By Maxine Wehling, RDH
Many hygienists have profound experiences in the clinical setting. I wish to share a recent example that involved a young woman, Charlotte Wise, who came to our dental office this past summer. Her story illuminates the influence we have in our patients' lives.
To impact not only oral health but total health, dental hygienists have the unique opportunity to change the lives of the patients they serve. The correlation between periodontal disease and systemic conditions is well documented. As part of a comprehensive periodontal program, the incorporation of specific laboratory tests further strengthens the link between oral and systemic health.
When a diagnosis of periodontal disease is made, two specific laboratory tests may be used. Prior to initiation of periodontal therapy, the patient is asked to complete blood work. The C-reactive protein test, also known as CRP, measures the patient's level of inflammation in the body. Periodontal infection may elevate CRP levels. CRP is a general marker of infection and inflammation that alerts dental and medical professionals when further testing is indicated to determine conditions beyond periodontal disease. These may include heart attack and stroke risk, cancer, rheumatoid arthritis, lupus, as well as other conditions. The ultra-sensitive CRP is measured in mg/l, and a range is given on the pathology report for relative risk for future cardiovascular events with the following categories: low < 1.00, average 1.00 to 3.00, and high > 3.00.
To assess a periodontal patient's risk of diabetic complications, testing for glycated hemoglobin should be evaluated. Glycated hemoglobin, also known as HbA1c, refers to a series of stable hemoglobin components formed by the combination of glucose and hemoglobin. Because hemoglobin components are stable, the level provides an average indication of overall blood glucose levels over the prior two- to three-month period. The patient does not need to fast prior to the HbA1c evaluation. The test is shown in percent total hemoglobin, with a normal range of 4.50 to 5.70.
These lab tests were part of our comprehensive periodontal program when Charlotte Wise came to the dental office in July 2005 to have a symptomatic tooth evaluated. A young woman in her mid-thirties, Charlotte presented with moderate to advanced periodontal disease. Her HbA1c test was 4.80, within the normal range. The CRP value, however, was reported at 97.60. Charlotte was notified to contact her family doctor with the lab report. It was determined, with further testing, that Charlotte had Stage 3 lymphoma. She began chemotherapy the following week. Charlotte credits her dental visit with saving her life. As of this writing, Charlotte is at the halfway point of her chemotherapy treatment and seems to be responding well.
It is my hope that this story will inspire other clinicians to continue to improve their patients' awareness of overall health. The life that you help to save is worth the extra effort.
Maxine Wehling, RDH, can be contacted at Maxine Wehling. She is a 2005 recipient of the Sunstar Butler/RDH Award of Distinction and has served many public relations efforts on behalf of dentistry in her home state of Nebraska.
