"Fluoridation, improved education, emphasis on prevention and more competition have resulted in a decline in the dental business. New dentists now often work in several different offices just to have enough to do. A recent U.S. study found that people are getting half the number of fillings per capita they did in 1959, but are four times more likely to go to the dentist."

To me, this is a prime indicator of our success as a "health" profession, because we have actually reduced the incidence of dental disease through patient education in the benefits of regular preventive care. By helping patients to deal with causes, rather than just simply treating the effects, we have increased their health and their use of both preventive checkups and cosmetic restorative services. Why do you think dental professionals are so highly respected? Obviously, one of the symptoms of professional integrity is " . . . the provision of exemplary oral health services and promotion of the [patient's] attainment of optimal health . . . ," the prime directive in the vast majority of dental practices.

While placing patient health first, even when it could potentially reduce financial gain, is commendable, it poses problems to those practitioners that see a dramatic reduction in the incidence of dental disease as a threat to their livelihood. This is the "conundrum" the many professionals must unravel if their practice is going to remain viable into the 21st Century.

The first step in solving the problem is a matter of perception. Is our success in the reduction of dental disease a stumbling block to the profession or a stepping stone to greater opportunities?

"OUT OF THE DARKNESS, INTO THE LIGHT"

The History of dentistry as a profession was born out of the need to treat the ravages of dental disease. "Spreading cellulitis, loss of eyes, facial paralysis and disfigurement were all too common [at the turn of the century]. [The cause of dental disease was not clearly understood, and if you can't eliminate the cause of the problem, then you eliminate the things involved in the problem.] Full-mouth extractions and full dentures were the order of the day." Out of necessity, dentistry was disease treatment based, with an emphasis on palliative care.

In the late nineteen fifties, clinical research into the etiology of dental disease began to reveal many of the causative variables in the chain of dental disease and the ground work for preventive dentistry was solidified. In 1967 fluorescein plaque disclosing systems were developed for patient education and to accurately monitor patient oral hygiene.

Dental materials research, has made dentistry even more efficient at treating the effects of dental disease, and the study of oral bacteriology, and nutritional biochemistry and metabolism, has made the possibility of eliminating the underlying causes a reality.

DENTISTRY'S AS YET UNTAPPED POTENTIAL

The Mouth is an excellent diagnostic window on total health because it is the gateway to the human body. It is our greatest challenge to translate its diagnostic potential into a bright future for dentistry in its leadership role as a primary "health" care profession. The effect of various diet patterns on oral hard and soft tissue relationships is one of the keys to understanding the role nutrition plays in optimizing health, for the betterment of both the profession and patients alike.

"Health is not just a symptomless state; it has both depth and strength to it." - WKH

HomeTop

POSITIVE HEALTH INDEXING AND NUTRITION PROGRAM FOCUS
William K. Hettenhausen DDS

Because the medical model for our health care system tends to focus on the segment of the population with acute health problems in need of intervention, experience with patients seeking regular preventive care is very limited. Often people who think they are healthy do not perceive they have a need for medical attention.

In order to gain information on the healthy segment of society, information on their lifestyles and diet patterns is essential.

To collect positive health assessment information, people who feel they have excellent health should be encouraged to participate in a Healthy Lifestyle Assessment Program.

Positive Health Indexing is will provide a database for health lifestyle information to be shared with all members of the community.

Healthy individuals or families with very healthy lifestyles, (meaningful lives, loving relationships, and successful careers etc.), should be given the opportunity to share "how they got so healthy" by participating in a healthy lifestyle indexing program. In return for their help in providing lifestyle information, they would enjoy an example of a health centre prepared (balanced and cost-efficient) meal and receive their positive health index and personal health report.

Community members with extraordinary levels of health will be encouraged to join a healthy lifestyles role model program for youth.

The high level of dental health awareness in Thunder Bay, manifests in the regular use of preventive dental services, and a decreasing incidence of recurrent dental disease. It clearly demonstrates that an investment in public education and the communication of positive health values increases the level of community dental health and the diet patterns that support it.

