For the first time in U.S. history, a generation—the Baby Boomers—is expected to live longer than their children. Of the 17 wealthiest countries, the United States ranks last in life expectancy for males and next to last for females, as well as having the highest infant mortality rate. Chronic diseases like diabetes, heart disease, and more are rising, which explains why 75% of our nation’s healthcare expenditure is for preventable chronic disease. We can see the need to shift healthcare from the traditional diagnose and treat model to one that predicts and preempts systemic disease. This module makes the case that dentists—who most Americans see once every six months and spend nearly an hour with, during each preventive visit—are in a perfect position to partner with the patient and their medical professionals to revolutionize healthcare in the United States.

All the education in the world won’t change a person’s behavior. Think about yourself.
Knowing what you “should” be doing and actually doing it are two different things. So, before we explore the what to health-pieces to change, this segment will help you with how to help people choose change. Shifting from education which signifies a one-way communication scheme to facilitation, which signifies two-way communication—a dialogue—is the only way to enact real change in health behavior. In this module you will learn the how to help convert knowledge into action. By learning dialogue skills that are based on curiosity, following another person’s lead, and shifting from certainty to open-to-outcome, you will become the gifted facilitator who can help your patients literally turn their lives around.

During a dental visit just 50 years ago, dental hygienists cleaned our teeth, took cavity-detecting x-rays and then stepped aside as the dentist performed a simple dental exam—a look at our teeth. Today, we hopefully agree that during a preventive dental visit the hygienist includes a health history update, oral cancer screening and periodontal exam. But given that oral health has become critically linked to overall health, your periodic dental exam can be ever more individualized and comprehensive.  That exam depends on an expanded role for dental hygienists (and some clinical assistants). In this module, you will learn more about the future of dental hygiene, critical elements of their expanded role and the six critical elements of the hygiene-doctor hand-off during the doctor exam.

Since the beginning of time, the patient health history served primarily as a medical-legal catch-all. In dentistry it served mostly as a permission slip for patients to receive care.  Finally, Total Health Academy offers you a revolutionary way to record a person’s health history!  This form is organized in categories by disease/dysfunction.  It asks the patient critical screening questions within each category in order to:

1. Give the parent “Ah-ha” moments…. windows into the possible/probable cause of their child’s symptoms.
2. Help the caregiver (RDH, RDA and dentist) identify signs and symptoms of systemic diseases/deformities/dysfunctions as well as oral manifestations of common diseases.
3. Serves as a communication tool to bridge the gap between medicine and dentistry, helping you advocate for your patient, while creating co-referral relationships with medical professionals in your community.

This module will teach you how to integrate your Self-Screen.net package into practice. To remind you, SelfScreen.net is a collection of seven different self-screening tools to help patients, dental team members and and medical teams bridge the gap between oral health and systemic health.

By helping patients learn the risk factors for the most commonly debilitating systemic and oral health threats, and identifying their personal risk levels we have an opportunity to foster health, create physician referral networks, and become total health advocates for our patients.

Remember, your THA investment includes all seven SelfScreen.net tools: Diabetes/Pre-Diabetes, Acid Reflux, Obstructive Sleep Apnea in adults, Sleep Disordered Breathing and OSA in children, Chronic Systemic Inflammation from Food Sensitivities, Periodontal Disease (for medical professionals to identify and refer to you) and Caries Disease (for medical professionals to identify and refer to you).

Each of these are customized for practice identification with ties to your website and phone. SelfScreen.net includes tear-off paper tablets for easy distribution to medical teams—plus a personalized landing page, accessible from any electronic device, which will link potential new patients directly to your practice’s website/contact info. This module will teach you how and when to implement the self-screen tools, identifying the risk factors for various diseases/conditions, and how to communicate with other medical professionals for referrals back and forth.

