Dentistry has been stuck on the same message for over 200 years, and it no longer works. There are people with legitimate treatment needs, and we have products and technologies that allow us to address them better than ever before. Unfortunately, unless people are in pain, most don’t even stop to consider their oral health. On the rare occasion that they do, patients often think their needs aren’t urgent or important. In order for dentistry to compete with medicine for its rightful place on the health-care stage, the current model of dentistry must change.
The COVID-19 pandemic drew attention to the fact that the dental industry lacks a universal, impactful message. Initially, with the stroke of a pen, dentistry was deemed nonessential. Once dental practices were allowed to reopen, patients were nervous to return because we failed to take a firm stand and communicate a clear message about the importance of oral health.
Even now, many patients only want to have their teeth cleaned. They are stuck on the “brush and floss or else” message that has been drilled into their heads, but that isn’t enough. Dentistry has created generations of patients who’ve been conditioned to believe that routine cleanings and home care are the most significant components of prolonged dental health. They aren’t.
The problem with the "brush and floss" mantra
Dentistry’s blind allegiance to oral hygiene, to brush and floss, has given patients the false sense that they alone can control their oral health. Dental therapist recommendations are often met with denial and a patient’s promise to “really do a better job with cleaning to see if things get better.”
Dentistry needs to come to terms with an uncomfortable truth: If subgingival oral inflammation exists, brushing and flossing will have little to no effect. Improved oral hygiene is not treatment for existing subgingival disease. Rather, it is part of a program to prevent relapse of disease only after that disease has been eliminated.
There is now overwhelming evidence that inflammation of oral origin contributes to the systemic burden of inflammation. Medicine has long realized that, while inflammation does not necessarily cause chronic diseases, inflammation is the fuel that drives the development of diseases that rob people of their quality and quantity of life. This places a significant financial burden on health-care systems globally.
Medicine is increasingly focused on reducing contributions to systemic inflammation as an important therapeutic option for managing the inflammatory-driven chronic diseases related to aging. Even without absolute proof of causation, the potential contribution that oral inflammation can make to the initiation and progression of systemic diseases suggests that helping patients achieve and maintain a preferred level of oral health should be considered an essential component of overall wellness.
Despite overwhelming evidence that a preferred level of oral health can impact overall wellness, we continue to parrot the same message that we’ve been using for the past few hundred years: “Brush and floss twice a day and get your teeth cleaned twice a year.” The fact that “brush and floss or else” hasn’t motivated patients with unmet needs to take action isn’t evidence that the message has failed to get through. It’s confirmation that the message must change.
Even with significant public education, patients still don’t appreciate the urgency and importance of diagnosing and accurately treating oral disease. Even more concerning, many dental practitioners continue to take a procedure-focused approach to patient care rather than an outcome-focused approach. A reasonable definition of a preferred level of oral health is a dentition that is esthetic, functional, relatively inflammation free, and maintainable. Recommending a procedure to a patient as a menu option is probably not as effective as positioning restorative/prosthetic/orthodontic needs as part of a lifelong journey to achieve a dentition that is healthy and maintainable.
Few patients understand the goal of dental therapy or even the parameters of any oral disease that they may have.
Chronic inflammatory periodontal disease (CIPD) causes no symptoms, and most patients who have it are unaware. Often, only a dental professional can tell if CIPD is present, and many of the identified risk factors for CIPD are also risk factors for other systemic diseases. For all patients, but especially patients who already have risk factors for diseases potentially affected by CIPD, improvements in oral hygiene and adherence to routine tooth cleaning won’t diminish the inflammation.
Patients should be taught to form lifelong partnerships with trusted dental professionals, since this is a critical component of achieving overall wellness. Often, only a dental professional can determine if oral inflammation is present, devise a plan to get that inflammation to resolve as quickly as possible, and then partner with the patient to keep disease at bay.
The solution: A new narrative
For dentistry to work—for dental organizations to remain viable, for dental manufacturers and suppliers of goods and services to thrive, for DSOs to function more efficiently, for third-party payers to lower the cost of managing inflammatory based chronic diseases, and for medicine to see improved outcomes—patients must come in to dental offices, their needs must be recognized, and they must be motivated to assume the responsibilities of having those needs addressed.
A universal message that conveys the significance of attaining a preferred level of oral health, the need to partner with a dental professional for life, and the benefits of doing so (for both oral and systemic health) would benefit all stakeholders in dentistry. It would greatly benefit patients, as well.
Periodontal disease has to be clearly defined and identified as a serious problem. The need for restorative/prosthetic/orthodontic care as an integral part of achieving lifelong dental health and boosting overall health needs to be at the heart of dentistry’s new narrative.
It’s time to leave behind the dated image of the dentist as the senior member of the oral hygiene police with the dental hygienists as loyal foot soldiers in the war against plaque and embrace the concept of dentists and hygienists as important members of a vital health-care team with the goal of helping patients achieve better oral and systemic health. A new narrative for dentistry will require more widespread awareness of the essential role that lifelong dental management can play in overall wellness.
The time is now
It’s time for dentistry’s major players to come together and have a conversation. Together, we can cocreate a way to move the industry in a preferred direction. Let’s explore and find out how the new wellness approach to dentistry can work better for patients, for dental supply companies, manufacturers, providers, DSOs, private practitioners, organized dentistry, third-party payers, and anyone who has a stake in health care.
Editor's note: This article appeared in the August 2021 print edition of Dental Economics magazine.
Timothy G. Donley, DDS, MSD, is a dental specialist, lecturer, and author. Tracy Quinton is founder of the Quinton Group, and an organizational leadership strategist. Dr. Donley and Ms. Quinton are codirectors of Collaboration for Change 2030, an organization making an industry-wide effort to move dentistry forward.