It is interesting to note that "When the gateway of the body gets healthy, the rest of the body tends to follow suit!" WKH

"PREVENTION IS THE BEST PROTECTION"

"HEALTH MAY NOT BE EVERYTHING,BUT WITHOUT IT, EVERYTHING MIGHT AS WELL BE NOTHING" Anon.

HomeTop

COURSE DESCRIPTION

This one day course is designed to encourage health professionals and educators to adopt a preventive approach to teaching dental health and nutritional awareness. It stresses the importance of self-care, the benefits of regular checkups and teaches participants the psychology of helping others to put maximum distance between themselves and the possibility of disease. It is a refreshing health and wellness approach that can easily be translated into the office or school environment at all levels. This presentation is of special interest to health-oriented practitioners concerned with interceptive health assessment and diagnostics.

CLINICIAN: WILLIAM K. HETTENHAUSEN, D.D.S., received his Doctorate in Dental Surgery from the University of Toronto in 1972, and is the recipient of the Canadian Oral Prophylaxis Gold Medal, and the Hugh Alexander Hoskin Award for the highest standing in Oral Diagnosis. He is a general practitioner in Thunder Bay, Ontario, and is the Executive Director and Founding Officer of the "Your Teeth For a Lifetime Foundation". His practice is limited to consultation, diagnosis, teaching primary prevention, and diet analysis, by referral only.

This course involves 7 hours of instruction and is recommended for all dental health professionals, community health nurses and educators.

COURSE OUTLINE

Morning Session: "Your Teeth For a Lifetime"

A Preventive Dentistry Slide and Lecture Presentation

Over 60 intra-oral slides are accompanied by an in-depth lecture on clinical prevention based on a thorough understanding of the chain of disease. It spans more than eighty years of dentistry and illustrates the minimum requirements for sustained oral health. The entire presentation stresses the practical nature of prevention and its adaptation to any education based program.

Afternoon Session: "Nutrition For All Ages"

A Lecture Presentation on Dietary Analysis and Nutrition in Dentistry

Over 270 full family interviews and 2,500 individual quantitative and qualitative dietary analysis have led to the synthesis of an effective nutritional approach to preventive dentistry. This is probably the most relevant and interesting facet of both oral and systemic disease prevention. A discussion of balanced versus unbalanced foods and the criterions for dietary evaluation, are well explained and developed logically. Nutrition as a key to prevention is presented with a view to practical implementation within any dental health awareness program, as an effective means of disease control and health promotion.

HomeTop

"INTRODUCTION TO INTERCEPTIVE DIAGNOSTICS"
William K. Hettenhausen DDS, Executive Director & Lecturer

DENTAL / MEDICAL HEALTH EVALUATION

The earliest signs of dental disease are often painless, and if they do not hurt, we tend to overlook them. Apart from the obvious problems related to acute toothaches and advanced periodontitis, oral health assessment is far more medically relevant than you may think. Bleeding gums (re: a lack of interproximal gingival epithelial integrity) can lead to a bacteraemia, and soft tissue immune response to bacterial plaque can be a diagnostic indicator of systemic immunocompetence.

Because common dental plaque is clear, transparent, and almost invisible to the naked eye, 0.75% Sodium Fluorescein in buffered glycerol is used with dichroic blue filtered PLAK-LITE(tm) to cause the accumulations to appear a brilliant yellow-green. This makes it easy to evaluate oral hygiene effectiveness and to observe tissue vascular response to plaque deposits. It also inspires patients to take a more active role in their own health care.

This non-invasive oral health diagnostic assessment has the potential to provide valuable insights into those medical interventions, environments, diet patterns, and lifestyles that support or impair health.

The use of our Y.T.F.L. computer assisted Oral Health Evaluation System software has made it possible for us to graph patient progress over time and to monitor the response to various diet patterns and their effects on oral hard and soft tissue relationships.

