Casey Hein

• In the realm of periodontal-systemic links – what’s real and what’s hype?
• Can you explain to patients the significance of periodontal disease and why it’s so important to treat it?
• How can you collaborate with medical and nursing professionals to care for patients who have periodontal disease?

Several decades of scientific inquiry have produced evidence that periodontal disease may increase risk for a number of inflammatory diseases and conditions: coronary artery disease and stroke, diabetes and its complications, adverse pregnancy outcomes, and pneumonia, among others.

Dentists and hygienists are well positioned to counsel, screen, and appropriately refer patients who are at risk for chronic diseases like cardiovascular disease, diabetes, and obesity. Likewise, physicians, nurses, pharmacists, dieticians, and other non-dental healthcare providers have an important role to play in screening and appropriately referring patients at risk for periodontal disease. This course will empower dental and medical practitioners to integrate periodontal-systemic science into everyday patient care with ease and confidence. The program also provides a template for jump-starting cross-disciplinary healthcare collaboration and helps the dental team reframe the “check-up” and “cleaning” appointment.

Learning Objectives

• Describe the significance of periodontal infection in amplifying systemic inflammation
• Implement a new model of risk assessment that focuses on the patient’s cumulative inflammatory burden
• Screen and appropriately refer patients at risk for cardiovascular disease and diabetes
• Implement protocols for monitoring glycemic control in patients with diabetes or prediabetes
• Summarize clearly and simply, in patient-friendly language, the science behind periodontal-systemic interrelationships
• Build collaborative relationships with physicians, nurses and other non-dental healthcare professionals
• Implement bi-lateral point-of-care screening and referral for periodontal diseases and associated chronic diseases
• Identify barriers to implementing periodontal-systemic science into everyday patient care

Suggested Format: Full Day Session or 4 hour program
Suggested Audience: Dentists, dental hygienists, dental assistants, business staff

• Are you underdiagnosing or waiting too long to diagnose periodontal disease?
• What can you say to patients about periodontal-systemic links that is grounded in scientific evidence?
• How do you increase your patients’ acceptance of periodontal treatment?

In the past quarter-century, there have been major advances in understanding the role of periodontal infection and inflammation in the risk for systemic diseases, including coronary artery disease and stroke, diabetes, adverse pregnancy outcomes, and pneumonia, among others. This course explores the significance of periodontal infection in increasing systemic inflammation, and provides overviews of the biological mechanisms that link periodontal disease to a constellation of inflammatory driven diseases and conditions. This body of evidence provides a compelling case for early intervention of periodontal disease. Casey also suggests a number of hurdles and conditioned assumptions that hijack diagnosis of periodontal disease and patient acceptance of proposed treatment, with recommendations on how to overcome these challenges.

Learning Objectives

• Explain the biological mechanisms implicated in the inflammatory pathway linking periodontal disease to cardiovascular disease, diabetes, complications of pregnancy, pneumonia and other links under investigation
• Identify patients in the earliest stages of periodontal disease
• Identify the hurdles and conditioned assumptions that hijack the diagnosis of periodontal disease

Suggested Length: 3 hours
Suggested Audience: Dentists, dental hygienists, dental assistants, business staff

• Why the dental care needs of diabetic patients are different from those patients who do not have diabetes, and what specific clinical protocols should you implement?
• Do you wish you had evidence-based messages to help you discuss the importance of glycemic control with patients who have periodontal disease and diabetes or prediabetes?
• How can you collaborate with physicians, nurses and diabetes educators to care for patients who have diabetes or prediabetes?

Worldwide, an estimated 390 million people have diabetes—and that number keeps growing. This patient population has specialized needs when it comes to periodontal care. Treating diabetic patients is different than nondiabetic patients. To ensure optimal health outcomes, patients with diabetes and periodontal disease require collaborative case management.

This course provides an empowering vision for dentists and dental hygienists in screening for diabetes, pre-diabetes, obesity, and Metabolic Syndrome and offers practical ideas for jumpstarting collaborative case management with the medical community.

If your team is still treating patients who have diabetes the same way you treat patients without diabetes, this course is a must. Course participants will develop greater confidence in caring for diabetic patients and establish easily implementable clinical protocols to better address the needs of patients with diabetes.

