We have always paid a great deal of attention to issues that affect what is now becoming a much more publicized and researched issue, namely the oral-systemic link as it relates to your health.  We’ve always known that there is a huge connection between the health of your mouth and your general health.  In the last few years, research is confirming that connection.  One impact on both is the use of bisphosphonate drugs, such as Fosamax, Zometa, Reclast, Boniva, etc. They have a potentially significant impact on both oral and systemic health.

There has been a great deal written about the benefits and risks of bisphosphonate therapy to treat or prevent osteoporosis, especially in the last ten years.  Many of you, primarily women, have asked me my opinion since there has been a legitimate concern about oral problems in people who have taken one of the bisphosphonate drugs.

The main concern has been a fear of osteonecrosis of the jaw (ONJ) which has been reported as occurring in people taking the bisphosphonate drugs in a far higher than normal rate of occurrence.  Today, the discussion truly needs to be broadened beyond the bisphosphonate drugs to include other, newer medications, that function in similar ways, i.e., they prevent the resorption of bone that occurs in osteopenia and osteoporosis. 

So if I’m saying there is a fear of osteonecrosis of the jaw, what IS it?  Osteonecrosis of the jaw is a severe bone disease that can affect either the upper or lower jaw.  It causes destruction of the bone and can be progressive.  It can be extremely painful, but there is not always pain present.  The most effective treatment for it is to remove the damaged bone surgically, but that sometimes leads to further development of the disease on adjacent bone. 

Some of the initial research was reporting extremely high rates of ONJ in people taking bisphosphonates – some in the 10% range.  While ONJ was reportedly occurring primarily in women who were taking high doses of bisphosphonate therapy to treat breast cancer that had spread to their bones, it was also occurring in people taking much smaller doses to treat osteoporosis and osteopenia.  That was forcing many people, primarily women, to make a choice between avoiding possible ONJ and avoiding possible hip or spinal fractures due to osteoporosis. 

The Journal of the American Dental Association, in its November issue, (JADA 2011; 142(11):1243-1251) published an updated report based on a review of research and other literature that has been published since its previous advisory statement that was released in 2008.  This statement is much more positive than the last one.  The report indicates that the highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) is approximately 0.10%.  That translates to an incidence of 1 per 1,000 people taking any of these drugs.  (This study broadened the focus beyond bisphosphonates to include other related drugs used to treat similar diseases and lumped them all into the category of “antiresorptive agents”, thus the new abbreviation of ARONJ.)

The incidence of severe problems related to osteoporosis is far higher than the percentage of risk for ARONJ, so the recommendation is becoming more clear: if your medical doctor recommends that you take one of the anti-resorptive drugs to treat osteoporosis or other medical conditions, strongly consider taking his/her advice. 

Combining the already low risk of developing ARONJ with meticulous oral hygiene will certainly lower your risk even further.  That’s true because one of the precipitating factors to developing ARONJ is having a tooth extracted or requiring other bone surgery in your jaw.  If you are keeping your mouth in excellent health, your risk of needing any oral surgery is greatly reduced, thus also reducing your risk of developing ARONJ.

I’m delighted to be able to share this with all of you, since I know many of you have anguished over the decision about whether or not to take one of these drugs.  This will significantly reduce your risk of one of the major side effects. 

Please remember that getting an adequate amount of calcium and vitamin D on a daily basis along with performing regular weight bearing exercise will also help control or prevent osteoporosis.  Remember also, the healthier your bones are, the healthier your whole body, including your mouth, will be.

As always, our goal is to help you stay healthy.  Sometimes we can accomplish that through treatment, sometimes by coaching, and sometimes by keeping you well informed about how you can best stay healthy or improve your health.  All of which is our way of “helping you with healthy habits”, a cornerstone of the Kuttler Dental Team’s approach to your care.  Certainly helping you maintain good dental health means we need to pay attention to your total health—and the opposite is just as true.  The healthier we can help you keep your mouth, the healthier the rest of you is likely to be!

--Bill Kuttler, D.D.S.

Every two years as a licensed dental hygienist in the state of Iowa, I must report my continuing education credits for re-licensure to the Iowa Board of Dental Examiners.  This year as I am reviewing my records and compiling the last two years of my learning opportunities, I am in awe.

I have been in practice since 1973 when I graduated from the University of Hawaii.  Needless to say some things have changed over the years!  Who would ever have guessed the scope and variety of the things I am continuing to learn! In looking through the listing of classes I have attended, I am amazed by the scope, breadth, and variety of  topics contained in what I have most recently learned!