In June 2013, the American Medical Association officially recognized obesity as a disease.  According to the Centers for Disease Control and Prevention (CDC), 33.9 percent of Americans are overweight, and another 35.1 percent are obese – meaning only 31 percent of us are at a healthy weight.  A recent Harvard study suggests that the rise in obesity won’t begin to taper until at least 2050 when the U.S. will be on average 42% obese. You may find it encouraging that in a large survey of US dentists (cover of JADA 2010) about half expressed a desire to take part in this crisis, but only 1.6% were addressing obesity or diet in any way.  In this module, you will learn how to open the conversation with patients about their weight challenges, nutrition, diet, and weight loss. Also, how to help patients with sugar overload/addiction and why increasing fiber intake is so important.  Also, how to use the On Target Living Food Targets, Fooducate app, and other simple tools for patients to begin to make change.

When you hear about links between oral health and systemic conditions from heart disease and stroke to diabetes to pregnancy complications, one word always comes up: periodontitis. Treating periodontitis is the single most critical factor in maintaining your oral health and total health too. In this module, you will learn all known periodontal disease risk factors and prepare a personalized approach to care, use salivary diagnostic tools in preparation, use self-prophy skills to help the patient get ready for treatment with the fees for necessary tools provided for the patient, learn how to postpone, and coordinate full mouth disinfection with glycemic control or tobacco cessation, learn when debridement is necessary prior to full mouth disinfection, the principles behind full mouth disinfection when supported by target-specific antibiotic therapy, learn the role of antimicrobial Essential Smiles, and the concept of bundled fees for built in success.

Bone destruction around teeth is thought to be primarily due to the interaction between the individual’s immune response (current level of chronic inflammation) and the individual microorganisms living in the patient’s biofilm. Some of the bacterial stains most associated with bone loss are also the most threatening travelers—the bugs that course throughout the blood stream and nestle into blood vessel walls or other organs to multiply there. Now, using a single drop of saliva, we can detect the presence and concentration of these threatening bacteria, as well as identify the antibiotic specificity to fight back. From now on your full mouth disinfection therapy will never be the same. We can also use the same drop of saliva to identify the patient’s genetic susceptibility to periodontal disease and other cardiovascular disease risks. In this module you will more about salivary diagnostics as a game-changer in periodontal treatment outcomes and restorative treatment planning.

Until our last breath on earth, our bodies are constantly at work, striving against all odds to heal from the barrage of threats it receives—from injury, infection, allergens, physical and chemical agents, tissue death, genetic defects and a host of other insults. Putting ourselves in an optimal state of health means we need to slow down the harmful insults and reduce inflammation throughout the system. Learn what chronic systemic inflammation is and its effects on the body, how to uncover the history of CSI, the use of the self-screening tool for patients and help them to understand and identify CSI for themselves, help patients identify the possible sources of CSI and the root cause, and the process of using a food cleanse to identify bio-specific pro-inflammatory agents.

Did you know that heart disease is the number one killer of men and women across ethnicities and socioeconomic classes? Oral disease can be a significant risk factor in developing cardiovascular disease (CVD). Chronic inflammation from gum disease, traveling bacteria from gum disease, and traveling bacteria from tooth decay all play a role in the development of CVD. In this module, you will learn about the links between oral health and CVD, how heart disease develops, how patients have a heart attack or stroke from a bacterial plaque, even in the absence of atherosclerosis,  how and when to test patients’ saliva to identify for genetic risks for CVD, and how to facilitate positive lifestyle changes with patients who demonstrate multiple risk factors.

A century ago, cigarettes (and chewing tobacco) were much simpler – no filters, no vent holes, fewer added chemicals (herbicides and pesticides in particular). Now, cigarettes are more addictive and deadlier than ever. According to the 50^th Anniversary Surgeon General’s Report on Smoking and Health, lung cancer risk for smokers rose dramatically between 1959 and 2010. The risk for people who never smoked stayed the same. That’s true even though smokers in the 21^st century smoke fewer cigarettes per day than earlier smokers. What do all those chemicals and smoke do to a patients’ oral health? Increased risk of gum inflammation, recession and disease, two times the risk of tooth loss, as well as the increased risk of oral and pharyngeal cancer. In this module, you will learn how to help patients with tobacco cessation, how to dialogue without judgment and facilitate change—even with patients who aren’t ready to quit, present a nicotine fading plan for patients preparing to quit, learn about the success/failure rates of several quit methods including cold turkey method, nicotine replacement therapies, quit-medications, acupuncture, hypnosis.  Learn how to coach patients for personalized success, how and when to write prescriptions for Zyban and Chantix and discuss coordination of periodontal therapy with smoking cessation.

