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Flossing and systemic health

March 22, 2010
DentistryIQ recently had the opportunity to interview Robert Pick, DDS, a periodontist in Chicago, about the impact flossing has on overall health.
By Vicki Cheeseman, Associate EditorDentistryIQ recently had the opportunity to interview Robert Pick, DDS, a periodontist in Chicago, about the impact flossing has on overall health.DentistryIQ: Dr. Pick, what other ailments besides cavities are patients at risk for if they don’t floss?Dr. Pick: If patients don’t floss, the No. 1 ailment they are likely to get is periodontal disease. It will start as gingivitis, affecting only the gum tissue, and often ends up as periodontitis involving both the gum and bone. Interestingly enough, from new studies we know that patients who do not floss are often more susceptible to inflammation of the gum tissues. This, in turn, can be linked to inflammation often associated with cardiac disease.DentistryIQ: Explain the current philosophy about the link between gingivitis and oral-systemic health.Dr. Pick: Gingivitis and periodontitis, a more aggressive form of the disease, are directly linked to oral-systemic health issues, specifically cardiac disease and low-birth-weight babies. With cardiac disease, inflammation is the factor linking the two. Here is some interesting information for you: Cardiovascular disease, the leading killer of men and women in the United States, is a major public health issue contributing to 2,400 deaths each day. Periodontal disease, a chronic inflammatory disease that destroys bone and gum tissues that support the teeth, affects nearly 75% of Americans and is the major cause of adult tooth loss. And while the prevalence rates of these disease states seems grim, research suggests that managing one disease may reduce the risk for the other. A paper published in both the Journal of Periodontology and the American Journal of Cardiology this past July 2009, which has all of the above findings, also will now open the door for cardiologists to examine the patient’s mouth more closely and for periodontists to ask more questions relating to heart health and family history of cardiac disease. Although the exact mechanism is not known, it is thought that the infection and inflammation associated with periodontal disease is a factor in low-birth-weight babies according to multiple studies that have been conducted and published in referred scientific journals. Controlling periodontal disease early in a pregnancy, if not before, is advisable. Further, it is a well-known fact that when women become pregnant, they are also at risk for what we call pregnancy gingivitis. It does not happen to all women but a fair number of pregnant females due to hormonal changes. Their gum tissues become highly inflamed, bleed easily, and if left untreated can lead to loose teeth and/or loss of teeth. Pregnant women should be watched closely. It is this periodontist’s recommendation that pregnant women get their teeth cleaned every three months during the pregnancy and for the first four months postpartum. DentistryIQ: What do you do in your practice to encourage patients to floss?
Dr. Pick:
In our practice, our preventive phase of treatment is extremely important. At the initial visit, all of our doctors emphasize the importance of prevention. A surprise to most people is the frequency of cleanings. With some patients, the standard two-times-a-year cleaning is sufficient. However, in a fair number of patients — especially those who have been through periodontal treatment — every three months (four times per year) is the standard frequency of cleaning. Believe it or not, the “see your dentist twice a year” recommendation is from a toothpaste commercial dating back to the 1950s with no scientific basis! All of the large, evidence-based studies clearly show the every-three-month frequency. DentistryIQ: What is the most common excuse you hear from patients who don’t floss?
Dr. Pick:
The most common excuses I hear are: “I don’t have time,” or “I know better but it takes too long and I never did it as a child, and therefore it has never become a habit.”DentistryIQ: Is there a particular technology that helps you most to highlight problem areas in the mouth for patients?
Dr. Pick:
There is not a particular technology but a combination of technologies that, when used together, yield a great educational experience for our patients to show them what is wrong and/or diseased in their mouths. This includes a traditional dental exam with the use of a periodontal probe — a small, relatively painless, thin measuring device that allows me to spot various clinical forms of periodontal disease. All dentists should be using this device for exams. In addition, a full diagnostic set of dental X-rays should be taken. This usually involves 20 or 21 small dental radiographs taken every three years. Bitewing X-rays are not a diagnostic set. In addition to the above, my teammates and I take clinical pictures of all new patients with a digital dental camera. This often involves 10 to 20 photos. After the clinical examination, I can bring my patients to an educational room or show them right there at chairside their actual condition using a PowerPoint or Keynote presentation. We can also do before-and-after computer imaging and actually show patients what they will look like after treatment. Let’s say someone has a space between his or her two front teeth, the teeth are short and discolored, and the patient has too much gum tissue. By using pre-photos and computer imaging, I can show that patient within a fair degree of certainty what he or she will look like after treatment. Patients are often amazed and further surprised by the condition of their mouths. We can also go as far as to send a patient who is in need of implant surgery for a special type of CAT scan of the jaw. The CT scan is then uploaded into software that allows me to do a virtual surgery right there on the computer in real time. I can look at the patient’s jaw in 3-D and even rotate the jaw and look from positions that you cannot do clinically. I can save the surgery, and by computer imaging get guides so I can duplicate the implant surgery in the mouth that I accurately did on the computer! The technology is truly amazing and brings dentistry into the 21st century.DentistryIQ: How do you think general dentists can work with dental specialists and physicians to address the oral-systemic link more effectively?