I have:

• Been certified in the use of lasers for dental hygiene therapy
• Learned about the role of the dental team in sleep medicine
• Reviewed new preventive therapies and products including fluoride varnish and xylitol for reducing and eliminating cavities
• Learned about saliva testing for periodontal disease and dental decay
• Discovered more about testing for the DNA markers for the genetic links for the predisposition to dental disease
• Taken nutrition classes to learn about nutrition for women’s health,  nutrition for oral health, and dietary supplements for oral health
• Been certified in CPR  and OSHA, and attended reviews on infection control
• Taken over 24 hours of continuing education on the most recent data regarding periodontal disease  alone
• Taken  more than 13 hours of continuing education just on learning about new products, both prescribed and over the counter
• Given classes in dental yoga for jaw relaxation and stress reduction
• Heard more about myofunctional therapy to change swallowing patterns and orthodontic development for children and people with sleep disorders

So I just added up the total hours of my continuing education to report to the Iowa Board of Dental Examiners and discovered that I have taken 73.5 hours of continuing education in the two year biennium from September 2009 until the end of this month -- 39 of those just since the beginning of this year!  (This is not counting the non-clinical courses on behavioral and spiritual development, and business management and marketing classes that the Board of Dental Examiners does not recognize for re-licensure.)  The required number of continuing education by the state is 30 hours – so I was very surprised to learn that I have more than twice what is required!

Along with preparing my re-licensure application I am also in the midst of preparing to host my dental hygiene classmates from the University of Hawaii.  It’s the first time we have gathered in Iowa, but we have gotten together almost every 5 years since 1973.  This year, I want to pull out this list and compare notes with my buddies. I wonder if they are as excited as I am to be a dental hygienist.!  I wonder if they believe, as I do, that there has never been a better time to be learning, un-learning, re-learning, and exploring the myriad of opportunities research and scientific data has given us for continuing and integrating evidence-based clinical and behavioral dental hygiene practice.  I can’t wait to talk with my friends who have shared the history, the passion, and the commitment to dental hygiene with me.  I can’t wait to be with the same friends who helped me get through chemistry, microbiology, pharmacology,  and so much more. I know we will have a wonderful time!

(… And there will be a luau too!)

-- Sharon Kuttler, RDH

Recently I was introduced to a magazine called The Sun by a good friend of ours.  I loved it!  She loaned us her January issue, and it contained a variety of articles related to health—a topic of great interest to all of us at Kuttler Dental.  I appreciated the excerpted portion from Normal Cousins’ book entitled Anatomy of an Illness.  Although I’ve read the book before, it was a refreshing reminder of the patient’s perspective, and I appreciated the reminder.

However, the article that I want to highlight was an interview with Dr. Andrew Weil titled “Vital Signs; Dr. Andrew Weil Diagnoses Western Medicine”. Although western medicine was the subject, much of the article could have just as easily been focused on dentistry.  Both medical doctors and dentists are all trained to treat disease far more than we are to prevent it—although I’m happy to say that I believe dentistry has always been in the forefront of prevention and has emphasized it for many years.

Dr. Weil speaks of integrative medicine which he defines as “first and foremost focusing on the body’s natural healing potential, which has been ignored in conventional medical education and training.”He further explains the concept:

• Integrative medicine looks at the whole person, because patients are more than physical bodies. To understand health and illness you’ve got to look at the mental and emotional and spiritual dimensions, not to mention the person’s involvement in a community. If you pay attention only to the physical body, you limit your interventions to those that are often the most expensive and the most potentially harmful.

• Integrative medicine focuses on preventing disease and promoting health. Conventional medicine has failed us here, and that is one cause of the healthcare crisis. We are too occupied with managing cases of established diseases, most of which are lifestyle related and preventable. The essence of prevention is not colonoscopies and mammograms; it is understanding how our life choices reduce or increase the risk of disease. As a society we need to be helping people make better choices.

• Integrative medicine emphasizes the doctor-patient relationship, which was once a major reward of practicing medicine. In the era of for-profit medicine, that relationship has been sabotaged. If you work in a corporate practice that requires you to spend only five to seven minutes with each patient, you can’t form the kinds of relationships that foster healing and provide emotional satisfaction.

• Finally, integrative medicine embraces all therapeutic options that may be of value. That includes many that aren’t even on the radar of conventional medicine — simple, low-cost interventions like breath work and laughter therapy. The preference is for more-natural, less-invasive, less-expensive options whenever possible.

When I read Dr. Weil’s words, one of the big things I take away from them is that he is talking about the importance of first treating the patient and then that person’s disease.  That feels very different to me than treating the disease that happens to be occupying someone’s body.  I remember years ago hearing someone talk about the difference between saying someone is a diabetic versus saying someone has diabetes.  That has stayed with me ever since, and we’ve tried very hard to integrate that approach into our practice.  We try to care for our clients as people who may have dental problems and who almost certainly would like to prevent those problems from re-occurring in the future.

