Written by Steven Edwards, DDS Saturday, 31 July 2004 19:00
In 1996, I accidentally discovered (blundered into) OF during an argument with a physically fit female patient. She thought my efforts to teach her proper oral hygiene were insulting, until I fortuitously asked her to think of me as an oral fitness trainer-much like her personal physical fitness trainer-and to think of my suggestions as oral fitness tips instead of oral hygiene put-downs. In an instant, she realized that I was not some sanctimonious ogre ridiculing her "hygiene." So she relaxed, apologized for her outburst, listened intently, and eventually left the office smiling. Amazed and motivated by defusing that oral hygiene argument so easily, I decided to expand the fledgling OF spark. OF has since changed my life, altered my career, and helped many patients, which is why I would like to share it with you.
WHAT IS ORAL FITNESS AND HOW DOES IT WORK?
The physical fitness concepts applied to oral care include nutrition, supplementation, exercise physiology, ergonomics, ranges of motion, paths of motion, injury prevention, disabilities, cognition problems, and more.
If we could distill these concepts into an OF equation, then it would be written as follows: OF=M+N+S+Pr+Oc+Pt+Pc.
(4) Pr=PerioRobics (improving periodontal circulation and fighting stagnation)
(5) Oc=OraCise (exercise physiology, ergonomics, paths of motion, etc)
(6) Pt=Personal training
(7) Pc=Professional care
Very simply, the basic physical fitness targets are the following: muscle, fat, heart, and circulatory systems.
Physical fitness basically focuses on 5 actions: safely building muscle, preventing muscle loss, safely burning fat, preventing fat accumulation, and enhancing cardiac/aerobic/circulatory performance.
Analogously, the basic OF targets are the following: enamel, dentin, and alveolar bone; plaque, tartar, and pathogenic microbes; and crevicular fluid flow, periodontal blood circulation, and saliva flow.
OF also focuses on the following 5 actions:
1) building, remineralizing, and maintaining hard dental structures;
2) preventing demineralization and loss of hard structures;
3) safely "melting" or "burning" plaque, tartar, and pathogens;
4) safely preventing accumulation of plaque, tartar, and pathogens; and
5) enhancing periodontal, crevicular, and salivary circulation.
Organizing OF into an equation with multiple variables, target tissues, and actions allows it to become essentially digital. Also, by including other actions or goals such as desensitizing teeth, freshening breath, and fighting dry mouth syndrome, one could customize the OF equation into hundreds of permutations for a tremendous improvement over standard "analog" oral hygiene. In addition, the oral environment safely becomes clean by default when focusing on oral fitness instead of hygiene. In fact, standard oral hygiene alone can damage teeth and periodontium (eg, overzealous brushing and brushing too soon after acidogenic meals). What's more, even physical fitness without oral fitness can damage teeth. How? Dehydration during exercise and multiple feedings throughout the day become multiple cavity attacks for most people. Therefore, people absolutely need oral fitness training to protect their dentition.
In other words, a person performing standard oral hygiene is like an untrained person supposedly exercising at a gym, merely moving weights around, oblivious to any sort of fitness program, ignorant of nutrition and supplementation, suffering injuries, failing to achieve desired results, stagnating, and hitting a wall or impassable plateau. This describes virtually everyone in America. No wonder our country's periodontal disease rate of about 75% is approximately the obesity rate of 66%- because very few people understand fitness,physical and oral, and most healthy people can simply thank their genetics or just dumb luck. Just as a fitness trainer helps a bodybuilder break a plateau, we need to help our patients safely blast past the plateau at which they have been stuck since the days of "Look, Ma!No cavities!"
WHAT IS AN ORAL FITNESS PROGRAM?
A physical fitness program must have at least 7 components: motivation, nutrition, supplementation, aerobics, resistance, personal training, and professional care.
The table shows the 7 components of a physical fitness program on the left side and an oral fitness program on the right side, with shared concepts in the middle. It also shows the relative importance of certain aspects. (PerioRobics and OraCise are explained below.)
THE 7 COMPONENTS OF AN ORAL FITNESS PROGRAM
Without motivation, nothing happens. Find hot buttons, turn-ons, pressure points, fears, needs, or wants such as whiter teeth, fresher breath, more confidence, less pain, monetary savings, etc. The basic desires of sex and money are brooding in there somewhere, so look for tasteful ways to capitalize on those aspects (like fresh breath for 4 hours on a date, fresh breath in the morning, more sales, better job).
This is such a huge and important subject that improperly following just this one component can destroy a fitness plan, even if everything else is followed correctly. Nutrition involves calories in and out, proteins, fats, carbohydrates, metabolic rates, timing of foods, and tons more. Dr. Atkins was basically correct regarding avoidance of simple and high glycemic carbohydrates. A diabetic diet would be good for teeth as well.
OF supplements include many of the physical fitness supplements of vitamins, minerals, and herbs, plus fluoride, chlorhexidine, triclosan, sanguinarine, stabilized chlorine dioxide, iodine, baking soda, casein phosphopeptide, green tea, coffee, urea peroxide, essential oils, zinc citrate, coenzyme Q-10, antibiotics, anti-inflammatories, and more.
PerioRobics is the concept of enhancing the circulation of periodontal blood, lymph, crevicular fluid, the agitation of plaque, and disruption of tartar-anything to do with causing turbulence and preventing stagnation: flossing, water jets, sonic vibration, ultrasonics, squishing and swishing, etc.