Learning Objectives

• Explain the biological link between diabetes and periodontal disease
• Incorporate evidence-based information on the interrelationship between diabetes and periodontal disease into everyday dentistry
• Monitor and document glycemic control in diabetic patients who have periodontal disease (or diabetic patients who may be at risk for periodontal disease)
• Identify patients who may be at risk for Metabolic Syndrome
• Build collaborative relationships with physicians, nurses, and other non-dental healthcare professionals to cross-screen and cross-refer patients at risk for diabetes, prediabetes and periodontal disease
• Communicate evidence-based messages to patients about the interrelationship between diabetes and periodontal disease
• Implement clinical protocols specific to the care of patients with diabetes

Suggested Length: 3-4 hours
Suggested Audience: Dentists, dental hygienists, dental assistants, business staff

• What primary care services, traditionally provided by physicians and nurses, can you perform?
• Can dental professionals really perform point-of-care testing using blood?
• Medical-dental integration is a great idea, but where do you start and what are the challenges?

In this new era of medical-dental integration, the expectation is that dental professionals will become more involved in risk assessment, early diagnosis, and co-management of various medical conditions. Indeed, dental professionals are uniquely positioned to provide many primary care services that have traditionally been delivered by physicians and nurses. This leads the way for a new model of care, the ‘Non-Physician Primary Care Provider’,* ushering in an alternative approach to meeting the needs of millions of people who live with multi-factorial chronic diseases.

This course explores medical screening in the dental setting, including the use of questionnaires, visual examination, point-of-care technologies, manual measurements and salivary diagnostics to screen patients for cardiovascular disease, diabetes, poor glycemic control, HPV, HIV, hypertension, dermatological lesions, various cancers, and biometric health, among other things. The challenges to implementing these primary care services into the dental setting will also be discussed

Learning Objectives

• Discuss drivers of the Non-Physician Primary Care Provider model of care in dentistry
• Implement screening tools such as questionnaires, point-of-care technologies, salivary diagnostics, and smart phone applications, among other methods
• Introduce bi-lateral point-of-care screening and referral to the medical and nursing communities
• Overcome the challenges in implementing primary care services in dentistry
• Identify attitudes about implementing this new practice paradigm and areas where more education and training is necessary to be successful in providing primary care services in the dental setting

Suggested Format: 2-3 hour program
Suggested Audience: Dentists, dental hygienists, dental assistants, front desk staff

• Why should you perform chairside glucose testing?
• How do you implement glucose testing in the dental office?
• How can you be paid to perform glucose testing?

As dental providers we cannot ignore the overwhelming statistics on diabetes.

• More than 125 million people in the US have diabetes or prediabetes.
• Close to 10% of cases of diabetes are undiagnosed.
• Among people who know they have diabetes, about 9% are untreated.
• Of adults who are treated for diabetes, perhaps as many as 80% are poorly controlled.

Because oral problems are among the earliest signs of diabetes, the dental office often becomes patients’ point-of-entry into the medical system. Dentists and dental hygienists are uniquely positioned to identify patients who have diabetes or prediabetes, monitor blood sugar and reinforce recommendations for diabetes self-care.

The American Dental Association recently approved CDT codes for in-office, point-of-care testing (POCT) for HbA1c, and capillary blood glucose. This has paved the way for dental providers to better co-manage patients who have diabetes or who are at risk for diabetes by utilizing fingerstick technologies and other screening methods. Many insurance companies are now paying claims for glucose testing in dental offices. Participants of this new course will walk out fully empowered to screen patients for diabetes and prediabetes, and implement chairside glucose testing.

Learning Objectives

• Explain the difference between and rationale for HbA1c testing (D0411) and capillary blood glucose testing (D0412), identifying patients who are candidates for these two chairside glucose tests
• Perform blood glucose testing utilizing finger-stick techniques, glucometers, and HbA1c analyzers
• Describe how the results of glucose testing may impact treatment decisions
• Identify the pros and cons, and barriers to implementation of glucose testing in the dental setting

Suggested Format: 2-3 hour program
Suggested Audience: Dentists, dental hygienists, dental assistants
Optional:  An additional 1 hour hands-on training with glucose meters

How much do you know about the link between metabolic syndrome, obesity, inflammation, and periodontal disease? Why can’t dentists and dental hygienists overlook overweight and obesity in everyday patient care? How do you start difficult conversations about weight loss with overweight patients?

Obesity, as we hear almost every day, is taking a devastating toll on human health and wellness. In fact, it may be the single greatest threat to global health. Worldwide, the prevalence of obesity has more than doubled since 1980, and projections suggest that 1.2 billion people will be obese by 2030.

