Richard H. Nagelberg, DDS
An explanation or description of lifespan is unnecessary, as it is understood by all to mean the duration of existence of an individual. No one, including physicians, dentists, and health-care professionals of all stripes, can promise to extend an individual's lifespan at the current time.
There is some research indicating that a modified fasting diet and frequent exercise can extend lifespan; however, it is preliminary at this point. Healthful recommendations including an active lifestyle, smoking cessation, proper diet, and so on are worthwhile, but will not necessarily extend lifespan. What they can accomplish, though, is to extend an individual's healthspan.
Healthspan is the length of time an individual has good health, which is defined by the majority of people as good brain function, mobility, and independence. This certainly varies with age. A 45-year-old man or woman may define mobility as playing golf and tennis, marathon running, or downhill skiing. When that same person is 75 years old, he or she may define mobility as the ability to play golf or just walk.
Ideally, the healthspan and lifespan are the same, meaning that a person enjoys a good healthspan for his entire lifespan, or as close to that as possible. Many people have a wide variation in their healthspan and lifespan, in which case they may exist for a short or long period of time without good brain function, mobility, and independence. Nursing home populations, among others, certainly have individuals whose lifespan exceeded their healthspan. Another way of expressing this is to do what we can to help people enjoy a good quality of life, as defined by each individual, for his or her entire life. It is good to have a long lifespan. It is at least as good-if not better-to have a long healthspan.
When we care for our patients, we are affecting their health and well-being beyond the oral cavity. We certainly cannot say that we are extending their lifespan, but we can say we are extending their healthspan. Some patients may include the ability to chew adequately as part of their definition of healthspan. Indeed, with periodontal disease as the leading cause of tooth loss, dental professionals are in a unique position to restore patients' ability to function.
On a more global level, however, maintaining or returning someone to excellent periodontal health reduces the risk for diabetes and cardiovascular diseases, both of which can have devastating consequences for healthspan and lifespan. As importantly, periodontal pathogens, independent of periodontal disease, can affect healthspan and lifespan.
If we can redirect our thinking outside our usual domain and bring the impact of what we do to the forefront of our minds, we will truly understand how influential we can be. This is a huge responsibility, but also a huge opportunity to affect total health.
Understanding that periodontal therapy and home-care recommendations are a way to potentially increase healthspan is an example of redirected thinking. Providing salivary bacterial testing for patients with a family history of cardiovascular diseases to identify periodontal pathogens implicated in atherosclerosis development, followed by showing patients how to reduce those bacterial populations, is another example of redirected thinking. Acting on research findings rather than just understanding them will help us become oral-systemic centers of excellence.
If we can cut through all the minutiae of periodontal disease pathogenesis, treatment alternatives, adjunctive agents, etc., we can easily see that the central feature requiring our undivided attention is bacteria. Bacteria are the causal agents of periodontal disease and have direct effects on vasculature, even in the absence of periodontal disease. Advising, recommending, cajoling, and persuading our patients to practice meticulous home care is among the most important things we can do to increase healthspan. It is the daily reduction in bacteria that drives periodontal health and increases the longevity of favorable periodontal treatment outcomes.
It is not adequate to merely recommend increased home care without specific, individualized product recommendations and usage instructions, as well as monitoring at every recare or maintenance interval. We are moving into a totally new era of health care with the advent of individualized medicine and dentistry driven by genomics. Concepts such as healthspan need to be embraced and acted upon.
Richard H. Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations. He lectures on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity.
