Treatment Collaboration: Confusion to Confidence

Treatment Collaboration: Confusion to Confidence

00:01 Pathogens and Why Baseline Testing is Essential
02:25 More on Plaque
03:34 The Vital Tests for Confidence

We can't just look for clinical disease because when they do those CIMTs, the carotid intermediate thickness, and they're looking for these soft plaques, they are more related to the microbial levels. We have to know if those pathogens are there, if those microbes are there or not. We always want to clinically address our patients and be looking at them in diagnosis, but we've been missing a key piece to be competent in our treatments. And that's what is there microbially.

Baseline testing is the essential takeaway, an objective point of view. It allows us to answer, "are the pathogens even there? How much of those pathogens are there? And then what is the growth pattern?"

Who are these pathogens we keep talking about? There are 700 that we focus on. The ones that make the biggest impact in the mouth are called keystone pathogens. They are five bacteria and because these are the ones that have an impact on the rest of the body: Aa, Pg, Td, Tf, and Fn. And so what these top five can do is this horizontal gene transfer. We call them quantum sensing, nutrient exchange, epigenetics. They can control other species. These are really the top four traits of these pathogens. They control the entire oral microbiome. They are the most destructive in the oral cavity, they're the ones that cause the bone loss. They are resistant to many of our treatments and products, and they are the ones that Dr. Pritchard's been really educating you on, how they cross over into the bloodstream.

A plaque is a semi hardened accumulation of a substance from fluids that are bathed on an area. And we saw that, right? That blood flow and we could see that they were able to cross over. It's no different in the mouth. They're constantly being bathed by these types of fluids. Plaque on the teeth equals plaque on the heart equals plaque on the brain. Plaques are plaques, and we need to understand that and be able to communicate that clearly with our patients.

We can do a saliva test and see if those five are there because then those are the ones that can cross over any of the epithelium or endothelium lining. This is then that accumulation of going from confusion to confidence that we can then work together collaboratively because it is truly the test as we showed you at the beginning, even if we just start with those four top four tests.

Yes, so whether they're ordered in the dental office or in the non-dental office, we first need to start with looking, "is this person oxygenating well day and night?" And of course, we're all familiar with the cone-beam CT, which gives us the anatomy of the airway. A sleep test, whether it's a home sleep test, or it's a formal in-lab sleep test, some way to measure oxygen all night long.

And then the nitric oxide test, or some way to determine if the individual has adequate levels of nitric oxide. I will just say, while we're on this slide, remember with your sleep test. I said it earlier, but don't just focus on the A. H. I. There's so much gold to be found in the additional results that you get from the sleep test, even from a patient's wearable at home, to determine if they have high levels of oxygen, 96% or higher all night long.

Otherwise, there's some improvement to be made. High risk pathogens, as Lora's talked about so beautifully. So a saliva test, whether you order it either office and then the inflammatory markers myeloperoxidase and PLA2, specific for plaque that is dangerous in the wall of the artery until proven otherwise.

You've got a high-risk situation on your hands if you have elevated myeloperoxidase and PLA2 that cannot be resolved by one office alone. It takes us coming together. C Reactive Protein for global look at inflammation. ADMA, we didn't mention in the previous slide, but that is the way that I prefer to see if there's an impairment in nitric oxide in this person's body, because elevated ADMA tells us that there's an impairment in the nitric oxide pathway that we need to address, usually relating back to poor oxygenation.

And the hemoglobin A1C, we've put it here. It's not the best way to look for diabetes as Lora talked about earlier, or is this person on the path to diabetes? Do they have insulin resistance? But. A1C and other tests that we're going to talk about in the future to determine the metabolic health of the individual in front of us.

And then arterial health, we've talked about the ultrasound for carotid intima media thickness, and then the CT scan with artificial intelligence, of the coronary arteries. So if we start simply looking at these four things and having conversations together between, us, then we'll begin to move towards that confidence and collaboration we're all looking for.

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