Brian L. Mealey, DDS, MS, Associate Professor, Dept. of Periodontics, Effective June 2006:
As a periodontist, I see the devastating effects that periodontal diseases can have in ad- Head, Specialist Division vanced stages — loss of teeth, poor esthetics, inability to eat or function well. It’s hard and Graduate Program Director, University to tell a patient that they are going to lose their teeth. Try telling a 25-year-old woman 2 of Texas Health months before her wedding, or your local TV newscaster, whose smile is critical to his business, Science Center at that they are going to lose their front teeth. To some, losing teeth seems to be “no big deal.” To San Antonio, TX others, it has the same effect on the psyche as an amputation or mastectomy would have. In my practice, I also see the efforts that have to be made by my patients to treat periodontal diseases before they reach these late stages, and to maintain oral health over the long-term. It takes money, time, and persistent motivation, things that are often seem in short supply. What helps my patients most? My technical expertise? Probably not. I think what helps them most is education. The patient with knowledge of his disease is the easiest patient in the world to work with, and the one most likely to have successful outcomes.
I do not have periodontal disease, but I do have diabetes. When I was first diagnosed over 20 years ago, I went through the same thing every other newly diagnosed patient goes through. If you don’t have this disease, you can’t really understand it. Believe me. The mental images that confronted me as I first learned about my diabetes were stark: images of my young family without their father, or of them having to drive Dad to the dialysis center every other day, or the black emptiness of blindness before my eyes as my daughter’s wedding march is played. Over the past 20 years, this picture of doom has been replaced by one of... sameness. My life is the same kind of life as my non-diabetic wife, kids, friends, and colleagues have. Yes, I use an insulin pump that can be a pain in the neck. Yes, I have my moments when I still feel sorry for myself over the inconveniences that my diabetes causes. But overall, I’m pretty much the same as you are. Having the greatest doctors in the world has been a huge part of that for me. So has technological evolution. But most importantly, so has education. Learning about diabetes and having a sound knowledge base has been my best weapon in the fight.
Education is what we do every day. Physicians, dentists, dental hygienists, nurses and other healthcare providers must accept responsibility for establishing and maintaining a current knowledge base in order to help their patients along the path to health. What we know today about the relationships between diabetes and periodontal diseases means absolutely nothing if that knowledge is not disseminated throughout our professions and to our patients. We know that the oral cavity is a source of inflammation that can have effects extending well beyond the boundaries of the lips and the posterior oropharynx. As a profession, we simply must get ourselves out of the days where the mouth was considered a disembodied part. The historical legacy of the barber-dentist must end.
I recently attended a continuing education course with my wife, who is a nurse. The course, given by a neurophysiologist, was on the inflammatory nature of obesity, diabetes, and Alzheimer’s disease. Toward the end of the course, the speaker spent 30 minutes discussing periodontal diseases and their associations with these other conditions. I imagine I was the only dentist in this audience consisting of over 100 physicians and nurses, and I was pleased to hear the outstanding questions from those in attendance. It was clear that for most in the room, this was the first time they had heard of the oral condition, periodontitis, being associated with systemic conditions like diabetes. What was encouraging to me was that the audience had no difficulty making the link, once they understood the inflammatory nature of periodontal diseases.
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