies and sophisticated restorative materials have made it
possible for dentists to improve their patients’ smiles in lifechanging ways. Exciting developments continue to propel
dentistry forward into a bright and promising future.

As the future of dentistry takes form, we must work to make
sure we do not lose ground already gained. Fluoridation, for
example, is under threat by a poorly informed movement to end
fluoridation in communities around the country, despite its
strong and well-established positive impact on oral health. In
Texas, the Community Fluoridation Committee helps inform
community leaders about the importance of continuing the
fluoridation program.

Also, difficult challenges exist that demand to be addressed.
There is a critical need to improve access to oral healthcare services for people living in underserved areas, as well as the poor,
disabled, and elderly. This need will become even more pressing
as our population ages and chronic health conditions affect a
larger segment of the population. According to estimates, one
in five Americans will be over 65 by the year 2050, and senior
patients are more likely to have retained their natural teeth than
in the past. Health care reform still has not successfully
managed to include oral health services, and comprehensive
care is out of reach for many. Whether the challenge of equitable
access is addressed by changes to the dental workforce or by
expanding the role of dental students, identifying the most
reasonable and appropriate scope of practice will be a defining
factor in the future of dentistry.

Adding select diagnostic screenings and other health care services to routine dental care appointments will help dentists
manage the needs of patients more effectively and provide an
opportunity to construct crucial bridges between dental care
and other health care services.

Dentists are in a unique position to identify possible health
problems, and this point of contact is an important opportunity
42 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

by Tina Cauller

to refer patients for follow-up testing. Most dentists already
conduct some health screening as part of routine care. Patients
have been routinely screened for hypertension at their dental
visits for years. Most have added screening for oral cancer and
periodontitis and many dental practitioners now offer intervention for smoking cessation. Periodontal disease is an important
contributor to the total systemic inflammatory burden, which
compounds the risk of cardiovascular and respiratory disease,
diabetes and other health problems.

Integrating dentistry and primary care is an opportunity to
improve the overall health of all Americans. Training to recognize possible indicators of diabetes, such as xerostomia,
periodontitis, and fungal infections, as well as adding glucose
testing as part of routine dental visits, could help identify undiagnosed cases of this potentially life-threatening condition.
Radiographs taken as part of regular dental care can reveal bone
loss in the mandible associated with overall changes in a
patient’s bone density.

Symptoms of sleep apnea are often recognized for the first time
at a dental visit, and early diagnosis and treatment can identify
patients at risk for associated disorders such as cardiovascular
and respiratory disease, and may even halt progression of the
severity of the disorder. Dentists may be the first line of treatment in mild cases of sleep related breathing disorders. New
diagnostic testing techniques, such as salivary testing, are being
evaluated for inclusion in the diagnostic acumen of the dental
practice. Scientists are currently studying the diagnostic usefulness of salivary testing for markers of inflammatory, infectious
and immunologic disease, including systemic diseases such as
breast cancer.

The dentistry of the future will almost certainly look different
than the dentistry of today. It may feature a functioning team
of interprofessionals, fundamentally changed dental education,
and an evolution from experiential to evidence-based dentistry
founded on a thorough meta-analysis of rigorous scientific
research.

It has been said that the only constant is change, and change
can be fraught with pains and missteps. But change in the paradigm of dentistry also presents an opportunity to have a positive
influence on the overall health and wellness of patients. If
dentistry applies the same perseverance and inspired innovation that it took to get where we are, we will be well-prepared
for the challenges that lie ahead.