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“We have the only prevention relationship left in all of health care. It puts us in a prime position to be able to help predict and preempt major disease.”

Dr. Susan Maples, Holt, MI

Susan Maples

We are pending a health care crisis, most people think we’re in it but it’s really coming at us at 90 mph and we have an amazing opportunity to help with some of that.  So what we’re really doing is teaching – I’m teaching dentists how to look in the mouth with super powered eyes to be able to pick up 120 different clues of what’s going on with the rest of the body and starting with infancy all the way to the end of our lives.  That’s what it’s about. This is the future of dentistry, trying to help our profession take their rightful place at the table.

About 75% of what we’re spending on health care right now is for preventable illness and since we have the only prevention relationship left in all of health care, with six month preventive relationships, it puts us in a prime position to be able to help predict and preempt major disease.  Not just how oral disease impacts the rest of the body but how metabolic disease shows up in the mouth and how to help people turn the ship around rather than just writing scripts and looking the other way. There’s too much sickness for them to really go into prevention, so we’re sort of putting a bunch of buckets underneath the leaky ceiling and not getting up and looking at the root cause.  So this is a way to help people with this regular relationship kind of turn the ship around.  Not just lifestyle related illness, but things like HPV and oral cancer which is the largest spreading sexually transmitted disease and increasing oral cancer by 30% a year.  When I say lifestyle related disease, we’re talking about pre diabetes, diabetes, obstructive sleep apnea, acid reflux, chronic systemic inflammation, food sensitivities and toxicities.  I mean I could go on and on.  So it’s kind of a full-on approach and my contention is that if we reach down to generations below us and really help kids get in the driver’s seat for a preferred future, we can make a big different ultimately.  Right now the statistics are that 42% of our country will be obese by 2050, one in three diabetic, and one in two heart disease.  So it’s pretty sad.

Well the book is called Blabber Mouth! 77 Secrets Only Your Mouth Can Tell You to Live Healthier, Happier, Sexier Life. It’s written for the consumer.  It’s three or four pages for each chapter and there are several chapters, of course.  It’s designed more as a reference book and so people pick it up and start reading usually the sex section first or the areas they find interesting.

So Blabber Mouth was my attempt to help educate the public and it turns out that about 90% of what’s in there most dentists don’t know.  When I say that, there are certainly parts that talk about how to care for your mouth and what’s a healthy mouth look like.

But the mouth-body connection has been a growing interest and concern as we’ve watched our patients get sicker.  And I mentioned that we, as preventists, have been trying to prevent oral diseases all this time which is caries disease, tooth decay, periodontal disease, occlusal disease which is the wear and tear from bruxism, you know cracking for mobility infraction, tooth loss, etc.  And oral cancer which takes more than teeth, it takes lives and bone and takes people’s dignity and ability to eat, smell and taste.  We’re losing ground on all of those.  So I started looking at the big picture.  Well, we’re losing ground because people are sicker.  They’re coming in with more complicated health histories, multiple providers, lots of medications.  I started having an interest in these complications but what I noticed is there was an academy called the American Academy of Oral Systemic Health that was already in place.  And I started going to that meeting and realized there were other people like me who were curious about this.  Now in the early piece of this, and a lot of people have already gotten the message that the oral systemic connect or the mouth-body link had to do with chronic inflammation, its role on the vasculature, and then also traveling microbiomes, the bugs that travel from the mouth and lodge themselves into the walls of blood vessels causing stroke and heart attack.

Anyway, so this mouth-body connection of bacteria to the rest of the body was kind of my early interest and then it really grew to what else are we seeing.  We’re able to look in the mouth and see quite obvious signs of obstructed airways, sleep disorder breathing, certainly sleep apnea should be readily apparent to us, and acid reflux which of course lead’s to Barrett esophagus and esophageal cancer but also causes erosion and visible irritation.  We have pre diabetes and diabetes by-directional relationship between diabetes and periodontal disease.  So I did a research study myself in my office with the head of endocrinology at Michigan State University where we tested 500 of our patients who had no history of diabetes and 20% of them were either pre diabetic or diabetic and didn’t know it.  And correlating that with what’s going on with their gum tissue and how to come up with a dental friendly screening tool where we could recommend that people get A1C testing or communicate with physicians and help patients if it’s not too late, kind of turn the ship around so they can avoid the obvious repercussions of diabetes like losing an eye or losing a kidney or losing a limb.

Periodontal disease is a very complicated disease and we’ve overlooked diabetes as a causative factor.  Now the fact that 1 in 3 of us will be diabetic by 2050, we cannot overlook that anymore because to take a sharp instrument into an infected pocket of bacterial infection in a patient’s mouth who has unstable glycemic levels is really not good for the patient at all.  We need to be working in conjunction with their medical team to get glycemic control in conjunction with working with the gum disease.  Because the high glycemia makes the gum disease worse and the gum disease makes it impossible for the patient to control their hyperglycemia.  So we have to work together.  So that was that particular piece. And then another piece is of course smoking cessation.  We know that smokers lose teeth from gum disease and I’m really trying to help dental teams develop a smoking cessation program in their office so that we can stop scraping teeth and pretending we’re making a difference on these smokers.  If we can actually help them quit smoking, then we really have something.  We see also lots of chronic sensitivities from gluten and dairy and some other food sensitivities like nightshades, tomatoes, potatoes, peppers, eggplants, things like that that show up in the mouth that we can differentiate between a bacterial response and one to food sensitivities or funguses like all the different strains of candida.  So there’s a lot you can tell by a single drop of saliva too.

I believe that people who trust you will accept a treatment plan. I believe a really significant way to do that is to take a look at the patient’s whole health and talk to them about what’s really important to them in general.  And maybe dentistry isn’t their first thing, maybe we’re trying to help them get medical care that’s better for them if they’re not feeling hurt or understood.  We get lots and lots of very complicated patients.  As you can imagine, a dental office that practices total health, we get people who kind of hear by word of mouth that we sort of hold the container for the whole ball of wax and take a look at their whole big picture and then the dentistry becomes, they become very trusting of us and try to keep our ability to act as their advocate to gain the help that they want. So I think that personal relationship and taking time to talk – our initial exam is two hours and about an hour of it is the preclinical interview.  So it’s really investing in a relationship with that patient.

A lot of people wonder if I switch from what I’m doing, I look into models with an explorer for holes in the teeth and I look with a probe for periodontal disease and I treat those by my traditional means… and if I stop and put my instruments down and I talk to people about this and help them figure out how to turn it around and I do these diagnostic tests, how is that gonna help my bottom line?  And I want to say certainly you start attracting people who value health so they’ll pull out their own discretionary dollars and spend it which is very unusual for most dental offices; they don’t want to spend their own money, they want insurance to pay for it, that’s sort of our mindset. The other thing is they refer to friends.  We also get lots of referrals from medical teams because we write lots of letters of advocacy for our patients whenever we find different systemic problems or even oral disease that relates to systemic problems.  We write letters and so we’ve built a very large network of physicians that are referring patients.  We also get higher levels of case acceptance which we talked about.  And we’re also adding little pieces to the hygiene visit

This is a mission for me.  So I took 122 flights last year and I love doing it.  I love to share it.  I also speak to service organizations and the public.

So if you like this kind of thing, check out Total Health University.  You can contact the director of sales right through the website totalhealthu.com. If you want to see what a telehealth practice looks like on our website, go right to drsusanmaples.com and you can kind of check out the website and go from there too.

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