Dr. Pick:
General dentists have always been involved and will continue to be. With some of these new, highly important correlations between periodontal disease and cardiac disease, it is important that patients with periodontal diseases who need treatments beyond the scope of that particular GP be referred early and appropriately to a periodontist.DentistryIQ: How can dentists get the word out better to the general public that flossing affects overall health much more than we think?
Dr. Pick:
Getting the word out there is key. This will be done through avenues just like this in the media. In addition, each practice will have to evaluate its protocols for patient education.DentistryIQ: How is your team involved in helping the dentists of your practice get the word out about the dangers of not flossing?
Dr. Pick:
Since we are a team in the true sense of the word, we have a very special, tailored periodontal program for each individual patient. DentistryIQ: Tell us about your dental specialty.Dr. Pick: My dental specialty is periodontics; it is one of the two surgical specialties of dentistry. I completed a residency in the specialty, which is a three-year training program after dental school. In addition I did my Master’s Degree in oral pathology at the same time. I deal with treating diseases of the gums and bone, and I place dental implants and their associated additional procedures including sinus elevation surgery, bone grafting, ridge augmentation procedures, and soft-tissue grafting. I do root coverage grafting, what we call esthetic crown lengthening and functional crown lengthening procedures, and a whole host of laser procedures. I also perform biopsies and removal of oral lesions and tumors. I am big on minimally invasive and microscopic procedures when applicable. Finally, there are a group of nonsurgical procedures that I do when I can. DentistryIQ: Describe your dental practice.Dr. Pick: My practice is actually an “our” practice. I am part of a wonderful team that practices together at Manus Northwestern Oral Health Center. We are the former faculty practice of Northwestern University Dental School, and we have privatized and grown to be the best of the best! I work with seven wonderful general dentists, a prosthodontist, an orthodontist, an endodontist, and a pediatric dentist. Together we form a team of GPs and specialists. Because of this we operate more like a medical team, and our patients never have to leave the facility. It makes for easy communication, and the end result is our patients get the best care there is.DentistryIQ: Where is your practice located?Dr. Pick: We are located in Chicago on North Michigan Avenue. We are in the center of what is referred to as the Magnificent Mile, and we are one block from Northwestern University Medical School and Northwestern Memorial Hospital. Our office is in the Professional Tower of a hotel, hence our out-of-town patients who travel to see us can stay at a discounted rate right in the building.DentistryIQ: Dr. Pick, thank you for your time.

Dr. Robert Pick received his dental degree in 1980, Certificate of Residency in Periodontics in 1982, and his Master of Science Degree in 1982, all from Northwestern University Dental School. At graduation he was awarded the Outstanding Student in Periodontics from the American Academy of Periodontology. Dr. Pick is currently engaged in the full-time private practice of periodontics and implants in Chicago. He is also a member of the attending staff of Northwestern Memorial Hospital and a clinical associate professor of surgery at Northwestern University Medical School. Dr. Pick is a fellow in both the American and International College of Dentists. A popular lecturer, Dr. Pick presents programs both nationally and internationally on practice management/motivation, periodontics, and implant dentistry. He has published numerous articles in the scientific literature, authored and co-authored numerous chapters on periodontics, implants, and lasers for various textbooks, and co-edited and wrote the text, "Lasers in Dentistry." Dr. Pick has been featured on live, closed-circuit TV programs at the Chicago Dental Society and the Hinman Dental Meetings. He is recognized by Dentistry Today as one of the top Leaders in Continuing Education. Dr. Pick was the recipient of the 1998 Gordon J. Christensen Outstanding Lecturer Recognition Award. Most recently he has been included in the premiere issue of The Best Dentists in America, which is peer-reviewed. He is a member of the O.K.U Honors Dental Society and the Pierre Fauchard International Dental Honors Society. Dr. Pick is an official spokesperson for the American Dental Association on implants, periodontics, and lasers. He has frequently been featured in the broadcast and print media. In his spare time, Dr. Pick is a commercially rated pilot, an avid guitar player and guitar instructor at the world-renowned Old Town School of Music, a model railroader, and a collector and restorer of Classic Corvettes.