How holistic can dental care be?
Featured Products Promotional FeaturesPosted by: Dental Design 22nd March 2024
We frequently talk about the importance of ‘holistic healthcare’ in society today. But what does it really mean and how beneficial is it to our patients?
The term ‘holistic’ is defined as ‘the act of dealing with or treating the whole of something or someone and not just a part’. Interestingly, the Cambridge Dictionary definition gives the example of holistic healthcare here.[i]Within the dental world, a holistic approach to care means that we as professionals are considering patients as human beings, making recommendations based on their overall health and wellbeing – not exclusively treating the teeth and gums with no regard for anything else. For some clinicians, holistic dentistry also highlights the importance of minimally invasive intervention, protecting the natural structures and offering treatment in the most progressive way possible.
As an endodontist, this very much aligns with my own values and perspectives in dentistry. I fully appreciate the merits of dental implants as a solution for missing teeth but, wherever applicable, I believe in saving the tooth and keeping it in the mouth for as long as possible before extraction is absolutely required.
In adults, research suggests that 97%, 81% and 76% of endodontically-treated teeth survive for 10, 20 and 30 years, respectively – when patients maintain good oral hygiene and adhere to an adequate recall programme.[ii] Though not all these teeth may have been candidates for dental implants, prolonging the need for implant surgery in just a small number of cases will have given those patients a less invasive solution and saved their natural teeth for decades.
Such an approach is particularly relevant when treating children – dental implants are not yet designed to last forever in the mouth, so prolonging the time at which an implant is placed is essential for young people. Studies have shown 80% of endodontically-treated teeth to survive past 5 years in 15-18-year-olds, with 65% of endodontically-treated teeth lasting this long in 12-14-year-olds.[iii]
Similar principles can be applied in other disciplines too – restorative treatments should start with the most conversative option and work upwards, same for periodontal therapies. Though more difficult, the same concepts should be implemented when it comes to cosmetic dentistry and smile makeovers, perhaps starting with orthodontics to reduce the need for tooth preparation ahead of veneers.
However, holistic dentistry is much more than this. It’s also about prevention and integrating healthcare in a way that helps individuals to improve and protect their overall health and wellbeing. For example, in dentistry we use risk assessments to determine a patient’s chance of developing dental issues and then we guide them towards prevention behaviours. We help them improve their oral hygiene routine, enhance their brushing technique and educate them about the importance of a balanced diet and exercise.
But truly holistic care can’t be restricted to only dental habits.
There have been an increasing number of calls for dentists to consider performing risk assessments and initial screenings for a much wider range of health conditions. Some members of the profession are already integrating these protocols into their patient consultations, for which there are various relatively simple tests available. These include screening systems for BMI, cholesterol, blood sugar levels and blood pressure.
Several advantages exist for implementing such tests. Patients visit their dentist every 6-12 months, meaning they attend far more regularly than they do their GP practice, allowing for more routine checks and therefore faster identification of issues. With significant associations between many of the aforementioned measures and dental disease, this type of screening can help patients to lower their risk of oral health problems with more tailored preventive routines. That is, of course, in addition to increasing the chance of early detection for systemic health conditions.
In a perfect world, such screening would be beneficial for the dental team in that we would gain a more comprehensive understanding of our patients. From here, we could customise recommendations more effectively for better treatment outcomes. Though this is still true, the realities of introducing more tasks to the already busy appointment schedule could add an extra level of stress for many clinicians. Then there is the accessibility of screening tools, the financial responsibility of purchasing associated equipment and the professional liability of how to communicate any abnormal findings. Current tools offer arbitrary results that indicate the need for referral, but as these evolve, do we as dental professionals risk overstepping our clinical remit and how might this impact our dental indemnity?
In no way am I suggesting that the dental team should shy away from such progress. As already mentioned, I am very much a fan of preventing invasive treatments and protecting every patient’s natural anatomy through a holistic approach. But, as is true in every area of dentistry, we must be aware of how we expand our capabilities and the impact of new technologies on our patients and our personal liability. If we get it right, we could be taking some very large and positive steps towards the integrated healthcare that many of us dream about.
For further information please call EndoCare on 020 7224 0999
Or visit www.endocare.co.uk
Dr Michael Sultan Bio:
EndoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist Endodontist practices. Through the use of the latest technologies and techniques, the highly-trained team can offer exceptional standards of care – always putting the patient first. What’s more, EndoCare is a dependable referral centre, to which dentists from across the country send their patients for the best in specialist endodontic treatment.
[i] Cambridge Dictionary. Holistic. https://dictionary.cambridge.org/dictionary/english/holistic [Accessed November 2024]
[ii] López-Valverde, I., Vignoletti, F., Vignoletti, G. et al. Long-term tooth survival and success following primary root canal treatment: a 5- to 37-year retrospective observation. Clin Oral Invest 27, 3233–3244 (2023). https://doi.org/10.1007/s00784-023-04938-y
[iii] Bufersen, S., Jones, J., Shanmugham, J. et al. Survival of endodontically treated permanent teeth among children: a retrospective cohort study. BMC Oral Health 21, 589 (2021). https://doi.org/10.1186/s12903-021-01952-y
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