Insulin resistance is a chronic inflammatory state in which the body does not adequately regulate the insulin pump.   This leads to pre-diabetes and type 2 diabetes—and even causes the diabetic patient to require more and more medication.  Fortunately, many of the 89 million US adults, who have insulin resistance and prediabetes (77 million don’t know it), will be grateful to have you catch it and help them alter their lifestyle before they lose an eye, a limb, a kidney or their teeth!   In this module, you will learn the progression of chronic fructose exposure and the secret nutritional deficiency that can turn things around.  Also how to recognize the risk factors for prediabetes and diabetes, how to use your customized self-screen.net tool, advantages of A1C testing over fasting plasma glucose and oral glucose tolerance test, when to order (or perform) an A1C test, the best ways to communicate diabetes status with the patient’s medical team, and most importantly, how to facilitate effective health change behavior in the diabetic or pre-diabetic patient who is ready for a lifestyle change.

Type 2 diabetes and its devastating complications has escalated to epidemic and financially catastrophic proportions and is expected to affect one in three U.S. adults by 2050. Diabetes is the number one cause for blindness and kidney loss. Meanwhile, there are well-documented associations between periodontitis and diabetes, each making the other worse. Grouping these facts provides compelling reasons to identify and address diabetes in your patients and work collaboratively to gain glycemic control and periodontal disease control at the same time. In this module you will learn documented diabetes risk factors, when and how to do point-of-care A1C testing, communicate with the patient’s physician(s), facilitate health change behavior and work together with medical teams to gain more predictable outcomes for periodontal disease control and longevity.

Most people are surprised to learn that dental caries (tooth decay) is the number one disease amongst U.S. children, affecting 40% by the age of five. Nine out of ten of us over the age of 20 have cavities, or missing or filled permanent teeth, according to the National Institutes of Health. Perhaps a bigger surprise is the knowledge that caries is a transmissible bacterial disease—and it’s 100% preventable. After transmission, diet plays the greatest role in caries disease. Patients can cut the number of cavities they experience by cutting the frequency of exposure to liquid sugar, sugary foods and processed carbs, which has the added benefit of improving the health of the rest of the body. In this module, learn the causative risk factors in our new understanding of caries disease, discover why caries disease is considered 100% preventable, learn the sources of acid affecting caries, learn to address dry mouth caused by multiple prescription medications and recreational drug addiction, as well as the new roles of topical fluoride varnish, xylitol, calcium phosphate, antimicrobials, and acid neutralizers.

For the past six years, the occurrence of oral cancer in the United States has continued to climb. But with an incidence rate that hovers around three percent, you probably wouldn’t hear much about it, if it weren’t for this: One in three Americans diagnosed with oral cancer dies within five years; many others are horribly disfigured. Also, the American Society of Clinical Oncologists reports that by 2020 the number of HPV-related oral cancer in men will surpass cervical cancer in women. Among newly diagnosed cases of oral cancer, the fastest-growing segment is people under 40 infected with HPV type-16. While vaccination lowers the risk of acquiring HPV infection and the risk of oral cancer, it does not prevent infection from more than a dozen other types of HPV infection that are associated with oral cancer. In this module, you will learn the differences between oral cancer risk from HPV and other causes like tobacco and alcohol, and how to talk to patients about HPV infection, detection and prevention. Also, learn how to use the saliva OraRisk® test for persistent HPV infection, how to use the report to help your patient reduce consequential oral cancer risk, and how to use the Identifi® technology as an adjunct to your oral cancer screening examination.

