Thursday, March 12, 2009

Shirt Crazi

My father told me that it's human nature for people to perform as well as they feel, and that the way a person is dressed affects how they feel. It was always important for him as a practicing dentist to come to work each day looking his best. His shoes were always polished and his tie sported a distinctive symmetrical knot.

At the Jacobs Smile Center, we have a dress code that I feel contributes to a feeling of teamwork. Our clinical team coordinates their scrub and jacket combinations depending on the day of the week. Front office members wear either a coordinated business suit or our signature blue logo cotton blouse and dark dress pants.

Yesterday I found that this concept is thought important in the least likely of places. It was my day to volunteer as a dentist at the Care Free Dental Clinic, a volunteer clinic whose mission is to serve the homeless, low income and uninsured people of our county. Our fourth patient presented for treatment, sat in the dental chair, and said she was told by C. J. to say hello to me.

"Do you mean C. J. Skerbeck?" referring to the owner of our regional traveling carnival. "Yup, she's the one," the lady replied.

I asked, "what do you do for the carnival?" I was given a brief explanation of a job I had never heard of before. "I am the person who gives out the clean shirts every day to the carnival workers. You know, nobody gets a clean shirt unless they are wearing clean, dark bluejeans or black pants. They must be clean and in good condition. It's important that they look good everyday, because they are all representatives of our carnival. If I don't give them a clean shirt each day, they have to go home and change or they just plain-out can't work for us that day. Every day, every worker gets a fresh, clean shirt. I'm the one who washes every shirt. I'm the one who decides if they work today or not."

I thought for a moment. "Your job sounds important. What do the other carnival workers call you? Please don't use any words I can't repeat."

"They call me the Shirt "Crazi" she laughed. "I don't care. I make sure they all look good, and C. J. counts on me to make sure that's how it is. My second most important job that I do is selling tickets and handling the money." At this point I understood that the Shirt Crazi must be really important. I guess Dad was right, even the important people at the Skerbeck Carnival know that looks are important in your job.

Saturday, March 7, 2009

Gumdog Millionaire

What do the slums of Mumbai, India and your mouth have in common? Beside the fact that they can both be dirty places, your mouth is also a place inhabited by mostly "good" residents. Like the occupants of the Mumbai slum in the recent award winning movie Slumdog Millionaire, your mouth also may house some really "bad" characters.

Dental research has identified nearly 700 different bacteria living in the human mouth, most of them "good". Newer technology has allowed us to identify with great accuracy thirteen "bad" pathogenic bacteria believed to be involved with degenerative periodontal (gum) infections. My first exposure to this technology was through a course I took by Lou Graham, DDS about 3 years ago. In the past year I have sampled about 200 people with signs of periodontal disease or infection looking for these horrible critters.

Analyzing these bacterial test results has been a large eye opener for my dental team and for me. We have found many more "Gumdog Millionaires" than I could ever had imagined. I see a gumdog millionaire as a person who is rich indeed. Rich and teeming with microorganisms too nasty to inhabit the slums of Anymouth, USA. Of all the bacterial tests I have done to date, only one person had a test returned with no periodontal pathogens. I even had to do a free retest to confirm to myself that this could have occured. Now keep in mind that I am only testing people with evidence of periodontal infection or disease, but impressive none-the-less!

Where, why, how? Research is still out on the final answer to these questions, but this is what we know so far. Periodontal pathogenic bacteria are probably passed from a caregiver to a child in a family setting at an early age - coughing, sneezing, kissing, tasting off the same spoon, drinking out of the same cup, sharing a straw. People with a stronger immune system are less likely to take on the new bugs, while those with lesser immunity will begin to host the bugs earlier.

As a person ages or their immune system is challenged, the "bad" bugs may overgrow, now showing the signs and symptoms of gum infection or periodontal disease. Present in larger quantities, these bacteria are next passed through saliva again to the person's spouse or partner.

Most recent shocking findings in my dental office are that married couples that we have tested in the past 4 weeks have all shown the same combination of pathogenic bacteria present in their mouths, and we have even found these bugs in the same quantity in each partner. I have tested about 6 couples and 1 family unit to date. Father, mother, and child demonstrated the same bacteria!

At a recent course sponsored by Hain-Diagnostics, I learned that four of these bacteria (called red complex) predispose people to a 700% greater chance of having heart disease. People with two other (called green complex) bacteria are more prone to diabetes. Orange complex bacteria can be related to inflammatory diseases such as rheumatoid arthritis. The presence of these bacteria shows a risk factor, not necessarily causal. Research is beginning to point to a causal effect, though in some cases.

These bad bacteria are difficult to get rid of, but it can be done. Removing pathogenic bacteria may not eliminate things like heart disease, cancer, diabetes and arthritis, but it will definitely remove some of the risk factors. The earlier in life that bad bugs are detected and treated, the greater chance of having a healthy adulthood, continuing into the "golden years".

Oh, yea - don't be kissing your dogs on the face either. Last Monday's patient informed me that he was taking his dog to the vet for periodontal treatment. The vet said that the dog would get heart disease if this kept up! Another dentist I met recently had a woman's dog tested for periodontal bacteria. Amazingly, the dog and owner shared the identical bad bugs. The dog's better now, by the way. The woman finally tested clean after the dog was treated.

"Now Jamal, your final question is worth a staggering 20 million rupees! Which periodontally pathogenic bacteria can raise your risk of heart disease by 700%? Is it A: Aggregatibacter actinomycetemcomitans? B: Porphyromonas gingivalis? C: Tannerella forsythia? or D: Treponema denticola? . . . . What is your final answer?"

"I know the answer is all of the above," spats Jamal, "as I have been a Gumdog Millionaire!"