From Reactive to Proactive Dentistry

Time is a critical factor in dentistry that can significantly influence a patient’s treatment experience, often determining the outcome and overall cost of care. The scenario of a patient experiencing tooth or jaw pain but delaying a visit to the dentist highlights the profound impact of time on oral health. There are different scenarios in which a patient may delay seeing the clinician, including but not limited to the following:

One common reason for delaying dental visits is potential anxiety. Many individuals experience fear or apprehension associated with dental appointments, leading them to postpone seeking professional care. Unfortunately, this delay can allow minor dental issues to progress into more significant problems.

Financial constraints often play a role in patients postponing dental visits. Concerns about the cost of treatments may deter individuals from seeking timely care. Paradoxically, delaying treatment due to financial reasons can lead to more substantial expenses eventually as conditions worsen.

The fast-paced nature of modern life and busy schedules also can contribute to delayed dental visits. Individuals may prioritize work, family, or other commitments over their oral health. This postponement may result in the exacerbation of dental problems that could have been addressed more effectively with timely intervention.

Unfortunately, this patient does not realize that the pain may worsen over time until few or no options remain. Dental pain, in the case of this fictional patient, can be a sign of underlying issues such as cavities, infections, or gum disease. When patients ignore or delay addressing this pain, the condition may worsen. What initially might have been a manageable concern can escalate into a severe and debilitating problem. It may get so bad that a tooth must be removed, which will be far more costly overall than if the patient had visited a clinician when the pain began.

This is an example of the complications that proactive dentistry can mitigate. Proactive dentistry, with its emphasis on preventive measures, underscores the importance of addressing dental issues early. Regular checkups, treatment planning, and sufficient patient education may enable dentists to identify and treat problems in their initial stages, preventing the need for more extensive interventions later. So, how does one take a dental practice from being reactive to proactive?

Technology Guides Prevention

What might be the most obvious starting place, and the most vital, is taking stock of the dental practice’s armamentarium. A good armamentarium should aim to make the practice more efficient, offer more diverse treatment options, and become more clinically effective.

“Reactive dentistry typically means waiting until there are symptoms of a problem, [whereas] preventive dentistry includes employing strategies that can help prevent ever having a problem in the first place,” says dental hygienist Sarah Crow, RDH.

Crow has been a dental hygienist since 2005 and works at Salem Dental Arts in Massachusetts. She is a United States Guided Biofilm Therapy (GBT) trainer at EMS Dental as well as a senior executive consultant with the Cellerant Consulting Group. Crow is a vocal supporter and avid proactive clinician, aiming to keep her patients’ oral health at the forefront of the conversation. Crow insists that it is on the practitioner to take charge of their patient’s oral health journey.

“Dental technology is advancing rapidly, but you won’t see it if you’re not looking for it. Dental professionals have the responsibility to embrace lifelong learning. This requires taking action to learn about the latest and greatest in the field,” Crow says. “Our patients deserve to have access to these new technologies and it’s up to us as dental professionals to stay on top of the latest science.”

Cellerant offers clinicians valuable insight on products and technologies that demonstrate value in the dental practice. “Each year the Cellerant team collaborates on the latest technologies in the market and votes to award these dental product companies with the ‘Oscar of Dentistry,’ ” Crow says. “This nonprofit, unbiased team volunteers their time, seeking out top-tiered emerging and tried-and-true technologies to be recognized for their outstanding products.”

Technology is a key factor in the dental practice and an even more valuable tool in the preventive arsenal, according to dentist and Viome Scientific and Business Advisory board member Ed Zuckerberg, DDS, FAGD. “Advancements in dental technology, such as those introduced by Viome, are pivotal in transitioning dentistry from reactive to proactive and preventive. Thanks to technologies like digital imaging and saliva-based diagnostics, early detection tools and personalized treatment plans are now possible,” Dr Zuckerberg says. “These advancements allow for more precise, less invasive, and personalized care. They enhance patient education and engagement, promote continuous monitoring, and facilitate a comprehensive understanding of oral systemic health.”

Viome has a variety of dental products designed to protect and strengthen the “oral microbiome,” as it is described on the company’s website.¹ One such technology offered through Viome is its Oral Health Pro.

“Viome’s Oral Health Pro with CancerDetect™ uses proprietary RNA sequencing technology and AI [artificial intelligence] to detect early signs of oral and throat cancers from a simple saliva sample. These technologies enable dental professionals to identify and address issues long before they become visible to the naked eye or cause symptoms, facilitating early intervention and preventing progression,” Dr Zuckerberg says.