The acidification of the American diet affects more than erosion of enamel and mucosal inflammation. Highly acidic foods/drinks and foods that acidify the blood such as excessive caffeine intake and a diet high in animal proteins can have negative systemic effects such as bone deterioration, kidney stones and growth interruptions. Learn why we want to balance our acid-base chemistry, how to make food choices that help balance the acid-base chemistry of your body and what to eat to make that happen. Also discover what two foods are acidic in the mouth but increase total alkalinity in the rest of the body.

Learn the role nutrition plays in the development of acid reflux, how to identify the warning signs of acid reflux and how to help patients balance the pH of their esophagus, mouth and airway.Acid reflux affects as many as 60 percent of Americans a year and 30% on a weekly basis, according to Dr. Jamie Koufman, a leader in acid reflux treatment and author of Dropping Acid: The Reflux Diet Cookbook and Cure—and sales of prescribed and over-the-counter anti-reflux medications now exceed $13 billion per year. Reflux can be identified in the mouth by patterns of enamel erosion and if caught early can prevent such deadly complications as esophageal cancer, which has increased by about 500% since the 1970s. Learn how to use the customized self-screening tool for acid reflux, how to recognize risk factors, know when to refer for definitive diagnosis and treatment, and how to facilitate for diet change and weight loss.

Also, in this module learn how to identify the telltale “silent” signs of acid reflux, the role bio-individual nutrition plays, other tips for overcoming reflux, as well as the inherent dangers of long-term use of PPI medications.

Dental health and mental health go hand in hand. Clinical depression, a psychiatric illness that impairs, mood, thoughts, and behavioral patterns, often goes undiagnosed, untreated and unmentioned. Despite this, the death rate for clinical depression is higher than that for breast cancer. In addition, gum disease and depression are both inflammatory disorders. Recent research shows the increased inflammatory burden from periodontitis could worsen depression. Of course, depression impacts oral health in a variety of ways, all negative. The associated lack of interest in personal hygiene means those suffering from depression go a week, two weeks, or even longer with little care for their teeth. In this module, you will learn how to identify the signs and symptoms of depression, discuss concerns with patients, and how to help patients suffering from depression facilitate positive outcomes in their own lives.

We tend to blame red, puffy gums on lack of good oral hygiene, but we now know it’s not that simple. Since the mouth is the first part of the GI tract, gum inflammation often presents as the first sign that a patient is reacting to individual-specific food sensitivities. Dig a little deeper and you might discover other GI disturbances such as discomfort, burping, bloating, diarrhea or constipation. All these symptoms might be relieved if we can help a patient learn what is causing the irritation(s) and once identified, strategize for long-term healing. This module will give you an introduction to a food-based elimination diet to help identify common sensitivities and toxins and help you, your team members and/or your patients take a much more significant role in oral and overall health.

Hypertension has long been considered a silent killer. Often without signs or symptoms, it puts patients at increased risk for cardiovascular disease, kidney disease, pulmonary disease, and the list goes on. The preventive dental visit is an excellent time to screen for hypertension, and it’s as easy as the press of a button on an automated blood pressure cuff. This module will remind you of the general risk factors and visual signs of hypertension, the guidelines and divisions of diagnosis, and when to refer to medical teams for collaborative care.

Oral health has been associated with various types of pregnancy complications, from stillbirth, preterm birth and low birth weight to miscarriage and preeclampsia (high blood pressure and fluid retention in the mother). These complications may cause the baby’s death, either before birth or within the first year of life. How does this happen? Dangerous bacteria from a mother’s gum infection (even from pregnancy gingivitis) can travel via the bloodstream to affect the unborn baby. Communicating to pregnant patients that keeping the gums healthy before and during pregnancy helps to protect the health of the mother and the baby. In this module, you will learn the links between pregnancy and oral health and how to tailor care to address the health needs of a woman during her child-bearing years.