As strong predictors of comorbidity, obesity and Metabolic Syndrome can no longer be ignored in everyday patient care. Recent studies have proposed a correlation between obesity and periodontal disease; numerous investigations have also suggested an interrelationship between Metabolic Syndrome and periodontal disease.

This energizing, revelatory course empowers the dental team to identify patients at risk for overweight and obesity, overcome the difficulty in discussing weight, build collaboration with the medical community to cross-screen and cross-refer patients at risk for obesity and periodontal disease, and educate dental patients about the role of obesity in increasing risk for periodontal disease.

Learning Objectives

• Explain the biological mechanism that is theorized to link obesity and Metabolic Syndrome to periodontal disease
• Describe the concept of cumulative inflammatory burden
• Identify dental patients who are overweight or obese
• Recognize patients who may be ‘inflammatory-primed’
• Overcome the difficulty in discussing weight with patients
• Educate patients about the impact of overweight and obesity on periodontal health
• Identify patients who might benefit from referral to physicians and specialists for weight management
• Implement clinical considerations in caring for obese dental patients
• Build collaboration with the medical community to cross-screen and crossrefer patients at risk for obesity and periodontal disease

Suggested Length: 3-4 hours
Suggested Audience: Dentists, dental hygienists, dental assistants, business staff

• Can you help patients who are depressed?
• Is there an easy way to identify patients who might be depressed?
• How do we address depression in members of the dental team?

With one in six people experiencing depression some time in their lives, it’s likely that during a typical day, we will see a number of patients whose lives have been touched by depression. Prolonged depression can be devastating ― impacting both physical and emotional health, including increased risk for alcohol or drug addiction, trouble with school or work, problems with relationships, social isolation, excess weight gain, self-mutilation, and suicide. A recent model that utilized dentists and dental hygienists to intercept patients with depression, was overwhelmingly successful when recently piloted in the Indian Health Services.

This course begins with a brief overview of the most common types of depression and associated risk factors. The PHQ-2 tool will be introduced to provide a simple way to preliminarily screen for depression. Complications common to patients with depression, homecare regimens for their unique dental needs, and key messages for patient education will be discussed. We’ll also tackle the ‘elephant in the room’― depression in members of the dental team. We must care for ourselves before we can care for our patients. Please join us for this important and long overdue course.

Learning Objectives

• Identify risk factors for depression, and utilize the PHQ-2 screening tool to recognize patients who may be depressed and refer them to physicians or behavioral health providers for formal diagnosis
• Describe the connection between depression and poor overall health and how depression may increase the risk for caries and periodontal diseases
• Prescribe homecare products that help prevent caries, xerostomia and other complications common in patients with depression
• List key messages to educate patients about how to maintain oral health
• Recognize daily challenges that dental professionals face; assess personal mental well-being and if appropriate, buffer work-related stress, and address risk factors for depression specific to personal and professional life

Suggested Format: 2-3 hour program
Suggested Audience: Dentists, dental hygienists, dental assistants, front desk staff
Optional:  An additional 1 hour hands-on training with glucose meters

• What is the most recent evidence regarding pregnancy and periodontal disease, and what should dental teams be doing with this information?
• Do you wish you had evidence-based, sensitive messages to help you discuss with women the risk periodontal disease may pose to healthy pregnancy?
• How can you educate and train physicians, nurses, and midwives to screen pregnant women for periodontal disease and refer suspected cases for dental care?

It is well recognized that infection and inflammation is associated with a significant proportion of adverse pregnancy outcomes, and one of the most common sources of infection and inflammation is periodontitis. It’s been estimated that periodontal diseases, including gingivitis, affect 75% of pregnant women.

Periodontal infection has been correlated with such pregnancy complications as preterm birth, preeclampsia, gestational diabetes, and delivery of small-for-gestational age infants.

Oral healthcare providers who care for women of child-bearing age should be aware of the evidence that supports the possibility that periodontal infection may be a modifiable risk factor for adverse pregnancy outcomes.

This case-based course empowers oral healthcare providers to incorporate into everyday patient care evidence of the relationship between periodontal disease and risk for adverse pregnancy outcomes.

