Periodontal Disease – Are We Doing Enough?

An Interview with Dr. Ron Schefdore

In this interview with Dentaltown Magazine’s Editorial Director Dr. Thomas Giacobbi, Dr. Ron Schefdore shares his thoughts on the link between periodontal disease and systemic health and what dentists can do to better address the cause of periodontal disease. According to Dr. Schefdore, perhaps it is time to treat periodontal disease like the systemic condition it appears to be.

What is the appropriate line between the practice of medicine and dentistry?

Schefdore: In today’s environment the research shows that periodontal disease elevates cholesterol, glucose levels and C-reactive protein levels. So dentists serve as a safety net by screening those levels at the beginning of periodontal treatment and again after treatment. If they are elevated after treatment we then refer those patients over to their physician because we have identified themas having a possiblemedical problem. So we’re never diagnosing anything.We’ll never take the place of physicians.

Do you think that physicians should be referring their patients with systemic conditions to the dentist or the other way around?

Schefdore: It is kind of a double-edged sword.We really need to check them out and get the perio under control before they can really make a diagnosis about patients’ cholesterol, or evenwhen determiningwhat kind ofmedicine to put themon for diabetes because periodontal disease will fluctuate those values. So the physicians need to refer to the dentist. The problem is, and the insurance companies confirm this, we as dentists and hygienists are not really diagnosing periodontal disease and treating it the way that we should.

How would you characterize the proper treatment of periodontal disease? Is it something beyond scaling and root planing and three- and four-month re-care visits?

Schefdore: Absolutely. We find that if we handle periodontal disease from a threepronged approach, we get much better and longer-lasting results. The three-pronged approach addresses 1.) the bacterial issues, 2.) the nutritional and oxidative stress issues and 3.) an underlying medical problem. So we developed a program that 78 percent of patients will actually do. Secondly, we developed a periodontal nutritional supplement and had it tested at Loma Linda University10 years ago and that needs to be initiated to address those problems. Thirdly, we take those three blood tests, cholesterol, C-reactive protein and glucose, to see if there is an underlying medical problem at the end of our periodontal treatment so the patient can stay well long term.

How long have you been using this protocol in your practice?

Schefdore:We’ve used this protocol for 10 years. The blood test, which is the final piece of the puzzle, was introduced about five years ago inmy practice. I was the first one to be with a Clinical Laboratory Improvement Amendments (CLIA) license to take moderately complex blood lab tests in a dental office. After I got my license, the government wouldn’t allow any other dentists to get this license, so I talked to Bio Safe labs in Chicago and they developed FDA-approved finger-stick tests for the dental office. The nice part about those tests are that they have a patient consent form and the dentist and the patient will receive a professional report fromthe lab and these lab kits are about eight times cheaper than if you go into a hospital or a blood lab to get for the same test, FDAapproved and lab accurate.

In your practice and in your experience, are the tests something that are covered by insurance and how is that process handled in terms of presenting that to the patient as well?

Schefdore: What we do is we present the package to the patient. So in other words we don’t confuse the patient at all, we just give them a package price to solve their periodontal disease. That will be all the supplies, the scaling and root planing, and laser treatment if necessary.We already know what case type it is and what it is going to cost to get them well. Medical and dental insurance at this time doesn’t cover the three blood tests and those three blood tests only cost a dentist $70. They cost about $350 at the hospital.

Is there a liability issue for the dental office that is performing these kinds of tests? In other words, if I do a cholesterol test on my patient and he has elevated cholesterol, is he my burden until I make sure he has seen a physician for proper treatment?

Schefdore: Absolutely there is a liability. That is why we developed the technique to take the liability out of the dental office. The way around it is to use the Bio Safe kits because they have the patient consent form and Bio Safe lab is giving the patient the report. They are sending it to their home. So now the patients are responsible because they have the report and Bio Safe lab has the liability because they came up with the report. So that takes all the liability out of the dental office and that is why you want to run it like this. You don’t want to run those over-the-counter tests.

Just to play devil’s advocate, what if a physician says to you, “If you suspect that the patient has other medical conditions due to your diagnosis of periodontal disease, shouldn’t you just send the patient to me to be worked on for those diseases and potentially others rather than getting the results and then sending them over?”

