Interview: Partial or complete edentulism puts patients at greater risk of systemic co-morbidities

After your undergraduate degree, you specialized in prosthodontics. I am curious to learn why you chose a career in teaching.
It was by pure luck. During my last year of dental school, I had signed a lease for a dental office in a building to be constructed in Raleigh, North Carolina. However, it took the builder two and a half years to complete construction. As I had nothing to do in the interim, I approached my mentor at UNC [University of North Carolina at Chapel Hill] about a part-time teaching position. After discussions, he offered me a full-time one-year contract, which was extended to a second year contract. Although I left to enter practice once the building had been completed, I had fallen in love with teaching. That started my path down the academic road!

When you became dean, one of your goals was to move the school forward as a leader in innovation. What steps have you taken to achieve that goal, and what is the situation three and a half years into your tenure?
Our two greatest achievements have been to become the fourth Center for Research and Education in Technology center in the U.S. and the second school of dentistry to implement Epic Wisdom [electronic health record] to integrate with our medical center. The Regions CRET Innovation Suite opened this year and is an eight-operatory, state-of-the-art dental clinic with high-tech digital equipment. Our fourth-year dentistry students will spend a minimum of three weeks in the clinic, as will our dental hygiene students. It will provide them with exceptional education in dental care with cutting-edge equipment. The Epic Wisdom implementation enables us to have an electronic health record that spans the entire UMMC health care system. No other systems allow that to occur presently. We’re the first school to use the 2018 version of Epic Wisdom, and many other schools are now inquiring about the process for conversion from existing systems to Epic Wisdom.

Could you tell me more about the community outreach I believe you also wanted to develop through your position as dean?
We have implemented two programs since I started as dean in January 2016: Community Outreach Dental Externship (CODE) rotations and Dental Mission Week. The CODE program places our fourth-year dentistry students into Mississippi dental practices, corporate practices, public health clinics, etc. for a six-week period. This program enables them to treat a cadre of patients that the Jackson metro area doesn’t provide, in particular pediatric dentistry patients. In addition, they learn how private dental practices (urban and rural) operate, which is invaluable to them as they complete their training. Finally, for those clinician-educator faculty whose offices they practice in, it gives the faculty the opportunity to test potential associates for their practices and concomitantly allows the student to get a feel for the practice and the community.

Approximately one-third of our students either have become associates or now practice in their CODE rotation locations—it’s been win-win for everyone. The students also receive clinical credit for many of the procedures they perform on CODE rotations toward their graduation requirements. The Dental Mission Week program began in February 2017. For an entire week, we open the school of dentistry clinics to provide free care to the citizens of the Jackson metro area. This in in partnership with the UMMC schools of nursing, pharmacy, medicine, and health-related professions, which provide medical triage screenings on the patients we treat. We provide exams, radiographs, cleanings, extractions, root canal therapies, most operative procedures, and even dentures during the one-week program. Student also receive credit toward their graduation requirements. Both programs have provided over $4 million in uncompensated dental care since their inception.

Another of your goals as dean is to “put the mouth back in the body.” How have you so far collaborated with the dental profession to achieve this?
This continues to be a challenge. While our programs (CODE and Dental Mission Week) continue to gain incredible traction and notoriety for us and have been highly successful, getting into the other UMMC educational programs to teach the students the importance of oral health as it relates to general health is only now beginning to gain traction. This is due to differences in schedules and the burden of adding something to already overcrowded student schedules. We are making progress, but it is slow.

Adhesives are a $1.1 billion industry globally. Does this indicate to you that the majority of dentists today have ceased to associate them with treatment failure and finally realized their potential benefits in improving their patients’ well-being, or do you feel that there is still a lot of work ahead in educating both patients and dental professionals?
I believe that the majority of marketing of dental adhesives has been directed by the companies toward the dental consumer and that many dentists still don’t understand the benefits of denture adhesive use for their patients. Hopefully, my presentation at the meeting, along with the recent white paper on denture adhesives from the Oral Health Foundation, will better reach the dental profession and enable dentists to understand the benefits of denture adhesives for their patients.

According to the World Health Organization criteria, edentulous individuals are considered to be physically impaired, disabled and handicapped. The impact edentulism has on a person’s psycho-social well-being is easily understood. Could you expand a little more on the effect it has on systemic disease occurrence?
While we don’t fully understand the relationship, there is strong evidence that patients with no teeth, or with fewer than 20 remaining opposing teeth, are at greater risk of multiple systemic co-morbidities. These include cardiovascular disease, chronic obstructive pulmonary disease, dementia and oral carcinoma. This may be a result of chronic inflammation (from ongoing periodontal disease, dental caries or pulp necrosis) or simply from the impact of tooth loss on what patients can now eat—if you consider that most edentulous patients cannot (or will not) consume a high-fiber diet and opt for a softer, carbohydrate-rich diet, the implications for obesity and diabetes become apparent. The periodontal community has demonstrated the correlation between chronic periodontal disease and cardiovascular disease, diabetes, and low preterm birth weights in pregnant women. Patients with no teeth, or with fewer than 20 remaining teeth, have also been shown to have a higher incidence of mortality from all causes, compared with patients with more than 20 remaining teeth. The bottom line is that we should strive to maintain a healthy dentition in our patients for as long as possible and continue conducting research to demonstrate the cause–effect relationships.

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