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The Impact of Context on Adaptive and Proactive Behaviors in Dental Practice

It couldn't be more apparent that the context of the dental practice is rapidly shifting. Who a dentist is, how they are trained and educated, their roles in the healthcare system, what a dental practice does, is about to change dramatically.

Stakeholders of dental practices – dentists, DSOs, suppliers, vendors, advisers, third parties, dental schools, employers, government, are now becoming acutely aware of this contextual shift. What these stakeholders must realize - context is decisive. Context ultimately determines what succeeds and what fails within it. Context decides what grows and what perishes within it.

The mounting evidence is causing this contextual shift in part by researchers, academics, think tanks, and universities, who have and are currently exploring the relationship of dental disease to systemic disease. The evidence has gone from editorial and expert opinion pieces to case reports, cross-sectional studies, case-controlled studies, and now at the brink of massive cohort studies, resulting in the quality of the evidence being reliable and compelling.

Periodontal inflammation, caries and sleep apnea are coconspirators in exacerbating, and possibly inciting, numbers of chronic and other inflammatory vulnerable conditions.

Dental disease is becoming recognized as an accomplice in diabetes, stroke, heart attacks, renal disease, Alzheimer's, dementia, rheumatoid arthritis, cancer, and the list continues to grow.

Besides the relationship to systemic illness, a powerful economic driver is causing this contextual change. The 3.8 trillion-dollar healthcare system is over 17 percent of the GDP. This percent of the GDP increases every year, which is unsustainable. Dentistry is less than 5 percent of the 3.8 trillion dollars. Still, it can save the system an estimated 10 to 25 percent in case-management costs while at the same time producing far better health outcomes.

Covid-19 has also been a promotor in this contextual shift. During the pandemic and "reopens," it became evident care procedures could be delivered in a dental practice at much less cost than when delivered in a medical setting. More importantly, dental practices were far better at gaining patient compliance when delivered in a dental office for not only oral issues but chronic systemic issues as well.

Lastly, the context is shifting when articles and abstracts appear in the general dental practice literature.

The emerging context demands dentists and their dental practices become a much more functional part of the healthcare system. This new context calls for the dentist and hygienist to deliver diagnostic and preventive primary care procedures. This new context calls for the dentist and hygienist to participate with other and different healthcare providers in a cohort group. The new context challenges a dentist to transform from an oral mechanic and local diagnostician to a dedicated medical provider participating in their patient's general health. The A Time That's Come: The Integration of Primary Care in Dental Practice Conference focuses on this transformation.

Context is decisive. It decides what wins and what loses. It determines what succeeds and what fails. Those dentists and their dental practice stakeholders who realize the context is shifting to medical-dental integration and are committed to getting ahead of this shift will be those who succeed in this new context.

Dr. Marc Cooper

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