During the program's development and use, it soon became readily apparent, that although most dental health problems (80%), could be explained in terms of poor hygiene (plaque accumulation patterns) in the presence of refined carbohydrates, a significant percentage (20%), could not. Because we could not explain this percentage in terms of a local etiology, systemic factors affecting immune response were implicated.

This approach makes it possible to evaluate systemic immunocompetence non-invasively, by expressing it in terms of the degree of soft tissue vascular response to common dental plaque.

The goal of this presentation is to review basic oral diagnostic information, and to set the stage for the the mouth can be effectively used as a diagnostic window on the state of a patient's systemic immunocompetence.

We would greatly appreciate your comments and suggestions. If you are interested in receiving further information on the YTFL Lecture Series, please feel to contact me at ytfl@tbaytel.net, by voice 807/622-2600, Fax: 807/344-3078 or mail Y T F L Foundation, P.O. Box 2631, THUNDER BAY, Ontario P7B 5G2.

HomeTop

THEORY: The mouth is the gateway to the human body. It provides an easily accessible opportunity to observe the vital biological dynamics of periodontal health and its immune response to the chronic irritation caused by the resident bacterial micro flora in common dental plaque. It is the logical place to develop a diagnostic window on local manifestations of systemic immunocompetence and the diet patterns that support or impair it.

HYPOTHESIS: By disclosing, observing and recording dental plaque accumulations and adjacent gingival soft tissue redness or vascular response, it is possible to select, compare and contrast the diet patterns that most obviously impair or enhance gingival health. Diet patterns that can be demonstrated to sustain or generate improved health in the oral environment are also likely to have a similar effect on overall health and resistance to disease (immunocompetence).

APPARATUS:

• Basic Exam Tray + Instruments (a mouth-mirror, periodontal probe, explorer, cotton 2X2)
• PLAK-LITE(tm) Disclosing System (FD&C #8 yellow disclosant and dichroic filtered blue light)
• Personal Computer: Oral Health Evaluation System (OHES), records, charts, diet sheets, reports.

METHODOLOGY: The first appointment is for patient orientation, charting and initial oral health evaluation. Selected patients are given a 6-day dietary record to complete. Followup appointments are scheduled at two week intervals for a minimum of three appointments with subsequent recall or referral. Patients receive a printed Oral Health Evaluation System report after each appointment. This includes a personal dentogram (map of their mouth) and its plaque accumulation patterns, oral hygiene instructions, a graph of their progress along with any professional recommendations (ie. suggested treatment plan).

1. ORIENTATION: Explanation of the role that plaque plays in dental health and disease.
2. DISCLOSING: Sodium fluorescein (FD&C #8 Yellow) disclosant under dichroic filtered light is used to highlight plaque for both diagnosis and patient self-observation.
3. CHARTING: Patient dental/medical/nutritional history and dentogram.
4. ORAL HEALTH EVALUATION: Computer OHES Database Management System(DBMS) Oral Hygiene Index (OHI) and Gingival Health Index (GHI)
5. PATIENT ORAL HEALTH EVALUATION REPORT: Introduction to OHES, Dentogram of teeth, plaque and potential gingival problem areas, oral hygiene overview, recommended treatment plan, and graph of progress over time.
6. DIETARY RECORD (6-DAY): collected from selected patients when indicated or where appropriate)

OBSERVATIONS: Data from initial beta testing of the Oral Health Evaluation Software with 55 patients shows that approximately:

• 78% of patients present with a direct relationship between OHI and GHI (local factors are primarily implicated)
• 20% of patients present with OHI(+) GHI(-) (Negative systemic factors implicated)
• 02% of patients present with OHI(-) GHI(+) (Positive systemic factors implicated)

CONCLUSIONS: When diet patterns from the 22% of patients, in which systemic factors are implicated, (ie. local factors cannot explain why they have exceptionally high or low resistance to periodontal disease) are cross-referenced, dietary patterns which obey basic biological concentration perspectives and contain few anti-bacterial preservatives appear to be the most nutritious and health generative.