Learning Objectives

• Explain how the structure and integrity of gingival tissues change during pregnancy
• Describe the evidence supporting a relationship between periodontal disease and adverse pregnancy outcomes
• Cite the risk factors for preterm birth and preeclampsia
• Express patient-appropriate messages to educate women of child-bearing age about the importance of oral health and the potential impact of periodontal disease on pregnancy
• Summarize the findings of various consensus opinions related to the oral healthcare of pregnant women
• Identify pregnant women who have oral health problems that may place them at greater risk for an adverse pregnancy outcome and communicate concerns to the patient’s physician
• Educate and train physicians, nurses, and midwives to screen pregnant women for periodontal disease and refer suspected cases for dental care

Suggested Length: 3-4 hours
Suggested Audience: Dentists, dental hygienists, dental assistants, business staff

• Does periodontal disease really increase the risk of heart attack?
• Is there something you should do differently for patients who have (or are at risk for) cardiovascular disease?
• How can you collaborate with physicians, nurses and diabetes educators to care for patients who have or who may be at risk for cardiovascular disease?

Since groundbreaking research on the potential connection between periodontal disease and cardiovascular disease (CVD) appeared in 1989 (Mattila), there has been a plethora of publications about this subject in many prestigious medical journals. Explanations on the biological mechanisms by which periodontal disease could cause systemic inflammation, promote atherogeneis, and increase the risk for myocardial infarction and stroke are wellfounded. Although short-term studies suggest that treatment of periodontal disease can reduce systemic inflammation and endothelial dysfunction, evidence that periodontal therapy can prevent atherosclerosis, heart attacks or stroke is lacking. What are dentists and dental hygienists to do with this inconsistent information?

This course helps oral healthcare professionals to make sense of the research and consensus opinions on the links between periodontitis and cardiovascular disease. The program empowers participants to incorporate the latest evidence on the relationship of periodontal and CVD, screen patients to identify those who may be at risk for CVD, and build collaborative relationships with non-dental healthcare providers to increase point-of-care screening and cross referral of patients at risk for CVD and periodontal disease.

Learning Objectives

• Recognize the significance of cumulative inflammatory burden
• Discuss the relationship between periodontal disease and atherosclerosis and periodontitis as a modifiable risk factor for heart disease and ischemic stroke
• Accurately articulate the risk periodontal disease may pose in the development and progression of atherosclerosis
• Identify patients at risk for cardiovascular disease
• Articulate key messages for educating patients about the relationship between periodontal disease and CVD
• Implement strategies for medical-dental collaboration in caring for patients at risk for periodontal disease and atherosclerosis
• Articulate the findings of various consensus opinions related to clinical application of evidence of the association between periodontal disease and atherosclerosis

Suggested Length: 3-4 hours
Suggested Audience: Dentists, dental hygienists, dental assistants, business staff

• What is the magnitude of the unmet needs for dental care in older populations – how are we ‘dropping the ball’ on caring for this high-risk group?
• How might untreated periodontal disease predispose nursing home residents to lifethreatening diseases?
• How can all healthcare providers—including dental professionals—contribute to the well-being of nursing home residents through screenings and treatments for oral-systemic issues?

In the past several decades, medical and nursing communities have seen a wealth of scientific evidence that supports the important role of oral health in sustaining overall health and well-being. But we have been slow to adopt standards for collaborative care between medicine and dentistry to implement this science.

Given the prevalence of periodontal disease and caries in older populations (most of which goes undiagnosed), it is reasonable to assume that most people entering nursing homes have untreated periodontal disease and decayed teeth.

Poor oral health places older adults at greater risk for malnutrition. Furthermore, periodontal disease increases the risk for inflammatory-driven diseases such as cardiovascular disease, stroke, aspiration pneumonia, complications of diabetes, and rheumatoid arthritis. These diseases are the most prevalent in nursing homes and are costly to treat.

This course proposes protocols for nursing homes that fosters a collaborative practice arrangement between nurses and dental hygienists.

Learning Objectives

• Describe the unmet needs for dental care in older populations, the prevalence of periodontal disease and caries in this at-risk group and how these oral diseases compromise the health of older adults
• Implement bi-lateral, point-of-care screening and referral of older people with dental diseases, and related inflammatory-driven diseases such as cardiovascular disease and diabetes
• Describe how nurse-dental hygienist transdisciplinary collaboration could improve health outcomes in nursing home residents

Suggested Length: 2-3 hours
Suggested Audience: Dental hygienists, dentists, nurses, physicians, and other nondental healthcare providers