Schefdore: That’s a good question. The physicians here in Chicago told me I need to get the periodontal issues solved first since they elevate other blood chemistries and once we get themcontrolled they can then run tests and come up with anmore accurate diagnosis. What happens in some cases is that the C-reactive protein levels on this Healthy Heart Dentistry program most of the time drop between 30 and 90 percent within eight weeks. So if you don’t solve the periodontal problems first and you send the patient over to the physician, they are going to chase all kinds of diseases, where the disease was really just inside their mouth causing that kind of inflammation. Same thing with cholesterol; I had one patient drop 40 points in eight weeks on his cholesterol. If we had brought him over to the physician first before doing the periodontal healthy heart dentistry program he would have certainly been on statins.

You had mentioned that these results are different at the beginning of treatment. Are you repeating the tests after the periodontal treatment is complete?

Schefdore: Yes.What the physicians tell me in this area is that if there is a slight elevation in the glucose levels go ahead and treat the periodontal situation before you send them over there. If there is more than a slight elevation, refer that glucose patient over right away because our tests are the only FDA-approved for diabetics because it is a double test. It’s an instant glucose test and it’s a HBA 1-C, which is the average glucose for three months. So if they are positive on both tests that mean for they are certain they are going to be a diabetic but the physician has to diagnose that and we need to get those patients over to the physician right away.

What would you recommend to a dentist who is interested in providing this level of care for their patients? What would your recommendations be for the dentist to educate the local physicians?

Schefdore: The best avenue is knowledge. The dentists have to become knowledgeable on blood tests because we have not been trained in this area. So they really need to order the blood test, try it on them and their staff and get a few patients going before they talk to physicians. They really have to go through the healthy heart dentistry program and get up to speed on things that they have never been accustomed to before. Neutracuticals being introduced to periodontal care is very new to dentists.When they are experts they can go out and go to the offices like we did and do lunch and learns. It takes about a year to a year and a half to establish a relationship with a physician before they start referring to your office.

We had one patient whose physician could not help her get rid of her ulcer. It was a helicobacter and helicobacter thrives in periodontal pockets. I told that physician that he needed to send those patients over tome and letme go through their perio. Sure enough, this patient had 5-6mm pockets. So we cleared up the periodontal issues, put them on the neutracuticals and she never had a problem with stomach ulcers ever again.

Let’s say a patient comes into your practice, you diagnose periodontal disease, you recommend a course of treatment but the patient rejects it. Maybe they only want scaling but they don’t want to do the neutricuticals or the blood tests. How do you handle that?

Schefdore: I developed a step-by-step DVD program for the dental office along with themanual and if they follow my DVD and themanual and a one-hour lunch and learn with me, we will teach them how to present the 15 steps to the patient. We have a 93 percent acceptance rate – even with patients who can’t afford it. It comes down to training and being able to explain this to the patient so you do get an acceptance rate.

If you tell a patient he has gum disease and he doesn’t want to have scaling and root planing, do you discharge himfromyou practice if he is not willing to accept recommendations?

Schefdore: I don’t have a problem with the few people who don’t accept; I have a form that they sign that we’ve explained that they have gum disease and that this could be related to other diseases. It is a nice form that says the patient denied the treatment and we have them sign it and date it.When they come in for their next check up we go through the whole thing again and we’ll have themsign the formagain.Our rule is three strikes and then you have a loving conversation with them and ask, “Look, Mary, why are you here? I am giving you recommendations and you are not taking them.Why are you coming here?” We will say in a very loving way that maybe this isn’t the office for them because we can’t just keep cleaning up disease. We are looking for patients who actually want to handle disease.

What would you say to dentists out there who are providing more traditional approaches to treating periodontal disease?

Schefdore: We evolve and we grow in medicine and dentistry as time goes on. The next level is addressing the underlying medical issues that cause periodontal disease and the nutritional and the oxidative stress issues. So if they are not addressing that, they are not addressing two-thirds of the problem. The results are going to be that you are going to be re-scaling patients every few years and the check ups are not going to be as good. There are some dentists who are okay with that, but I am about getting people well for life and getting the public to think the dental office is their first stop in their overall health. It is a whole another paradigm shift but it will get all dentists much busier and more profitable if we practice this way.

Interviewee’s Bio
General dentist and published author Ronald L. Schefdore, DMD, is the creator of Healthy Heart Dentistry programs and runs his practice out of Westmont, Illinois. For more information, please visit www.yourcelebritysmile.com or www.healthyheartdentistry.com.