The at-home saliva test is said to empower patients to take charge of their own oral health journey, with specialized plans that aim to personalize care, according to Dr Zuckerberg. “Advancements in dental technology allow for more personalized and effective treatment plans. For instance, Viome’s technology analyzes the gene expression of the oral microbiome and human cells, providing insights unique to each individual’s oral ecosystem,” he says. “This level of personalization means that dental professionals can tailor prevention and treatment strategies to the specific needs and risks of each patient, leading to better outcomes and more efficient care.”

The thesis of proactive dentistry is just this—early intervention coupled with personalized treatment plans that allow the clinician (and the patient) to detect and prevent any issues before they become serious problems. Because preventive care is so intrinsically tied to hygiene, hygienists also are potential advocates for proactive dentistry. Per Crow, there are a plethora of products and technologies that hygienists can harness to function as preventive guardians.

Importantly, the GBT protocol from EMS Dental is a minimally invasive methodology that aims to make the patient more comfortable while effectively assessing teeth and gums for biofilm. GBT moves through a variety of steps, outlined on their website²:

1. Assess teeth and gingiva for any issues after a rinse with mouthwash.
2. Disclose to patient by making the biofilm visible utilizing the EMS Biofilm Discloser.
3. Motivate the patient by reinforcing the importance of good oral hygiene and prevention.
4. Use the AIRFLOW® series to remove biofilm, stains, and early calculus. Also remove biofilm from gingiva, tongue, and the palate.
5. Use PERIOFLOW® nozzle to remove biofilm in pockets greater than 4 to 9 mm.
6. Remove the remaining calculus using the PIEZON® series of instruments.
7. Do a final biofilm check.
8. Schedule the patient’s recall and see whether they liked the treatment.

Crow is a proponent of and an expert on GBT protocol, training clinicians in the United States on how to effectively implement this protocol in the dental practice. “What is the hygienists’ biggest battle in their workday, you ask? It’s time. Racing the clock to meet each patient’s needs every hour on the hour can be exhausting, leaving hygienists feeling burnt out and unsatisfied,” Crow says. “The GBT protocol allows hygienists to have more time during their appointments to employ preventive dental technologies. This painless approach relaxes patients, which helps lead them to agree to more frequent recare appointments and reenergizes the hygienist’s passion for their work.”

Another technology that Crow finds notable is VoiceWorks, a voice-activated periodontal charting software that lets clinicians share results with the patient, further reinforcing confidence in the treatment. According to Crow, this tool is a game changer.

“Allowing the patient to hear their probing results from a ‘third party’ validates the hygienist’s findings. This technology is a data-driven approach to evaluating the efforts set forth by the patient and assists in setting individualized recare frequencies based on these results,” she says. “This method allows for a comprehensive periodontal evaluation to be completed by a solo practitioner, and a resource to refer to from future appointments to gauge if the preventive treatment plan is working.”

Creating a preventive treatment plan can be challenging if the practitioner does not have a complete look at the patient’s tooth structure, gingiva, and whole mouth. That is why imaging technology like the CALCIVIS®Imaging System comes highly recommended by Crow, aiming to eliminate subjectivity and anxiety when it comes to proactive care.

The CALCIVIS Imaging System harnesses the power of bioluminescence to visually demonstrate the release of calcium ions from demineralized tooth surfaces. The practitioner takes an image of the tooth surface using the device, which contains an LED light. Once the LED is turned off and the CALCIVIS photoprotein is sprayed on the surface, the clinician then takes another image of the bioluminescence that is generated between the photoprotein and the calcium ions. This gives practitioners a first look, before even visual defects are observed, at any problem areas on the patient’s tooth, whether it be occlusal, labial, buccal, or lingual.³

“The CALCIVIS Imaging device helps to bring those blurred lines into focus when it comes to preventing caries,” Crow says. “For patients to value and comply with preventive approaches, they need evidence that preventive treatment is necessary. A wise woman once said, ‘The mind can’t know what the eye can’t see.’ This could not be truer when it comes to our patients. Utilizing technology such as this reinforces the need for remineralizing varnishes and other interventions to aid in the stability of sound enamel structure.”

Imaging technology, particularly innovative solutions like CALCIVIS, holds immense potential in propelling dental practices toward a proactive approach to oral health. As dentistry evolves, these advanced imaging tools offer a transformative avenue forward, enabling practitioners to detect, diagnose, and address dental issues in their early stages.

Even something as straightforward as an intraoral scanner can fulfill proactive measures, acting as a strong visual aid for detecting any underlying problems. “Modern dental technologies also play a critical role in patient education and engagement. Intraoral cameras and digital scans allow patients to see and understand their oral health conditions, making them more likely to engage in preventive measures,” Dr Zuckerberg says.