OraCise is the application of resistance training techniques to oral hygiene. This means following proper paths of motion and ranges of motion of the exercise implements (brush, flosser, tongue scraper,
toothpick, proxabrush, etc); following an organized program; applying ergonomics, safety, and injury avoidance; considering disabilities and cognitive problems; etc.
(6) Personal Training
OF personal training is what the hygienist should do instead of teaching oral hygiene. It is nonconfrontational, fun, interesting, and not insulting, unlike ordinary hygiene instructions.
(7) Professional Care
This is dental diagnosis, treatment planning, guidance, coaching, follow-through, surgical intervention, restorative treatment, etc. Patients sometimes need a skilled professional to intervene and restore things back to as normal as possible. Coaching means we are on the same team as the players (patients). We have a common adversary (plaque). Coaches command respect and earn love from their team.
"TEETH FIRST": A SAMPLE ORAL FITNESS ROUTINE
In "Teeth First," the teeth take priority over the body. Flossing comes before showering. Brushing precedes washing the body. Fluoride outranks shampoo and conditioner. I hope that future articles will allow more elaboration; however, suffice it to know that every OF aspect has a specific purpose and scientific rationale over and above any product name. Names of products are not to be construed as endorsements, and all products are picked for dozens of reasons that include such parameters as fun, ease of use, simplicity, convenience, cost, drama, safety, effectiveness, substantivity, etc.
The following materials are needed for "Teeth First": bathroom sink, shower, shower caddy, Glide floss, Colgate Total toothpaste, Oral-B Cross Action manual toothbrush, Act fluoride, tongue scraper, and Trident Advantage gum with Recaldent.
(1) Before showering, think"Teeth First" and stand in front of the bathroom sink while squishing and swishing a glob of toothpaste between the teeth.
(2) Squish and floss all the toothpaste between the teeth. Flossing first with toothpaste dredges out plaque to be brushed away and replaces plaque between teeth with toothpaste between teeth. Squishing toothpaste can also prevent toothbrush abrasion.
(3) Step over to the shower and think "Teeth First." Grab your brush from the shower caddy and brush while the shower warms up.
(4) Continue brushing in the shower while wetting down.
(5) Continue squishing and swishing toothpaste while soaping up the body.
(6) Gargle and spit out before shampooing hair.
(7) Think "Teeth First" and apply Act fluoride to the teeth before shampooing.
(8) Squish and swish Act fluoride vigorously while shampooing and conditioning hair. Extensive fluoride soaking leaves teeth electronegatively primed to absorb maximum calcium ions from Trident gum in a later step.
(9) After rinsing off the hair conditioner, spit out the Act fluoride.
(10) Scrape the tongue well before ending the shower.
(11) After exiting the shower, think "Teeth First" and chew a piece of Trident Advantage Recaldent gum for 20 minutes to form an extra calcium-fluoride shield of protection that may last up to 3 days.
(12) Keep Trident gum handy for snacks and between meals and to maintain plaque in an alkaline condition and remineralize teeth as long and as often as possible.
SUMMARY, ORAL FITNESS CYCLE OF GROWTH, AND THE ORAL THEORY OF EVERYTHING
America is the fattest nation on earth and getting fatter. Food, fatness, and lack of fitness are killing us. Because food passes through the oral cavity, obesity and dental problems are intricately connected. Obesity is linked to myriad systemic problems. Dental problems are linked to several serious systemic problems, too. Physical fitness improves health but can damage oral structures. Oral hygiene can damage oral structures as well. OF blends the best qualities of both and safely improves physical fitness and oral health. OF is fun, interesting, and unique (as opposed to oral hygiene instructions). OF reduces stress and prevents arguments. Patients appreciate learning new things that will benefit them immediately (eg, fresher breath in the morning, less sensitive teeth in 5 days).
OF generates a dental practice cycle of growth. Nobody cares how much you know until they know how much you care; therefore, teaching OF establishes your care for patients like a coach cares for the team. Care engenders trust. Trust facilitates patients listening, learning, and accepting your diagnoses and treatment plans. Educated patients make better decisions about their healthcare and buy more of your services. Increased trust generally means patients like you more, and friendly patients are less apt to sue. OF puts the onus on patients and blows away urban legends because it scientifically proves that patients are responsible for their oral health and the longevity of their restorations, which further reduces your liability.
OF is a customer service that demonstrates to skeptical patients that you are not in the profession just to earn a quick buck, because OF is the only thing you truly do for your patients as opposed to everything else that you do to your patients. And therein rests one of the most important, yet subtle impressions that patients subliminally perceive. Trusting, happy, educated patients refer more often and refer more quality people resembling themselves. OF's newness and uniqueness create a niche for you. Having something new to discuss about your practice creates marketing potential and makes you appear better and more knowledgeable than the average professional. The good referrals grow. Production and collections improve. Goodwill increases. Practice value increases. Overhead decreases. Advertising and marketing budgets shrink from word-of-mouth referrals. Referrals allow the whole process to cycle continuously. Dentistry as a whole gets busier.
People visit dentists more frequently than they visit physicians. Therefore, OF offers dental professionals unique opportunities to improve our country's overall health and fitness while positively affecting dental practices. OF could just be the oral theory of everything.
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