Every year U.S. surgeons replace more than one million knees, hips, shoulders, elbows and ankles. With that elective surgery comes the small risk of bacterial infection that can lead to prosthetic failure and even death. We have long recognized the potential for oral bacteria, from pulpal abscess and active periodontitis, to enter the bloodstream and aggregate on the rough surfaces of the prosthesis. Preparing patients for a successful joint replacement means working with our patients and medical teams to recognize the importance of treating oral infections first. Then post-surgically, we have some responsibility too. Based on evidence of risks versus rewards, the American Dental Association, in conjunction with the American Academy of Orthopedic Surgeons, change the guidelines for antibiotic pre-medication somewhat frequently. The 2012 guidelines offer parameters around decision-making but leave much more to the judgment of the individual dentist. In this module you will learn these current recommendations, how to decide if and when to pre-medicate, and why we should not be deferring our judgment back to the orthopedic surgeon.

This module addresses two challenging questions: One, why are dentists prescribing more antibiotics when the rest of medicine is responsibly prescribing less? And two, why are we prescribing so many opioid pain-killers when we recognize their addictive nature and the societal permeation of opioid addiction? In this module we will grapple with the proposed answers to learn why we’re perhaps over-prescribing in each of these drug categories and what we might do instead.

One of the telltale signs of shifting from a health care model to a sick care model is the increasing number of medications listed (or not) on the patient’s health history. A-pill-for-an-ill has become a way of life, with television advertising (a U.S. phenomenon) predominantly focused on new and better medications for our lifestyle related illnesses. Of course, all these drugs have side effects of their own, not to mention interactional side effects when mixed with others. The most widespread patient complaint, caused by 400+ commonly taken medications is one that wreaks havoc with oral health and dental stability—xerostomia, or dry mouth. This module will teach you more about dry mouth but also more about how to identify other interactional side effects and communicate with medical teams as a generous act of patient advocacy.

We’ve talked about how salivary diagnostics helps us turn around some of the systemic risks from dangerous mouth bacteria as well as reduce a patient’s risk of discovering a late-stage oral cancer. But saliva holds a treasure chest of biomarkers that are about to explode. A single drop of spit will soon provide a rapid, noninvasive means to test for oral and systemic diseases, allowing results to be analyzed and available right in your office. We can now identify bacteria that cause cavities and periodontal disease, inflammatory markers that predict heart disease, and viruses like HPV and HIV. Very soon we will identify DNA/RNA biomarkers for many different early-stage organ and blood cancers such as the presence of early oral cancer, breast cancer and pancreatic cancer as well as A1C/type 2 diabetes and Sjogren’s syndrome. Learn why salivary diagnostics makes a difference in health outcomes and best practices for implementing salivary diagnostics into your dental office.

The US is now considered the least healthy of the industrialized countries, at double the cost of the next highest. Sadly, 75% of that overall price tag is for preventable illness. Dentistry has been the only health care profession historically focused on prevention, so it seems fitting that we take a more significant role in addressing the causes of lifestyle related illness and bridging the gap between medicine and dentistry. Our medical colleagues are ill-educated to navigate the mouth. They need our help in understanding how systemic diseases manifest there, as well as how oral disease impacts the rest of the body. Furthermore, receiving new patient referrals from your medical community has been a huge untapped resource for health-valuing new patients. In this module you will learn how to be a health advocate for your patient, best communicate risk factors and suspicions to your patient’s medical team, educate the medical community as to the many links between medicine and dentistry and build a network of co-referral relationships.

Total Health Academy is more than a collection of lessons, it’s a practice conversion toward a total health model of practice, and it’s exactly what health-valuing patients—the people who will spend their own hard-earned dollars on attaining optimal health—are seeking. It’s time to get the word out—to tell the world who you are. Unfortunately, the sphere of advertising has become more expensive and less effective. It often leaves us bewildered and disappointed in the results. In this module you will learn the most effective ways to use total health as a competitive advantage, spread the news about who you are, and at the same time, invest in your community by raising their health-awareness.

This module begins with basic marketing education and the rationale behind choosing target market patient segment(s) and creating satisfaction among them. For your total health dental practice your target market includes health-seeking patients—those who regularly invest in optimal health and refer their health-seeking friends. You will also learn some proven strategies, including club membership(s), designed to convert your current target market patients into apostles of your practice, spreading the news among their friends, family and co-workers. And if you’re interested in advertising, learn to put your investment in front of your target population.