A comprehensive report, consolidating various components of dental care like preventive strategies and risk assessments, serves as a valuable tool for patients and practitioners. This report harbors crucial information, findings, and recommendations, fostering a collaborative approach to oral health management that the patient may find empowering, according to Dr Zuckerberg. “Additionally, platforms like Viome provide detailed, accessible reports that help patients understand their oral health status and the steps they can take to improve it, fostering a proactive approach to their own health,” he says.

Empowering Patients for Their Own Preventive Paradigm

Although a patient may trust their practitioner as a source of information and care, there are many patients who can experience a sense of distrust and fear about dentistry. It can be normal to feel a bit of anxiety concerning the health of one’s mouth and body, but certain patients will shut down at the thought of listening to and even visiting the dentist. According to a study published in Dentistry Journal, there are a variety of reasons why a patient may not trust their practitioner.⁴

Although building trust or confidence may feel like a monumental task, there are little steps that practitioners may take inside and outside of the operatory to encourage patients to take initiative on their own proactive oral health journey. This may begin by having more conversation with the patient, according to Crow.

“Motivational interviewing and asking open-ended questions help the patient to have that ‘aha’ moment. When they answer their own questions with the hygienist’s nudge and feel like they figure it out themselves without being told, it allows space for the patient to be a part of the conversation during their hygiene visit,” she says. “Most people don’t like to be told what to do but giving evidence of disease and allowing the patient to come to their own conclusions lessens the blow. For example, if you have a patient in your chair with generalized gingivitis, who you know is not brushing properly, do not tell them so. Applying a disclosing agent and letting the patient see with their own eyes the bacteria that is growing in their mouth allows them to put the pieces of the puzzle together, and realize they have control.”

Because home care is so key in prevention, Crow suggests that some of these conversations with patients focus on the home care aspect because it is something over which the patient has more control. “Detailed documentation of their current home care regimen and professional suggestions allow the hygienist to follow up on how the patient has been doing with their home care routine,” Crow says. “Noting the patient’s most recent home care efforts and relating this to the results of their assessments gives the patient the satisfaction of knowing that what they are doing is either working or not working. This in turn can motivate the patient to continue or modify their proactive oral care habits.”

Good home care is crucial in protecting gingiva, preventing biofilm buildup and caries, and empowering patients to feel in control of their oral health journey.⁵ Alternatively, prevention inside the practice can be bolstered by a tool that continues to be a huge boon in health care: AI. AI can provide patients with the supplementary evidence that they may need regarding their oral health care journey, according to Dr Zuckerberg. Although they may trust their dentist, seeing an intelligent machine reach the same conclusion can only reinforce this trust and encourage proactive dentistry.

“The true revolution comes with the integration of AI. AI’s ability to learn and adapt rapidly means that with every new sample analyzed, the system becomes more sophisticated and more nuanced in its understanding. This continuous learning process enables a level of precision and personalization previously unimaginable. AI doesn’t just analyze data; it discerns patterns, predicts outcomes, and recommends preventive measures, making it an invaluable tool in proactive dental care,” Dr Zuckerberg says.

“Moreover, as AI technology continues to advance, its potential applications in dentistry expand,” he adds. “From predicting the progression of periodontal disease to customizing treatment plans for individual patients, AI is empowering dental professionals to take a more informed, proactive approach to care. The result is more effective prevention, more timely interventions, and ultimately better overall health outcomes.”

Viome’s approach to analyzing the human oral microbiome is a pioneering fusion of advanced RNA sequencing technology and powerful AI algorithms. By combining these innovative technologies, Viome aims to provide a comprehensive and detailed understanding of the complexities within the oral microbiome. This innovative approach not only enhances our understanding of the microbial community in the mouth but also empowers practitioners to take proactive measures in oral care.

“The power of RNA sequencing lies in its ability to provide a detailed look at the active, functional components of the oral microbiome. This allows for the detection of early biomarkers for conditions such as oral and throat cancer well before they manifest into more serious issues,” Dr Zuckerberg says. “Viome’s precision sequencing captures a comprehensive snapshot of the microbial and human gene expression, providing unprecedented insight into a patient’s oral health.”

Proactive care begins at the intersection of technology and patient participation, according to Dr Zuckerberg. “[AI is] redefining the very possibilities of what can be achieved. It’s a testament to the power of modern technology to improve lives and a clear signal that the future of dentistry is proactive, personalized, and preventive,” he says. “As dental professionals, embracing these advancements is not just an opportunity; it’s our responsibility to our patients and the future of health care.”

Avoiding Reactive Pitfalls

Although a dental practice may never be able to go truly proactive, there are ways to avoid falling back on reactive old habits. These may begin with recognizing when you are engaging in a proactive treatment plan vs a reactive one.

