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Patti DiGangi, RDH, BS, believes dentistry is no longer just about fixing teeth. Dentistry is oral medÂicine. Her work helps dental professionals embrace the opportunities and understand the metrics that accurate insurance coding provides. The ADA recognized her expertise by inviting her to write a chapter in its CDT 2017 Companion book and again for its CDT 2018 Companion. She is the author of the DentalCodeology series of easy-to-read, bite-size books. Her latest book, "Teledentistry: Pathway to Pathology" was co-written with Cindy Purdy, RDH, BS. She can be reached at email@example.com.
Millennials are more conscious than ever of how food affects their health.
The obesity and diabetes epidemics have cast food in a negative spotlight, and millennials have demanded healthier choices. Shirley has become acutely aware of this topic with recently diagnosed food allergies, and Patti has faced this challenge for many years. What does that mean for us? As modern millennial hygienists (MMHs), we now understand allergies are an inflammatory response.
Chairside experience can equal rote behavior
How do newly discovered allergies really affect dental hygiene treatment unless the patient is allergic to stainless steel or latex?
As we rediscover the interrelationship between oral condition and system-wide effects, we don’t know exactly how one affects the other. Allergies are just as big an issue as diabetes. Food allergies are proving to be an untapped aspect that could be an answer to patients who won’t respond to traditional periodontal therapy.
Overt and covert
Allergies present themselves in two ways: one overt and the other covert. The traditional rash, boils, hives, itching, cramps, vomiting, sneezing, wheezing, coughing, skin color changes, itchy eyes, fatigue, irritability, etc. are overt manifestations. In some areas of the industrialized world, up to 50 percent of the population is affected with allergies. The real issue (covert manifestation) is Immunoglobulin E (IgE), the antibody responsible for initiating all of those overt responses. IgE stimulates, or rather initiates, mast cells. Mast cells, as we were always taught, have binding sites for IgE stimulated by allergens, which triggers the release of substances from mast cells that can cause inflammation, which is where the perio connection comes in.
The increased covert inflammatory condition contributes to the overt periodontal markers, like bleeding. Will that affect health care providers' recommendations on periodontal treatment? The inflammatory cascade is working overtime, especially if the patient was unaware of his or her allergy status, like Shirley was.
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A body under attack from undiscovered toxins/allergens may be in an overreaction situation. The most critical consequence of this underlying inflammatory load is the laying down of arterial plaques. An undiagnosed IgE response increases the likelihood of having arterial plaques, which increases the likelihood of a periodontal condition.
Sleep apnea Increases inflammation
Sleep apnea is another under recognized problem that may be related to allergies and, even on its own, will cause an inflammatory response. Obstructive sleep apnea (OSA) occurs when the breathing is interrupted because of an obstruction of upper airway blocking air flow into the lungs while sleeping. Common signs of OSA are gasping and choking during sleep, dry throat upon awakening and excessive daytime sleepiness. The correlation between allergies and sleep apnea is the airway swelling as a response to allergens starting at the nose. The nose, obstructed by discharge, is a blocked airway.
Oral symptoms of sleep apnea include a scalloped tongue and enlarged uvula. Sleep apnea decreases systemic pH, including the oral cavity; increases the time for oral dryness; and, most importantly, increases inflammation in the body. Whether on the health history or stumbled upon during the oral cancer screening, these things can open the door to a meaningful conversation about the patient's entire health. Then, the conversation about insurance and payment can be mitigated to a level of understanding never before experienced.
Inflammation in health and disease
As we gain scientific knowledge about inflammation’s role in health and disease, applying that knowledge becomes more important and requires a new level of engagement by the clinician.
More efforts must be dedicated to the understanding of allergic sensitization and how it can be prevented. The identification of the pathological role of IgE and the subsequent release of inflammatory mediators and cytokines has enabled physicians to treat allergic symptoms with regard to the underlying immunological mechanisms.
As MMHs become the growing representative member of the health care team, this knowledge comes to the forefront. As rethinking and exploring status quo is innate, millennials will take more of a global look at the patient’s health and overall risk profile for catastrophic events. The one thing everyone needs to know about allergies is that they’re not just inconvenient.
Can you imagine a better health history? What would that look like? What questions would be added? Use the section below to share your thoughts and comments.