The conference

Right. I'm now blogging about the conference on periodontal disease. This is a rather nasty disease where, essentially, your gums (perio, around, dontia, teeth) get eaten away by bacteria until your teeth fall out. Please note: this is a very dumbed-down-for-literary-types explanation. All of you who actually understand the science will no doubt find me full of over-generalizations and worse. I can only say: be kind. :-)

I kept thinking of Ben through the whole conference because they emphasized so the connectedness of the human being. There's research, going back a good hundred years, about how the state of your mouth affects the rest of you. (They didn't say much about the spirit.)

Right now the big research is connecting gum disease with other inflammatory diseases: heart disease, diabetes, Alzheimers. Because, of course, when you've got these festering sores in your mouth just leaking bacteria in and out, it does bad things to your immune system. The more inflammation you've got in one part of you, the less your immune system will be able to fight inflammation in other parts of you. Therefore, if you're teetering on the edge of diabetes, the added bacterial in your immune system you get with perio will probably be enough to send you over the edge into full diabetes. I have in my notes an illustration of a little bacterial challenge sending a patient over the edge. They're carrying spears.

It was astounding to me how right they were about that central premise, and how wrong they managed to be about everything else, including convincing us of it. I spent quite a while analyzing the rhetoric. Their chief argument for making sure we practicing dentists properly diagnosed and treated perio was--increased profits. Becca and I sort of cocked our heads and went, "what about patient care???" And after that, to do them justice, we noticed they did mention the best interests of the patient a couple times.

A second rhetorical approach was mostly from one speaker. She went heavy on the inspirational-speak, words like "forward-thinking" and "go to the next level" and "empower." My cliche-detectors went nuts. She didn't even think about her metaphors. She just threw them all out in a lump.

She talked about a paradigm shift from cause-and-effect, disease-and-vaccination, to a "web of causation." The whole body-as-an-intricate-unit thing made sense to me, as long as we don't eliminate cause and effect. As a result (we learned) it's time to move away from mechanical "fill and drill" dentistry to critical thinking, especially with dentists acquring a firm background in science. I can approve of that, though it seems that filling and drilling will continue to be required as long as teeth rot. But using one's mind when one works on teeth is a very good plan, and using one's mind in a logical and evidence-based manner is better still. The thought that dentists might not be thinking is terrifying and I completely believe it, judging by some patients we get from other people...

At one point, she told us to do the perio thing because it was where the future was going. That's the sort of comment to make me stubbornly medieval. How does she know where the future is going? And who says it's going somewhere better than the present? Mere age doesn't make a thing better, but neither does mere newness. Both are chronological snobbery.

The second guy went deeply into the scientific and biological components of perio disease, and I'm afraid he lost me. He was a good old boy from Kansas who's been teaching for getting on for fifty years, and he had a habit of saying what he thought and consigning everything else to the nether regions.

He talked about the probability of a particular person getting perio disease. You've got to have the genetic predisposition and the presence of red-complex anaerobic bacteria--which means areas of your mouth that haven't been exposed to oxygen, i.e. brushed, in way too long.

The third guy mostly talked about the economics of periodontal disease. It felt money-grubbing to me--lawyer-ish, you know, finding every loophole to get as much money as possible. Then it occurred to me that the idea, really, can come down to having just weights and measures. You charge people for what you actually do for them. And that I can do perfectly happily.

The fourth lady spoke a lot about the interpersonal issues that can come up in an office. I found it very great cause to be grateful for my own pleasant and non-dysfunctional office. The economic guy told us--in the name of proper practice management--to keep close tabs on hygienist and doctor income per month. The fourth lady asked us to all get along. Apparently, in most offices, doctors, hygienists, assistants, and front office staff have a me-against-them attitude and stab everyone else in the back. But it seems to me, if you want to cause division and strife, just start making a fuss about who makes more money. Honestly!

So. I learned a great deal about periodontal disease, and even more about the contemporary dental mindset. All in all, a very worthy weekend.