Reactive dentistry is what we know well, from fillings to root canals to even surgery and/or extraction. These treatments and cases are vital. Proactive care does not seek to discourage patients from getting important care, but instead asks whether something is preventable.

“By focusing on early detection, risk prevention, and the maintenance of optimal oral health, proactive dentistry not only ensures better oral health outcomes but also contributes to the overall well-being of the patient,” Dr Zuckerberg says. “On the other hand, reactive dentistry typically involves treating problems after they have manifested, often requiring more complex and invasive treatments. Proactive dentistry fosters trust and loyalty in patient relationships and aligns with the broader health care shift toward preventive care.”

Shifting to a “proactive-first” mindset instills more confidence in the dental practice, from the dentists to hygienists and even patients. Being equipped with the tools to function as a shield is what proactive dentistry is all about. And even in situations where dentistry must be done in a reactive way, clinicians still can set the groundwork for more proactive dentistry in the future.

“A reactive patient typically has had nonexistent or negative past dental experiences that give rise to their current condition. This type of patient’s mentality is often more difficult for the dental team to ‘undo’ and often requires a careful choreograph of words to help the patient value their dental health and guide them to an understanding that their oral health is within their control,” Crow says. “It’s important for a dental professional to embrace a proactive mindset because, as we know, most dental issues are completely preventable. As dental professionals we must remember the oath we so proudly proclaimed on our graduation day. This was to ‘improve the oral health of the public’ and that ‘prevention is preferable to cure of disease.’ ”

A Proactive Rising Tide Lifts All

As mentioned by Dr Zuckerberg, health care has been at the forefront of proactive care, with regular, vital checkups that doctors can use to get a comprehensive view of a patient’s health. Pulling from general practice in health care, dental professionals can also engage in more proactive care. The oral-systemic link demonstrates that what happens in the mouth can reflect what is going on in the rest of the body.⁶

Bacteria in the mouth like Porphyromonas gingivalis is linked to a variety of systemic illnesses, according to Dr Zuckerberg, including cardiovascular disease, diabetes, dementia, and rheumatoid arthritis. There are abundant benefits of the collaboration between oral health professionals and doctors, according to Dr Zuckerberg.

“As a dental professional, I am deeply invested in the seamless integration of technology into dental care. I am a staunch advocate for a collaborative, multidisciplinary approach to health care,” he says. “Fully aware of oral health’s significant impact on overall systemic health, I am committed to actively promoting a holistic approach to preventive care.…This awareness lays the groundwork for a collaborative approach, ensuring that each specialist appreciates the significance of their role in the broader context of the patient’s health.”

Although collaboration may seem easier said than done, a variety of tools and programs exist to ensure this gap has shrunk. “Attending health care seminars outside of dentistry and inviting these health care professionals to sit on dentistry’s professional associations’ board of directors can bring an outside perspective and provide insights in an otherwise uncharted territory,” Crow says.

The integration of diagnostic tools in the realm of health care not only enhances the understanding of a patient’s condition but also revolutionizes communication among health experts. This transformative shift, coupled with secure channels for information sharing, creates a new avenue for collaboration and enables comprehensive discussions about a patient’s health. This is particularly evident in dental practices where diagnostic tools play a crucial role in showcasing the intricacies of oral health and its potential impact on systemic well-being.

“I fervently champion the use of advanced diagnostic tools. Innovations like those pioneered by Viome provide profound insights into a patient’s oral and overall health, enabling more precise and personalized care,” Dr Zuckerberg says. “By sharing these insights and methodologies with fellow health care professionals, we cultivate a more comprehensive understanding and treatment plan for the patient.”

References

1. Oral health solutions. Viome. Accessed January 15, 2024. https://www.viome.com/products/oral-health-solutions
2. Guided biofilm therapy. EMS Dental. Accessed January 15, 2024. https://www.ems-dental.com/en/guided-biofilm-therapy
3. Where nature and technology meet. Calcivis. Accessed January 15, 2024. https://calcivis.com/#nature-and-technology
4. Moore R. Trusting the dentist—expecting a leap of faith vs. a well-defined strategy for anxious patients. Dent J (Basel). 2022;10(4):66. doi:10.3390/dj10040066
5. Czwikla J, Herzberg A, Kapp S, et al. Effectiveness of a dental intervention to improve oral health among home care recipients: a randomized controlled trial. Int J Environ Res Public Health. 2021;18(17):9339. doi:10.3390/ijerph18179339
6. Oral-systemic health. American Dental Association. Updated September 11, 2023. Accessed January 15, 2024. https://www.ada.org/en/resources/research/science-and-research-institute/oral-health-topics/oral-systemic-health