Source: Oral Dis. 2008 Jan;14(1):1-7.

• Number of people with End Stage Renal Disease (ESRD) is increasing
• Atherosclerotic complications including stroke and heart attack are the primary causes of death in the ESRD population.
• Periodontal disease may be a treatable source of systemic inflammation.

• Cardiovascular diseases including heart attack, cardiac arrest, cardiac arrhythmia and stroke are the primary causes of death for ESRD patients.
• Mortality is highly associated with increased inflammatory burden.
• Periodontal disease contributes to systemic inflammation.
• The periodontal status of chronic renal disease patients needs to be carefully monitored.

• ESRD patients receiving renal replacement therapy including hemodialysis, peritoneal dialysis or kidney transplants will comprise an increasing segment of dental patient populations.
• The contribution of periodontal disease to the inflammatory burden makes it imperative to diagnose, treat and educate patients in the ESRD population about the critical importance of biofilm control and professional care, since their mortality is highly associated with inflammation.

I have been repeatedly asked over the last several months about the economy and it’s affect on dentistry. I work with many practices on site that are doing very well. These practices are from a variety of economic and geographic areas; however the one thing they have in common is that they market on a regular basis not only to the public, but to other professionals in their communities.

Consider this, as budgets become less flexible; patients are even more concerned about staying healthy. The healthier they stay, the lower their medical expenses and costs of prescriptions. This is an even bigger consideration for patients who are already at risk. When we work with our local health care providers we create reciprocal referrals. Medical practitioners want to know who in their dental community is up to date and being proactive with cooperative case management.

We must involve the medical practitioners in our treatment planning and case management when it comes to high risk patients such as those suffering with ESRD. Doesn’t it make sense for us to reach out and request the assistance of those medical professionals treating these types of patients on a regular basis? With that in mind, the following action plan will assist you as you reach out to your medical community to increase the health and wellness of your patients using dentistry as a vehicle to do so!

Before you start on your Action Plan, you should know what your end point goals are. Clearly write them out. Here are a few to choose from to get you started.

• Inform practitioners of relevant, impactful research.
• Cultivate relationships within the medical community.
• Increase referrals from the medical community.
• Identify our practice as one dedicated to understanding and incorporating research into clinical practice.
• Notify practitioners of our commitment to cooperative case management.

Please note – you will need to customize your action plan to meet your goals. Be sure to set target dates for the completion of each task and identify the team members who are responsible for each task. When several team members are involved in one task, it is a good idea to have a task or project manager, someone who is the point person.

1. Complete an internet search for all area physicians and institutions that are involved in the treatment of chronic renal disease. In addition to medical facilities, consider dieticians & nutritionists.
2. Organize your list geographically, possibly by zip code. Divide your community into four sections, as needed, depending upon the size of your community. (For more rural areas this step may not be needed, however in concentrated city areas you may choose to limit your geographic radius.)
3. Now that you know the number of providers in each section of your community you can determine how you will go about delivering the information.
4. Choose your venue. This step will need to be customized according to your goals and your resources. Here are three suggestions. (Please do not limit your creativity. Get your team members involved and brain storm ideas.)

• Inform practitioners about the research in a written format, ie.PerioFrogz pdf titled Summary of Research – ESRD on this website. Include a cover letter informing practitioners of your commitment to patient care through cooperative patient management. Include business cards or referral cards.
• Invite practitioners to a ‘meet and learn’ (afternoon or evening). Distribute copies of the information listed above and provide a short PowerPoint presentation or talk, 10 or 15 minutes or so detailing how you handle new patients, the level of care provided through your hygiene department as well as the variety of technologies you have in your office to enhance patient care. Discuss patient co-management strategies.
• Produce a newsletter exclusively for the medical community informing them of the research. Use the same data listed in the first bullet.

5. Now that you have determined your venue, break the project down into steps and set up a time line that involves the entire team. Divided the tasks among the team members (including the Doctor) so there is not a burden for any one person.

When the Team works together, the team reaps the rewards and ultimately it is your patients who will benefit from your efforts to increase awareness of the mouth body connection within your community. Most of all create some excitement and positive energy around this project and realize how much your community at large will benefit from your efforts.