Dentists on the frontline – Rachel PointerPromotional Features
Posted by: The Probe 5th January 2018
That people in the UK are getting larger is not news; that most people opt for a DIY weight-loss plan instead of asking their GP for help isn’t either. With so many diets available across all forms of media, including apps, plus traditional slimming clubs, a patient is unlikely to visit a doctors’ surgery until their weight is causing them health complications.
There may be more overweight/obese people than ever before (in England, the proportion of overweight/obese males increased from 57.6% to 67.1% and from 48.6% to 57.2% for females in 2013[i]) but failing to accept that weight gain has become a problem is still common.
When it comes to being overweight/obese, dental practitioners are often the first line of defence. We see our patients routinely, which gives us many opportunities to discuss a weight issue and ascertain if they have sought medical advice. There is also a clear relationship between obesity and poor oral health, so if someone is overweight, management advice must be offered. By striving to do more than keep the mouth healthy from one appointment to the next and by putting dental care in the context of general wellbeing, you will be providing a truly preventative service. A collaborative approach to weight loss, with both the dentist and GP on board, will be long lasting and have a positive impact on patient/practitioner loyalty.
Calculating Body Mass Index (BMI) is the most common way to find out if someone is obese or overweight.[ii] A BMI of 25-29.9 is ‘overweight’ and 30+ is ‘obese’. Treating obese patients is a challenge. Dental visits can be uncomfortable and humiliating, causing them to stay away. In 2015, a practice warned patients who weigh more than 127kg (19st) that they might not be able to be treated due to a weight restrictions on dental chairs.[iii] You must strive to ensure that their entire experience at your practice does not make them feel embarrassed, especially if mobility is a problem. Maybe referral to another practice that is better equipped to help will be necessary, for example, if there are lots of stairs to climb at your premises. Empathy and sensitivity are essential from every member of the dental team.
Obesity can complicate sedation, so you might need support. Also, “the position of anatomical landmarks may be less obvious if surrounded by fatty tissue… It may be impossible to palpate cervical lymph nodes in a large neck. Soft tissues can also make retraction with a normal sized mirror unsafe.”[iv] Reach out to other practitioners for advice and constantly communicate with the patient to make them feel valued.
For patients who are overweight rather than obese, the dental experience may be no less awkward because their dental health is not likely to be good. Caries/erosion are obviously more common with an unhealthy diet that is high in sugar and gastric reflux due to increased pressure on the abdomen also means more harmful acid ends up in the oral cavity. Xerostomia and chronic halitosis can be caused by dehydration if an individual is imbibing too many sugary drinks and/or alcohol instead of water. If a diet is lacking in healing nutrients, such as vitamins A, C and E, plus bromelain and glucosamine, any wounds or infections in the mouth will take longer to heal.[v] It’s not hard to see why an overweight patient may be reluctant to attend, to hear things they know are true – that their nutritional status is poor – but would rather bury their heads in the sand about. Being overweight comes with enough social stigmas so why add to them with a trip to the dentist?
But it’s not just ‘bad’ teeth. Being overweight can predispose a patient to periodontal problems, which can lead to serious issues requiring lengthy treatment and tooth loss. An increased BMI showed an increased risk of periodontitis, especially for females;[vi] more bleeding on probing and greater probing depth are further complications.
Encouraging overweight/obese patients to maintain regular appointments will help to build a relationship that extends beyond you simply being their provider of oral health and allows you to work in tandem with a GP. Home care needs to be reinforced. How to brush properly should be taught and effective adjuncts to compliment a good cleaning routine recommended. Tandex has a full range of high-quality and efficient products, including brushes, interdental brushes, plus mouthwashes for all your patients’ needs.
A sensible body weight is critical for good general and dental health, particularly periodontal health. You must address your patients’ weight issues to help them adopt a better lifestyle. With a variety of problems associated with being overweight, it is time that all dental practitioners embraced their position on the front line in the war against obesity.
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[i] Health & Social Care Information Centre. Statistics on Obesity, Physical Activity and Diet. England 2015. Published 3 March, 2015. Found at: http://www.hscic.gov.uk/article/2021/Website-Search?productid=20797&q=obesity+physical+activity+&sort=Relevance&size=10&page=1&area=both#top (accessed 8 June, 2016)
[ii] NHS Choices. Obesity. http://www.nhs.uk/Conditions/Obesity/Pages/Introduction.aspx (accessed 10 June 2016).
[iii] BBC News. Dentist chair weight limit warning at Maendy practice. Posted 31 July, 2015. Found at: http://www.bbc.co.uk/news/uk-wales-south-east-wales-33730215 (accessed 8 June 2016)
[iv] Reilly D, Boyle CA, Craig DC. Obesity and dentistry: a growing problem. British Dental Journal. 2009 Aug 22;207(4):171-5.
[v] MacKay DJ, Miller AL. Nutritional support for wound healing. Alternative medicine review. 2003 Nov 1;8(4):359-78.
[vi] Dalla Vecchia CF, Susin C, Rösing CK, Oppermann RV, Albandar JM. Overweight and obesity as risk indicators for periodontitis in adults. Journal of Periodontology. 2005 Oct;76(10):1721-8.
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