Table of Contents

Continuing Education
Case Report
Kois Center Case of Month
Literature Review

Compendium

January/February 2011, Volume 32, Issue 1
Published by AEGIS Communications

Salivary Diagnostics: A Catalyst for Medical/Dental Collaboration

By Ronald C. McGlennen, MD

Dentistry and medicine are on parallel evolutionary paths. Both are becoming increasingly focused on wellness and disease prevention. It is in the best interest and overall health of the patient that these parallel, but separate, paths converge quickly and that collaborative health management becomes the norm.

The realm of the profession of dentistry as adopted by the 1997 American Dental Association House of Delegates clearly explains dentistry as not only an essential component of overall health, it also states that dentists are involved in all disorders and diseases associated within the oral cavity, and that these diseases may affect overall health (my emphasis).

This definition, for many dental professionals, was more about the potential of dentistry. But now, more than ever, dentists have the opportunity to put theory into practice and show by key examples the potential of the dental office to preemptively diagnose and cure oral and systemic disease.

At the present time, the strongest catalyst for this new reality, other than ongoing research examining oral/systemic health links, may be advent of new salivary diagnostic tests ordered and collected in the dentist’s office. These tests are easy to use and require minimal investment, yet incorporate advanced and proven molecular science to produce accurate test reports that are relevant to a patient’s overall health.

Armed with these dependable screening tools, dentists are on the front line of health management and disease prevention. Those who incorporate salivary diagnostic tests into their practice are positioning themselves as invaluable "diagnostic scouts" of the medical profession; clinical allies who are able to refer patients earlier for better patient outcomes. Here are six reasons why the diagnostic scout model works:

  1. There are approximately 150,000 general dentists in the United States.
  2. Dentists’ specialized training makes them more qualified to conduct examinations of the oral cavity.
  3. The oral cavity is the gateway to the body.
  4. Most dentists see their patients once or twice a year—much more often than physicians.
  5. This frequency of patient interaction makes the general practitioner well qualified to conduct baseline tests for periodontal disease, oral HPV, and other conditions; monitor disease progression; and promptly refer to dental specialists and physicians.
  6. General practitioners, dental specialists, and physicians alike will be able to collaborate earlier, when patient outcomes are more likely to be favorable and the course of treatment less expensive.

Periodontal disease is the number one chronic infection known to exist in the human population. And it is an infection that is known to have both direct and indirect effects on diabetes, heart disease, and pregnancy, to name a few. Many periodontal infections go undiagnosed for many years, because prior to the introduction of salivary diagnostic tests, we did not have the ability analyze a patient’s genetic and molecular characteristics to actually know when periodontal infection begins, and determine which patients are actually at risk for developing infection later on.

Periodontal disease and diabetes are interrelated diseases. High levels of selected pathogenic bacteria may be the first sign diabetes, and reciprocally, a component periodontitis. Early testing to determine the types of microorganisms and quantity of these microbes can help direct more targeted therapy, and possibly lead to improved treatment and health outcomes. The information from the salivary diagnostic test reports can be shared with the physician for the co-management of patients with these two serious diseases.

HPV infections are causally associated with cervical cancer. Today, these same HPV types are believed to be the major risk factor for some oral cancers. Certain oral HPV strains (16 and 18) are now accepted as important risk factors for cancers that can occur in the ororespiratory tract. All dental clinicians now have the opportunity to use a salivary diagnostic test to determine who may be infected with the oral HPV virus and, in turn, at greater risk for these forms of oral cancers. Again, earlier detection and more aggressive follow-up may allow for earlier detection of lesions that may present health risks and, potentially, cancer.

Thanks to molecular DNA testing, dentists can now become more aligned with physicians in the collaborative health management of their common patients. What’s more, patients will begin to consider their dentists and their dental teams as true healthcare partners who are concerned for and contribute to the maintenance of their overall health—not just their teeth.