I also read Dr. Weil emphasizing the importance of forming a partnership between the physician ( I read “dentist” ) and the patient.  That resonates with me so very much, because I believe there is little we can do to effectively treat dental disease that doesn’t need to involve the person who has it.  While I can restore decayed or broken teeth, if we don’t change the environment of that person’s mouth, the problems will only re-occur.  And I don’t believe that helps anyone.

Lastly, I appreciate how Dr. Weil stresses the importance of treating the body, mind, and spirit.  While that may seem far out to some folks, especially as it relates to dentistry, I don’t agree.  In dentistry we are trying to prevent, and are treating, “life-style diseases”.  True preventive dentistry is far more than teaching someone to floss.  It is working with people to identify some of the causes of their dental problems—whether those might be cavities, gum disease, teeth-grinding, or others.  I believe those issues are significantly impacted by daily choices—their life’s style.  Whenever we are paying attention to someone’s lifestyle, I believe we are involving the entire person—truly their body, mind and spirit. 

Yes, we fix and clean teeth in our office, but we really want to help people require our services less in the future because they are healthier.  Helping people develop healthy habits is the most valuable service we offer at Kuttler Dental!

-- Bill Kuttler, D.D.S.

My day spent with Dr. Jeffrey Okeson at the Chicago Midwinter Dental Meeting last week was fascinating and helpful. He is the Director of the Orofacial Pain Program at the University of Kentucky College of Dentistry and has a very extensive academic background with a deep knowledge of research. As a result, I respect his opinions and information. And, as is often true at least for me, I resonated with him because I agree with his point of view.

Of the six hours of Dr. Okeson's presentation, he spent half of his time discussing current concepts in the causes of tempromandibular (the jaw joint known as the TMJ) disorders (referred to as TMD) that result in pain. He then reviewed various philosophies in dentistry and options for treatment in the other half of his presentation. He described five different treatment approaches based on the desired outcome for how the teeth fit and how the jaw works. This has become a very controversial topic in our profession, and treatment approaches widely vary--particularly as it pertains to the amount of treatment that is recommended in the different approaches.

I was delighted to learn Dr. Okeson's perspective is congruent with what I have learned over my years of study at the L.D. Pankey Institute. There I received ongoing post-graduate education in the area of restoring teeth to health and with attaining healthy jaw joint function.

Our approach has been research based and experience driven. We have had a great deal of success with our individualized approach, helping identify contributing habit patterns, counseling on options, and utilizing the 'less is more' philosophic approach that Dr. Okeson affirmed.

I especially smiled at Dr. Okeson's closing comments where he encouraged everyone to treat their patients in the same way that they would want their children, spouses, or parents treated - and that's the way we do it at Kuttler Dental!

--Bill Kuttler, D.D.S.

Wesley just celebrated his first birthday - and WE celebrated his first visit to our practice!

You may ask, "What can you do with a one year old at a dental visit?" Our answer: "LOTS!"

The entire Kuttler Dental Team is committed to helping you with the healthy habits to prevent dental problems - and what better time to begin than at the very start?

Before a child is even born, we are discussing preventive care with expectant parents and helping mothers care for their dental health during their pregnancy. We prepare our families with what to expect and what to be doing in those first few months, from taking care of the baby's gums and new teeth to starting good habits and dietary choices. As any new parent will tell you - so much happens so fast in those first months! We want to help the caregivers of our future little patients know what to do and why.

By the first birthday there will be some teeth to look at, some developmental clues to future issues, and lots of homework to discuss with caregivers. At the first appointment our dentist, Bill, does a thorough examination and answers any questions about the child's history and potential issues.

One of the things that sets us apart from most dental practices is that ALL children see a registered dental hygienist for their appointments. I have been fortunate in my dental hygiene career to have practiced with exceptional pediatric dentists, been employed as a dental consultant for Head Start programs, and presented dental health education for pre-natal classes. Those learning opportunities have helped us create a unique approach to how we work behaviorally and clinically with children in our practice. So when I see a child for their first visit (and for every visit from then on), we are developing a trusting relationship that will help each child not only have a healthier mouth and bright smile, but a positive attitude about going to the dentist.

Besides the examination, oral cleaning and fluoride treatment, the first visit with us is also a 'dental play date'! At this visit and each one after, we work to familiarize each child with who we are, what we do, what they need to do, and why. We make each visit educationally age-appropriate so that we can maximize our impact on what each child takes home and carries forward until we see them at their next visit. Special notes and letters to children reinforce our times together. Our loving and interactive environment builds trust and security, as well as good dental habits.

We look forward to seeing Wesley in 6 months - and working together with his parents to create not only a very bright and positive dental future, but also helping him with a positive attitude about dentistry and good dental health for his entire life!

-- Sharon Kuttler, R.D.H.