The Roots of Good Health

When Drs. John Hoag and Michelle Dotsch attended last year’s American Diabetes Association Expo in Seattle, they felt somewhat like fish out of water. The husband-and-wife team’s booth was situated among experts and vendors touting diabetes management, products and research, but the other attendees didn’t quite know what to make of them—because they’re dentists.

“We were the only private dental practice; doctors were asking why we were there,” says Dotsch. But the pair, who run their own Shoreline practice, Hoag and Dotsch, are part of a slow-growing movement among dentists to take a closer look at recent studies that link oral health with whole-body health. They are adapting the way they communicate with their patients to include getting more information about other health issues so they can look at a bigger health picture than simply isolat-ing and treating cavities or gum disease. They begin this dialogue having an advantage that many physicians don’t: They see their patients more often—at least twice a year if the patient is sticking to the recommended routine.

There have been a few studies linking periodontal infections with other systemic diseases; most notably, diabetes sufferers are at higher risk of periodontal disease, according to the National Institutes of Health’s National Institute of Dental and Craniofacial Research. Migraines are another ailment often treated by a physician, but they can have a dental cause due to issues like tooth grinding or jaw misalignment. Dr. Ron Inge, vice president and dental director for Delta Dental/Washington Dental Service, says, “[The studies] are changing many dentists’ perception of how they practice. It’s a slow change but they’re no longer just drilling and filling, instead looking at how oral health is impacting the entire body.” He adds, “Gum disease is a low-grade chronic infection and causes the same bodily responses as infections in other parts of the body.”

Dotsch recalls a conversation she had at the Diabetes Expo with a gastric bypass doctor: “[He] told us about a patient for whom he did the surgery, and shortly after the patient had her teeth cleaned without telling the dentist of her surgery, thinking it wasn’t important. She ended up back in the doctor’s office with the gastric ring inflamed and failing. When the doctor removed the ring, he had the area tested and oral bacteria were found on the ring itself. The doctor was shocked.”

Connections like these spurred Hoag and Dotsch to found the American Academy of Oral Systemic Health in 2011. In 2005 Inge cofounded, and is currently the executive director of, the Institute for Oral Health. Both organizations count as their members dentists and doctors who are opening the dialogue between physicians and dentists in overall patient health. Such partnerships are impor-tant because of the frequency with which patients often see their dentists. “We do see a lot of things that change before the doctors will,” says Dotsch. “Sometimes we will see signs of diabetes in the mouth before [patients are] even aware of it.” The Shoreline dentists are also one of the only practices in the state using Oral DNA, in which they collect a patient’s saliva and test it to determine which types of bacteria are present as well as to tell whether the patient is genetically predisposed to gum disease, which can change the dental treatment approach.

But while dentists like Hoag, Dotsch, Inge and others would like to see more communication between doctors and dentists, progress is slow, says Inge, thanks to the lack of connectivity between the two. In September, the Institute for Oral Health will have a conference in Washington D.C. (“The Role of Oral Health in Healthcare Policy”) which will discuss the economic impact of untreated oral health.“

Oftentimes, dentists are looked at as second-level health care providers,” says Inge. “We are trying to demonstrate our ability to contribute to overall health. We’re getting much more traction from the medical community by approaching it as dealing with infection.”