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White Papers & Research
Patient Co-management
By Dr. Richard Nagelberg
February 2011

Richard Nagelberg, DDS & Kim Miller, RDH, BSDH, RDHMP

Managing our patients in concert with our colleagues can take many forms. Perhaps the most common ones involve referring a patient to a dental specialist; periodontist, orthodontist, oral surgeon etc. Other times it involves conferring with our medical colleagues for a variety of reasons such as antibiotic regimens, clearance for dental work for patients who are pregnant or dental clearance for surgical procedures including cardiac and orthopedic procedures.

Going forward, patients will need to be co-managed to enhance treatment outcomes for diabetic individuals. The American Diabetes Association recognized the inter-relationship between periodontal disease and diabetes in 2008. Our physician colleagues should be referring their diabetic patients to their dental offices, in addition to referrals to the ophthalmologist and podiatrist. As dental professionals, we may have to bring this to the attention of our patients and their physicians. There are certainly some situations in which the physician is struggling to achieve good glycemic control, unaware that a mouthful of gum disease is contributing to the poor blood sugar control. Referring these patients to their dental office to get the perio disease under control will likely help improve glycemic control. If nothing else, the oral contribution to the total inflammatory burden will be removed.

As the mechanisms of various diseases are unraveled, we are gaining insight into different ways to address them. Not very long ago we did not have locally applied antimicrobials such as Arestin or host modulatory medications such as sub-dose doxycycline. Heroic measures including perio surgery were undertaken because implants were not available. Treatment protocols have an evolving nature, following advances in research. Gene and stem cell therapies are coming over the horizon and will be available sooner rather than later.

All these advances and co-management efforts are for our patients, the real reason for all of this. We should keep that in the forefront of our minds as we strive to enhance treatment outcomes.

©2011 Richard Nagelberg, DDS & Kim Miller, RDH, BSDH, RDHMP