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Local dentists cut their teeth on wellness: Larger office extends efforts to address total health

March 3, 2008

When dentists Harold Smith and Ted Brauer built their new office, they constructed more than a third more space than they needed for patients.

With the rest, Smith and Brauer started a health and wellness center that local not-for-profits can use free of charge.

So in addition to the whir of drill motors, their Castleton office frequently resonates with sounds of cooking classes, "gymborees" for kids, health screenings and health-related seminars.

"Excellence in dentistry is who we are. But we understand that the needs of our patients extend well beyond dentistry," said Smith, 65. "Our philosophy has brought us to our physical structure."

The 5,800-square-foot office, opened in September 2006, is Smith's and Brauer's answer to what they see as a community need-and what state officials see as a pressing public health issue.

Dentists often are in a position to identify patients with chronic diseases sooner than medical doctors can because they generally see patients more often. But when a dentist tells his patient to seek medical help for what appears to be diabetes or heart disease, getting the patient to actually do it can be difficult.

There are numerous barriers to helping patients understand, as well as to connecting them conveniently with a doctor who can help, said Kent Smith, a dentist who is the director of oral health at the Indiana State Department of Health (and no relation to Harold Smith).

"We are trying to find ways to establish a medical home, to establish a dental home, and integrate oral health into the general health," he said. "But it's a complex issue because you've got private practitioners, you've got group practitioners, and community clinics. Those providers may not always be in the patient's insurance network."

Nationwide, dentists got a big boost in their public health profile from a 2000 report on oral health from former U.S. Surgeon General David Satcher. The report said the mouth can function as an "early warning" system for some diseases, including diabetes, cardiovascular disease, osteoporosis and obesity.

Medical doctors are trained to look in patients' mouths as well. But many Americans see a doctor only when they have an illness. So dentists, who push their patients to visit every six months, often get the first look at signs of a developing disease.

"We are the family physician now," said Brauer, 30.

Smith and Brauer don't diagnose diseases. But they do several extra things to try to catch signs of disease early.

For example, they ask all their patients for a full medical history and to list their family physician if they have one.

Also, they roll a cart with a portable blood test kit around their office, offering cholesterol and glucose tests.

Smith has developed a specialty in treating obstructive sleep disorders, such as sleep apnea, which continually disturb a person's sleep. As a diplomate of the American Board of Dental Sleep Medicine, he can refer patients to other doctors, and he can make mouth equipment that can correct the problem.

"We're not diagnosing," Smith said. But, he added, "when a guy comes in, he's overweight and he's got a neck of 19 inches, and I look in the back of his mouth and he's got all this tissue back there, I know he snores." And that he probably has sleep apnea.
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