Systemic Factors and Conditions Affecting the Success, Failure and Prognosis of Dental Treatments

The pillars of dentistry that determine the success of clinical practice include accurate diagnosis and treatment plan; ensuring the longevity of the restorative/reconstructive work; adequate pain management; and predicting the influence of systemic conditions on the outcomes of dental treatment. Dental schools sort of prepare us to take a good medical history, and perform a thorough systems review, but many a times this becomes a mere bare necessity. This course is meant to take the dental clinician well beyond what most undergraduate programs (and many post-graduate programs) in dentistry teach and update our knowledge to the most current literature. It is my experience and hope that such a current update would be instrumental in ensuring the success of dental treatment, gives the clinician the satisfaction of positively influencing a patient’s life, and help to prevent falling into the abyss of the mechanically oriented professional.

Topics covered and some interesting facts:

Metabolic and Endocrine Disorders:
(Did you know the relation to sleep disorders and why the morbidity and mortality? How do these affect prognoses of Endo/ Perio/ Restorative / Oral surgical procedures)

• Pre-diabetes and Diabetes Mellitus
• Hypothyroidism
• Poly-cystic ovarian syndrome/disease (PCOS/PCOD)

Nutritional deficiencies:
(An often-unseen factor; When should we suspect these? What about micronutrients? When should a clinician suspect these as a possible cause of treatment failure)

• Vitamin D, folate, vitamin B12
• (Is vitamin D really a vitamin or a hormone?)
• Iron, ferritin, and TIBC
• (Do these have any impact on a patient with severe bruxism?)
• Micronutrients: Chromium, Cobalt, Zinc, Copper

Effect of common medications on dental treatment: Did you know????

• Commonly used proton pump inhibitors (“antacids”) can adversely affect implants and endodontic treatment?
• Antidepressants: adverse effects on implants, grafts, periodontal health and wound healing?

Autoimmune disorders:
(Did you know up to 2% of us walk around with rheumatoid arthritis? What are the orofacial manifestations of these conditions?)

• Rheumatoid Arthritis
• Systemic Lupus Erythematosus
• Psoriatic arthritis
• Polymyalgia Rheumatica
• Sjogren’s syndrome

Systemic Factors Affecting Jaw Pain

• What are the most common systemic conditions that manifest as jaw tiredness and jaw pain?
• What are the systemic conditions that can change a patient’s dental occlusion?
• What do you do when a “splint” alone is not working for the patient’s jaw pain?

The commonality of systemic disorders:
(What is common between periodontitis, anxiety, depression, and OCD What is meant by “spectrum of disorders” that dentists should know?)

Bruxism: What is the latest?

• What are the systemic conditions associated with bruxism?
• What are the medications causing bruxism?
• How do you manage a bruxer?
• Occlusal splints: do they work?

Chronic fatigue syndrome and Fibromyalgia: A dentist prone?
(Costing Americans 30% household and 50% labor force productivity. How about that patient whose bite you can never seem to make acceptable?)

Diseases affecting bone physiology and metabolism:
(Osteopenia, Osteoporosis, Bisphosphonates: Why are bisphosphonates so widely prescribed? What are the implications for the patient and the clinician?)

Joint hypermobility syndromes:
(Did you know JHS has many co-morbidities of significant interest to the dentist?)