All comments and suggestions are most welcome and appreciated - Thank you.WKH 96-08-15 ©YTFL Foundation 1996 Tel: (807)622-2600 FAX: (807)344-3078
E-mail: ytfl@tbaytel.net

HomeTop

Computer assisted health evaluation system. Dental/Medical development to help identify diet patterns. Diagnostic Systems (environments and lifestyles) that support optimum health (ie. resistance to disease). Expert systems research & software design

Our project strategy is based on the development of a computer assisted Health Evaluation System. This non-invasive diagnostic expert system will provide an opportunity to monitor changes in oral health status in response to various interventions, changes in diet pattern, lifestyle and environment.

This will help to provide health professionals and patients with early diagnostic information, suggestions, recommendations, and a graph of progress over time. It will also provide the research data for a health status survey, and reinforce the need for early diagnosis, regular checkups, and preventive services.

Because the mouth is the most easily accessible entrance to the human body, it is an ideal place to develop a health evaluation system. It is an excellent diagnostic window. The very first observable clinical symptoms of many diseases, including those caused by dietary micronutrient deficiency, and impaired immune response, are visible in the mouth. Oral hard and soft tissue reaction to common dental plaque can also provide a sensitive measure of the degree of host resistance to potential infection.

The goal of our continuing research in this area is the development and testing of a cost-efficient, non-invasive, computer assisted, health evaluation system with practical applications in both dentistry and general medicine.

Currently, a simple oral health evaluation system (O.H.E.S.) is being used and tested in selected dental offices. The number of teeth, plaque accumulation surfaces, bleeding areas and gingival sulcus (gum crevice) depths exceeding 3.0 mm are entered into the computer. This simple expert system targets certain individuals for comprehensive diet/medical analysis. It plots a graph of patient progress over time, and helps to identify those conditions that either support or impair a healthy soft tissue response.

A digitized optical scan imaging system is being developed to objectively record and index plaque accumulation and associated soft tissue vascular response. It shares the same expert system design principles as the initial oral health evaluation system, and because this system will not require the subjective evaluation of plaque surfaces and periodontal sulcus probing, it will have broader diagnostic application in both preventive medicine and dentistry.

Its use could then be extended to include physicians, nurses, and other health care professionals,in hospitals, senior citizen living centres, schools, malls, and remote communities.

HomeTop

If you have been a Y T F L member in the past, we would like to thank you for your support and encourage you to renew your membership now. If you have not yet had the opportunity to apply for Y T F L membership, we would like to invite you to join for 1997. If you would like to simply make a donation to the cause, any amount provides moral support and is most welcome.

MEMBERSHIP CATAGORIES:

• General Subscriber............$25.00 (first year free to first 15 new E-mail members)
• Hygiene Associate.............$45.00
• Professional Associate.......$100.00
• Patron Member................$200.00
• Life Member................$1,000.00

Since 1978, our Foundation has continued to promote "Better Health Through Dentistry", and the benefits of regular preventive dental care. We provide continuing education support and materials for a broad spectrum of health care providers in dental offices, schools, institutions and district health units.

"Every little bit helps". Because of our limited financial resources, we have difficulty in answering all of the many requests for Y.T F.L. information, services and materials. Memberships and donations make this work possible and they are greatly appreciated.

Kindly mail your cheque payable to:

Y.T.F.L. Foundation,
Box 2631,
Thunder Bay, Ontario.
P7B 5G2

Please E-mail the information below to ytfl@tbaytel.net :

Name
Degree
E-mail
Mailing Address
Phone/Fax Number
Special Interests/Comments

Tel.(807)622-2600 Fax:(807)344-3078 E-mail: ytfl@tbaytel.net
BN 10822 8008 RT
ONTARIO CORPORATION #3444681
CHARITABLE ORG.REG.#0579250-59-02

HomeTop